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Open Access 01-12-2017 | Study protocol

Protocol for project IMPACT (improving millions hearts for provider and community transformation): a quasi-experimental evaluation of an integrated electronic health record and community health worker intervention study to improve hypertension management among South Asian patients

Authors: Priscilla M. Lopez, Jennifer Zanowiak, Keith Goldfeld, Katarzyna Wyka, Ahmad Masoud, Susan Beane, Rashi Kumar, Phoebe Laughlin, Chau Trinh-Shevrin, Lorna Thorpe, Nadia Islam

Published in: BMC Health Services Research | Issue 1/2017

Abstract

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.

About Million Hearts ®. Million Hearts Campaign. Health and Human Services. https://millionhearts.hhs.gov/about-million-hearts/index.html. Accessed 29 March 2017.

Valderrama AL, Gillespie C, King SC, George MG, Hong Y, Gregg E. Vital signs: awareness and treatment of uncontrolled hypertension among adults-United States, 2003–2010. Morb Mortal Wkly Rep (MMWR). 2012;61(35):703–9. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6135a3.htm.

Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 2005;43:521–30.CrossRefPubMed

Anand SS, Yusuf S, Vuksan V, et al. Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the study of health assessment and risk in ethnic groups (SHARE). Lancet. 2000;356:279–84.CrossRefPubMed

Narayan KM, Aviles-Santa L, Oza-Frank R, et al. Report of a National Heart, lung, and blood institute workshop: heterogeneity in cardiometabolic risk in Asian Americans in the U.S. opportunities for research. J Am Coll Cardiol. 2010;55:966–73. https://doi.org/10.1016/j.jacc.2009.07.075. CrossRefPubMed

Sheth T, Nair C, Nargundkar M, Anand S, Yusuf S. Cardiovascular and cancer mortality among Canadians of European, south Asian and Chinese origin from 1979 to 1993: an analysis of 1.2 million deaths. CMAJ. 1999;161:132–8.PubMedPubMedCentral

Tillin T, Forouhi N, Johnston DG, McKeigue PM, Chaturvedi N, Godsland IF. Metabolic syndrome and coronary heart disease in south Asians, African-Caribbeans and white Europeans: a UK population-based cross-sectional study. Diabetologia. 2005;48:649–56.CrossRefPubMed

Wild SH, Fischbacher C, Brock A, Griffiths C, Bhopal R. Mortality from all causes and circulatory disease by country of birth in England and Wales 2001-2003. J Public Health (Oxf). 2007;29:191–8.CrossRef

Ye J, Rust G, Baltrus P, Daniels E. Cardiovascular risk factors among Asian Americans: results from a National Health Survey. Ann Epidemiol. 2009;19:718–23. https://doi.org/10.1016/j.annepidem.2009.03.022.CrossRefPubMed

10.

Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89:1322–7.CrossRefPubMedPubMedCentral

11.

Asian/Pacific American Heritage: May 2011. United States Census Bureau. http://www.census.gov/newsroom/releases/archives/facts_for_features_special_editions/cb11-ff06.html . Accessed 29 March 2017.

12.

Asian American Federation. Asian Americans in New York City: A Decade of Dynamic Change 2000–2010. http://www.aafederation.org/pdf/AAF_nyc2010report.pdf. Accessed 29 March 2017.

13.

Enas EA, Garg A, Davidson MA, Nair VM, Huet BA, Yusuf S. Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America. Indian Heart J. 1996;48:343–53.PubMed

14.

Misra R, Patel T, Kotha P, et al. Prevalence of diabetes, metabolic syndrome, and cardiovascular risk factors in US Asian Indians: results from a national study. J Diabetes Complicat. 2010;24:145–53. https://doi.org/10.1016/j.jdiacomp.2009.01.003.CrossRefPubMed

15.

