TY - JOUR
T1 - Protocol for project IMPACT (improving millions hearts for provider and community transformation)
T2 - A quasi-experimental evaluation of an integrated electronic health record and community health worker intervention study to improve hypertension management among South Asian patients
AU - Lopez, Priscilla M.
AU - Zanowiak, Jennifer
AU - Goldfeld, Keith
AU - Wyka, Katarzyna
AU - Masoud, Ahmad
AU - Beane, Susan
AU - Kumar, Rashi
AU - Laughlin, Phoebe
AU - Trinh-Shevrin, Chau
AU - Thorpe, Lorna
AU - Islam, Nadia
N1 - Funding Information:
This study is led by researchers from the New York University-City University of New York Prevention Research Center (NYU-CUNY PRC), funded by the Centers for Disease Control and Prevention [39]. The NYU-CUNY PRC is a public-private academic partnership between the NYU School of Medicine and the CUNY School of Public Health, and its mission is to implement, evaluate, and disseminate community-clinical linkage interventions to reduce cardiovascular disease disparities in ethnically diverse NYC communities. For this project, researchers from the NYU-CUNY PRC partnered with Healthfirst (HF), a not-for-profit managed care organization serving more than 35,000 South Asian members in NYC. Primary care practices enrolled into the study are part of HF’s provider network [40]. The team also engaged with IPRO, the federally-funded Medicare Quality Innovation Network-Quality Improvement Organization for New York State, Washington D.C. and South Carolina, under contract with the Centers for Medicare & Medicaid Services (CMS), to train provider networks on the use of EHR systems in order to implement and monitor Million Hearts® goals, as well as training on consistency in blood pressure recordings [41]. A coalition of South Asian community-based organizations with expertise in the development and implementation of culturally tailored community-clinical linkage models was engaged to provide feedback on the CHW component of the intervention, including reviewing and adapting CHW curriculum and patients materials [42, 43]. An independent EHR consultant was also hired to provide technical assistance to practices throughout the course of the intervention.
Funding Information:
The funding source: This study is supported by grant number U48DP005008 from the Centers for Disease Control and Prevention (CDC). Author’s contributions are additionally supported in part by grant number U58DP005621 from the Centers for Disease Control and Prevention (CDC), P60MD000538, U54MD000538-15, R01DK110048-01A1, UL1TR001445 from the National Institutes of Health (NIH). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the NIH and CDC.
PY - 2017/12/6
Y1 - 2017/12/6
N2 - Background: The Million Hearts® initiative aims to prevent heart disease and stroke in the United States by mobilizing public and private sectors around a core set of objectives, with particular attention on improving blood pressure control. South Asians in particular have disproportionately high rates of hypertension and face numerous cultural, linguistic, and social barriers to accessing healthcare. Interventions utilizing Health information technology (HIT) and community health worker (CHW)-led patient coaching have each been demonstrated to be effective at advancing Million Hearts® goals, yet few studies have investigated the potential impact of integrating these strategies into a clinical-community linkage initiative. Building upon this initiative, we present the protocol and preliminary results of a research study, Project IMPACT, designed to fill this gap in knowledge. Methods: Project IMPACT is a stepped wedge quasi-experimental study designed to test the feasibility, adoption, and impact of integrating CHW-led health coaching with electronic health record (EHR)-based interventions to improve hypertension control among South Asian patients in New York City primary care practices. EHR intervention components include the training and implementation of hypertension-specific registry reports, alerts, and order sets. Fidelity to the EHR intervention is assessed by collecting the type, frequency, and utilization of intervention components for each practice. CHW intervention components consist of health coaching sessions on hypertension and related risk factors for uncontrolled hypertensive patients. The outcome, hypertension control (<140 mmHg systolic blood pressure (BP) and <90 mmHg diastolic BP), is collected at the aggregate- and individual-level for all 16 clinical practices enrolled. Discussion: Project IMPACT builds upon the evidence base of the effectiveness of CHW and Million Hearts® initiatives and proposes a unique integration of provider-based EHR and community-based CHW interventions. The project informs the effectiveness of these interventions in team-based care approaches, thereby, helping to develop relevant sustainability strategies for improving hypertension control among targeted racial/ethnic minority populations at small primary care practices. Trial registration: This study protocol has been approved and is made available on Clinicaltrials.gov by NCT03159533 as of May 17, 2017.
AB - Background: The Million Hearts® initiative aims to prevent heart disease and stroke in the United States by mobilizing public and private sectors around a core set of objectives, with particular attention on improving blood pressure control. South Asians in particular have disproportionately high rates of hypertension and face numerous cultural, linguistic, and social barriers to accessing healthcare. Interventions utilizing Health information technology (HIT) and community health worker (CHW)-led patient coaching have each been demonstrated to be effective at advancing Million Hearts® goals, yet few studies have investigated the potential impact of integrating these strategies into a clinical-community linkage initiative. Building upon this initiative, we present the protocol and preliminary results of a research study, Project IMPACT, designed to fill this gap in knowledge. Methods: Project IMPACT is a stepped wedge quasi-experimental study designed to test the feasibility, adoption, and impact of integrating CHW-led health coaching with electronic health record (EHR)-based interventions to improve hypertension control among South Asian patients in New York City primary care practices. EHR intervention components include the training and implementation of hypertension-specific registry reports, alerts, and order sets. Fidelity to the EHR intervention is assessed by collecting the type, frequency, and utilization of intervention components for each practice. CHW intervention components consist of health coaching sessions on hypertension and related risk factors for uncontrolled hypertensive patients. The outcome, hypertension control (<140 mmHg systolic blood pressure (BP) and <90 mmHg diastolic BP), is collected at the aggregate- and individual-level for all 16 clinical practices enrolled. Discussion: Project IMPACT builds upon the evidence base of the effectiveness of CHW and Million Hearts® initiatives and proposes a unique integration of provider-based EHR and community-based CHW interventions. The project informs the effectiveness of these interventions in team-based care approaches, thereby, helping to develop relevant sustainability strategies for improving hypertension control among targeted racial/ethnic minority populations at small primary care practices. Trial registration: This study protocol has been approved and is made available on Clinicaltrials.gov by NCT03159533 as of May 17, 2017.
KW - Community health workers (CHWs)
KW - Community-clinical linkages
KW - Electronic health record (EHR)
KW - Health information technology (HIT)
KW - Hypertension
KW - Immigrant health
KW - Million hearts® initiative
KW - South Asians
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U2 - 10.1186/s12913-017-2767-1
DO - 10.1186/s12913-017-2767-1
M3 - Article
C2 - 29207983
AN - SCOPUS:85037661574
VL - 17
JO - BMC Health Services Research
JF - BMC Health Services Research
SN - 1472-6963
IS - 1
M1 - 810
ER -