Multi-ethnic Multi-level Strategies and Behavioral Economics to Eliminate Hypertension Disparities in Los Angeles County

Summary

The goal of the study is to promote equitable hypertension (HTN) management across the diverse patient population found in Los Angeles County Department of Health Services (LAC DHS) clinics.

To achieve this goal, the study team will conduct provider- and patient-focused outreach strategies to understand how to best support adoption of blood pressure management practices already available within LAC DHS.

LAC DHS clinics will be randomly assigned to one of three study conditions: 1) provider-focused outreach, 2) patient-focused outreach, and 3) usual outreach. The study will occur across 3 years with patient- and provider-focused outreach occurring in Year 1 and 2. In Year 3, study initiated patient- and provider-focused outreach will stop, and clinic use of patient- and provider-focused outreach practices will be observed by the study team.

Provider-focused outreach includes increasing cultural awareness of factors that hinder and support blood pressure control, increasing access to blood pressure medications, and providing blood pressure management education. Patient-focused outreach includes using culturally sensitive educational materials and reminders to improve patient understanding of blood pressure, education on how to manage the condition, and increasing awareness of available blood pressure management resources. Clinics assigned to the usual outreach condition will operate as per usual in Year 1 but will receive patient- and provider-focused outreach in Year 2.

Conditions

• Hypertension

Interventions

BEHAVIORAL

Patient-focused strategies

Patient-focused strategies to increase HTN management practices: 1. Hypertension registry: notify patients of their status, target education and resources to patients 2. Home BP monitoring: provide BP monitors, encourage reporting of home BP readings 3. Enhance standardization of home and office BP readings: patients trained by care staff, posters in clinics on how to measure BP correctly 4. Nurse-directed BP medication titration with CHW/Health Educator reinforcement: self-directed referrals to nurse-directed clinics and CHW/health educators 5. Enhance patient understanding of BP using culturally- and linguistically- tailored materials: tailored educational materials offered to patients in clinic, via text and the patient portal. 6. Social needs screening and linkage to community resources: awareness of and self-referrals to community resources 7. Behavioral science intervention messaging: posters in clinic waiting rooms, scripts for RN/PCP, texts to patients

BEHAVIORAL

Provider-focused strategies

Provider-focused strategies to increase HTN management practices: 1. Hypertension registry: identify patients with uncontrolled BP, notify care team 2. Home BP monitoring: provide home BP monitors, encourage reporting of BP readings 3. Enhance standardization of home/office BP readings: staff training, posters in clinic 4. Simplify treatment protocols using fixed-dose combo meds: education on fixed-dose combo meds 5. Nurse-directed BP med titration w/ CHW/Health Educator support: system for team-based care, referral to nurse-directed clinics \& CHWs/health educators 6. Enhance patient understanding of BP using culturally- and linguistically- tailored materials: Increased availability of tailored materials 7. Social needs screening and linkage to community resources: referral system to resources 8. CHW assigned to patients with complex medical and social needs: referral of complex patients to CHWs 9. Behavioral science messaging: posters in charting rooms, scripts for RNs

BEHAVIORAL

Patient- and provider-focused strategies

A combination of the 7 patient-focused strategies (see patient-focused strategies outlined above) and 9 provider-focused strategies (see provider-focused strategies outlined above) implemented simultaneously.

Sponsors & Collaborators

• National Heart, Lung, and Blood Institute (NHLBI)

  collaborator NIH

• University of California, Los Angeles

  lead OTHER

Principal Investigators

• Arleen F Brown, MD, PhD · University of California, Los Angeles

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Model

CROSSOVER

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2024-08-08

Primary Completion

2027-10-31

Completion

2027-10-31

Countries

• United States

Study Locations