Rajpathak SN, Gupta LS, Waddell EN, et al. Elevated risk of type 2 diabetes and metabolic syndrome among Asians and south Asians: results from the 2004 new York City HANES. Ethn Dis. 2010;20:225–30.PubMed

16.

Esperat MC, Inouye J, Gonzalez EW, Owen DC, Feng D. Health disparities among Asian Americans and Pacific islanders. Annu Rev Nurs Res. 2004;22:135–59.PubMed

17.

Yi SS, Thorpe LE, Zanowiak JM, Trinh-Shevrin C, Islam NS. Clinical characteristics and lifestyle behaviors in a population-based sample of Chinese and south Asian immigrants with hypertension. Am J Hypertens. 2016;29(8):941–7. https://doi.org/10.1093/ajh/hpw014.CrossRefPubMedPubMedCentral

18.

Fei K, Rodriguez-Lopez J, Ramos M, Islam N, Trinh-Shevrin C, Yi S, Chernov C, Perlman S, Thorpe LE. Racial/ethnic subgroup disparities in hypertension prevalence: results from the 2013-14 new York City health and nutrition examination survey (NYC HANES). Prev Chronic Dis. In Press.

19.

Abe-Kim J, Takeuchi D, Hwang WC. Predictors of help seeking for emotional distress among Chinese Americans: family matters. J Consult Clin Psychol. 2002;70:1186–90.CrossRefPubMed

20.

Narikiyo T, Kameoka V. Attributions of mental illness and judgements about help-seeking among Japanese Americans and white-American students. J Couns Psychol. 1992;39 http://psycnet.apa.org/fulltext/1992-40455-001.html. Accessed 29 March 2017.

21.

Shin JK. Help-seeking behaviors by Korean immigrants for depression. Issues Ment Health Nurs. 2002;23:461–76.CrossRefPubMed

22.

Chin JJ, Mantell J, Weiss L, Bhagavan M, Luo X. Chinese and south Asian religious institutions and HIV prevention in new York City. AIDS education and prevention: official publication of the international society for AIDS. Education. 2005;17:484–502. https://doi.org/10.1521/aeap.2005.17.5.484.

23.

Islam NS, Wyatt LC, Patel SD, et al. Evaluation of a community health worker pilot intervention to improve diabetes management in Bangladeshi immigrants with type 2 diabetes in new York City. Diabetes Educ. 2013;39:478–93. https://doi.org/10.1177/0145721713491438.CrossRefPubMedPubMedCentral

24.

Islam NS, Zanowiak JM, Wyatt LC, et al. A randomized-controlled, pilot intervention on diabetes prevention and healthy lifestyles in the new York City Korean community. J Community Health. 2013;38(6):1030–41. https://doi.org/10.1007/s10900-013-9711-z.CrossRefPubMedPubMedCentral

25.

Ursua R, Islam N, Aguilar D, et al. Predictors of hypertension among Filipino immigrants in the northeast US. J Community Health. 2013;38(5):847–55. https://doi.org/10.1007/s10900-013-9689-6.CrossRefPubMedPubMedCentral

26.

Cardiovascular disease: Team-based care to improve blood pressure control. The Community Guide, 2012. https://www.thecommunityguide.org/findings/cardiovascular-disease-team-based-care-improve-blood-pressure-control. Accessed 29 March 2017.

27.

Walsh JM, McDonald KM, Shojania KG, et al. Quality improvement strategies for hypertension management: a systematic review. Med Care. 2006;44:646–57.CrossRefPubMed

28.

Cardiovascular disease: Clinical Decision-Support Systems (CDSS). The Community Guide, 2013. https://www.thecommunityguide.org/findings/cardiovascular-disease-clinical-decision-support-systems-cdss. Accessed 29 March 2017.

29.

Viswanathan M, Kraschnewski JL, Nishikawa B, et al. Outcomes and costs of community health worker interventions: a systematic review. Med Care. 2010;48:792–808. https://doi.org/10.1097/MLR.0b013e3181e35b51.CrossRefPubMed

30.

