Closing the Gap on Health Disparity and Outcomes in Hypertension (2022-2023)

Background

Hypertension affects over 116 million adults in the United States, with direct costs projected to exceed $220 billion by 2035. Over one-third of Americans with hypertension are not aware they have it. Despite proven interventions outlined in practice guidelines, only 48% of patients who are diagnosed with hypertension have their condition controlled. 

Disparities are well documented in hypertension treatment, control and outcomes. Prevalence among Black Americans is much higher than non-Hispanic whites, and deaths attributable to hypertension are twice as frequent.

In Durham County, the prevalence of hypertension is 42%, with a strong association with residential racial isolation, suggesting opportunities to intervene at a neighborhood level to reduce hypertension disparities and improve overall population health.

Project Description

Building on the work of the 2021-2022 team, this project team will focus on the policy implications of a January 2022 ruling from the Centers for Medicare and Medicaid Services and the Agency for Healthcare Research and Quality. The ruling (eQMC 165) enables patient-reported self-monitored blood pressure (SMBP) readings to count as valid and reliable measures of the Healthy People 2030 blood pressure quality goals.

The team will pursue four main objectives:

  1. Reduce barriers to effective care (SMBP and optimized treatment) in the Durham community through targeted opportunities to improve access to care regarding blood pressure monitoring, diet, exercise and medical management. 
  2. Adapt proven strategies (patient-portal self-reported electronic health record communication strategies) for blood pressure measurement, monitoring and reporting, and improve delivery of evidence-based interventions to the Durham community, including the use of community-based resources, with guidance from and partnership with community members and stakeholders.
  3. Design an implementation and evaluation plan tailored to Durham County with patient and community stakeholders, with a focus on using the patient portal for SMBP and continuous quality improvement, and monitoring county-wide blood pressure outcomes through feedback and data dashboards.
  4. Develop a sustainability plan with community and external stakeholders using common practices that are generalizable to other communities and regions. 

The team will use existing reports to screen for hypertension in ways that could prevent further inequities. Team members, nursing students and community health workers will collaborate to improve community penetration.

Patient-level and system-level uncontrolled hypertension will be addressed through improved patient-portal access and use of SMBP, the most useful intervention identified for low-resource settings. Methods for development of the sustainability plan will be codesigned with community members, patients, families and local policymakers.

Anticipated Outputs

Peer-reviewed publications; portfolio of policy briefs, blog posts and journalism for lay leaders with messages for implementation of new SMBP ruling for local/national educators, clinicians and policy-makers

Student Opportunities

Ideally, this project team will be comprised of 4 graduate students and 15-20 undergraduate students with backgrounds in health policy, social sciences, nursing, medicine, pharmacy or physical therapy.

Students will be integrated into several productive work streams, including creating a roadmap of cardiology interventions for population health. Students will be part of the rapid iteration, observation and revision cycle. They will also be collecting data, speaking with participants and intervenors and then creating lessons learned.

Graduate students will have multiple opportunities to expand their skills, training and publication record. They will have significant teaching assistant responsibilities as well as opportunities to mentor undergraduate teammates. Graduate students will learn project and team management skills including personnel management, team building, delegation and academic compliance.

Selected students may have the opportunity to travel to the Duke-Margolis office in Washington, D.C. in June/July 2022 and/or to the American Heart Association Scientific Sessions in Chicago, November 5-7, 2022.

Timing

Summer 2022 – Summer 2023

  • Summer 2022 (optional): Complete IRB (amendment to existing protocol); complete literature review on policy implementation strategies; begin focus groups with community partners to gather information on local implementation strategies in high-risk areas
  • Fall 2022: Collect data in two parallel workstreams; pitch policy intervention to policymakers, convene health administrators and clinicians/provider groups
  • Spring 2023: Clean and analyze data; prepare presentations and publications of six-month outcomes
  • Summer 2023 (optional): Develop manuscripts

Crediting

Academic credit available for fall and spring semesters; summer funding available

See earlier related team, Closing the Gap on Health Disparity and Treatment Outcomes in Hypertension (2020-2021).

 

Image: Health Problems Caused by Hypertension, from The Surgeon General’s Call to Action to Control Hypertension

Health Problems Caused by Hypertension.

Team Leaders

  • Holly Biola, School of Medicine-Medicine:Geriatrics
  • Dana Carthron, School of Nursing, North Carolina Central University
  • Bradi Granger, School of Nursing

/graduate Team Members

  • Chin Kuo, Mgt of Clinical Informations
  • Chenxinan Ma, DKU - Global Health
  • Vivien Wambugu, Global Health - MSc
  • Sijia Wei, Nursing-PHD

/undergraduate Team Members

  • Jada Allen
  • Devan Desai, Public Policy Studies (AB)
  • Rohan Gupta, Economics (BS)
  • Camryn Johnson
  • Celina Ma, Biology (BS)
  • Jennifer Nguyen, Public Policy Studies (AB)
  • Rachel Poutre, Evolutionary Anthropology (BS)
  • Ashna Sai
  • Aemilia Sprouse
  • David Surzykiewicz
  • Anna Tharakan
  • Aiyana Villanueva, Evolutionary Anthropology (BS)
  • Velda Wang
  • Elliot Yoon

/yfaculty/staff Team Members

  • Hayden Bosworth, School of Medicine-Psychiatry and Behavioral Sciences
  • Amy Corneli, School of Medicine-Population Health Sciences
  • Christopher Granger, School of Medicine-Medicine: Cardiology
  • Tara Kinard, Duke Population Health Management Office
  • L Kristin Newby, School of Medicine-Medicine: Cardiology
  • Andrew Olson, School of Medicine-Duke Clinical Research Institute
  • Robert Saunders, Margolis Center for Health Policy

/zcommunity Team Members

  • Awania Buckner, Community Health Cooperative
  • Howard Eisenson, Lincoln Community Health Center
  • Deepak Kumar, North Carolina Central University
  • Anne Miller, American Heart Association | American Stroke Association