Martinez J, Ro M, Villa NW, Powell W, Knickman JR. Transforming the delivery of care in the post-health reform era: what role will community health workers play? Am J Public Health. 2011;101:e1–5. https://doi.org/10.2105/AJPH.2011.300335.CrossRefPubMedPubMedCentral

31.

Brownstein JN, Chowdhury FM, Norris SL, et al. Effectiveness of community health workers in the care of people with hypertension. Am J Prev Med. 2007;32:435–47.CrossRefPubMed

32.

Persell SD, Dunne AP, Lloyd-Jones DM, Baker DW. Electronic health record-based cardiac risk assessment and identification of unmet preventive needs. Med Care. 2009;47:418–24. https://doi.org/10.1097/MLR.0b013e31818dce21.CrossRefPubMed

33.

Persell SD, Lloyd-Jones DM, Friesema EM, Cooper AJ, Baker DW. Electronic health record-based patient identification and individualized mailed outreach for primary cardiovascular disease prevention: a cluster randomized trial. J Gen Intern Med. 2013;28:554–60. https://doi.org/10.1007/s11606-012-2268-1.CrossRefPubMed

34.

Fellows JL, Mularski R, Waiwaiole L, et al. Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals: study protocol for a randomized controlled trial. Trials. 2012;13:129. https://doi.org/10.1186/1745-6215-13-129.CrossRefPubMedPubMedCentral

35.

Kruse GR, Kelley JH, Linder JA, Park ER, Rigotti NA. Implementation of an electronic health record-based care management system to improve tobacco treatment. J Gen Intern Med. 2012;27:1690–6. https://doi.org/10.1007/s11606-012-2174-6.CrossRefPubMedPubMedCentral

36.

Adair R, Wholey DR, Christianson J, White KM, Britt H, Lee S. Improving chronic disease care by adding laypersons to the primary care team: a parallel randomized trial. Ann Intern Med. 2013;159:176–84. https://doi.org/10.7326/0003-4819-159-3-201308060-00007.CrossRefPubMed

37.

Walton JW, Snead CA, Collinsworth AW, Schmidt KL. Reducing diabetes disparities through the implementation of a community health worker-led diabetes self-management education program. Fam Community Health. 2012;35:161–71. https://doi.org/10.1097/FCH.0b013e31824651d3.CrossRefPubMed

38.

Islam N, Nadkarni S, Peretz P, Matiz LA, Hirsch G, Kane E, Collinsworth A, Kangovi S, Godfrey WK, Hyde J, Matos S, Kumar R, Lopez P, Zhong L, Thorpe L, and Trinh-Shevrin C. Integration of Community Health Workers into Primary Care Health Systems: The Time for New York is Now! NYU-CUNY Prevention Research Center. October 2016. NY, NY. http://www.med.nyu.edu/prevention-research/sites/default/files/prevention-research2/NYU-CUNY%20PRC%20-%20Integration%20of%20CHWs%20into%20Primary%20Care%20Systems.pdf. Accessed 29 March 2017.

39.

NYU-CUNY Prevention Research Center. http://www.med.nyu.edu/prevention-research/nyu-cuny-prevention-research-center. Accessed 29 March 2017.

40.

Healthfirst. http://healthfirst.org/. Accessed 29 March 2017.

41.

IPRO. http://ipro.org/. Accessed 29 March 2017.

42.

Kwon S, Patel S, Choy C, Zanowiak J, Rideout C, Yi S, Wyatt L, Taher MD, Garcia - Dia MJ, Kim SS, Denholm TK, Kavathe R, Islam NS. Implementing health promotion activities using community-engaged approaches in Asian American faith-based organizations in new York City and New Jersey. Transl Behav Med. In Press.

43.

Islam N, Riley L, Wyatt L, Tandon SD, Tanner M, Ratnam-Mukjerji R, Rey M, Trinh-Shevrin C. Protocol for the DREAM project (diabetes research, education, and action for minorities): a randomized trial of a community health worker intervention to improve diabetic management and control among Bangladeshi adults in NYC. BMC Public Health. 2014;14(1):177. https://doi.org/10.1186/1471-2458-14-177. CrossRefPubMedPubMedCentral

44.

Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50:217–26. https://doi.org/10.1097/MLR.0b013e3182408812.CrossRefPubMedPubMedCentral

45.

Handley MA, Schillinger D, Shiboski S. Quasi-experimental designs in practice-based research settings: design and implementation considerations. J Am Board Fam Med. 2011;24:589–96. https://doi.org/10.3122/jabfm.2011.05.110067.CrossRefPubMed

46.

Gliklich RE, Dreyer NA, Leavy MB, editors. Registries for Evaluating Patient Outcomes: A User's Guide. 3rd edition. Agency for Healthcare Research and Quality (US); Section IV, Technical, Legal, and Analytic Considerations for Combining Registry Data With Other Data Sources. https://www.ncbi.nlm.nih.gov/books/NBK208607/?report=reader. Accessed 29 March 2017.

47.

Clinical Decision Support: More than just ‘Alerts’ Tipsheet. Centers for Medicare & Medicaid Services. https://www.cms.gov/regulations-and-guidance/legislation/EHRincentiveprograms/downloads/clinicaldecisionsupport_tipsheet-.pdf. Accessed 29 March 2017.

48.

Reference card from the seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC 7). https://www.nhlbi.nih.gov/files/docs/guidelines/phycard.pdf. Accessed 29 March 2017.

49.

Meaningful Use. CMS. https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRIncentivePrograms/. Accessed 29 March 2017.

50.

Patient Centered Medical Home. NCQA. http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH.aspx. Accessed 29 March 2017.

51.

National Heart Lung and Blood Institute. Healthy Heart, Healthy Family: A community health worker’s manual for the Filipino community. http://www.nhlbi.nih.gov/health/prof/heart/other/chdfilipino/intro.htm. Accessed 29 March 2017.

52.

Project IMPACT CHW training materials. http://www.med.nyu.edu/prevention-research/projects/project-impact. Accessed 29 March 2017.

53.

eClinicalWorks. https://www.eclinicalworks.com/. Accessed 29 March 2017.

54.

MDLand. http://www.mdland.com/. Accessed 29 March 2017.

55.

SNAP Software. https://www.snapsurveys.com/. Accessed 29 March 2017.

56.

NCQA Hypertension Control Measure. https://www.hrsa.gov/quality/toolbox/measures/hypertension/. Accessed 29 March 2017.

57.

Kaiser Permanente Colorado high blood pressure and cholesterol management program. https://millionhearts.hhs.gov/files/SS_Colorado.pdf. Accessed 29 March 2017.

58.

Ferdinand KC, Patterson KP, Taylor C, Fergus IV, Nasser SA, Ferdinand DP. Community-based approaches to prevention and management of hypertension and cardiovascular disease. J Clin Hypertens (Greenwich, Conn). 2012;14:336–43. https://doi.org/10.1111/j.1751-7176.2012.00622.x.CrossRef

Title: Protocol for project IMPACT (improving millions hearts for provider and community transformation): a quasi-experimental evaluation of an integrated electronic health record and community health worker intervention study to improve hypertension management among South Asian patients
Authors: Priscilla M. Lopez
Jennifer Zanowiak
Keith Goldfeld
Katarzyna Wyka
Ahmad Masoud
Susan Beane
Rashi Kumar
Phoebe Laughlin
Chau Trinh-Shevrin
Lorna Thorpe
Nadia Islam
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-017-2767-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Protocol for project IMPACT (improving millions hearts for provider and community transformation): a quasi-experimental evaluation of an integrated electronic health record and community health worker intervention study to improve hypertension management among South Asian patients

Abstract

Background

Methods

Discussion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Discussion

Trial registration

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