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消除洛杉矶县高血压差异的多种族多层次策略和行为经济学

2026年9月25日 更新者：Arleen F. Brown, MD, PhD、University of California, Los Angeles

加州大学洛杉矶分校多种族多层次策略和行为经济学消除洛杉矶县高血压差异

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.

研究概览

地位

主动，不招人

条件

干预/治疗

详细说明

The UCLA DECIPHeR Alliance study, Multi-ethnic Multi-level Strategies, and Behavioral Economics to Eliminate Hypertension Disparities in Los Angeles County, is led by Dr. Arleen Brown and Dr. Alejandra Casillas. The study will focus on the racial and ethnic gaps in evidence-based treatment that contribute to hypertension disparities in the Los Angeles County Department of Health Services (LAC DHS). Of the 43% of LAC DHS patients with hypertension, 60% are uncontrolled. Racial and ethnic differences in hypertension rates and blood pressure control in the LAC DHS result from a multitude of factors such as diet, exercise, obesity, poverty, social support, hypertension measurement access, hypertension medication education, use, and adherence, hypertension community awareness and education, and variable health and socioeconomic resource access.

During the study's planning phase (UG3), barriers to and preferences for interventions and implementation strategies were identified at the patient, provider, clinic, health system, and community levels to tailor hypertension interventions with the goal of improving blood pressure control among racially and ethnically diverse safety net health system patients with uncontrolled HTN. This three-year phase included the formation of routine meetings with the study Steering Committee and five race- and ethnic-specific community action boards (CABs), a LAC DHS health system intervention and implementation planning group, a study meta-analysis team, a behavioral science subcommittee, and Technical Assistance meetings with NIH statisticians.

The intervention partners with LAC DHS to randomize clinics to one of three strategies: 1) provider-focused strategies, 2) patient-focused strategies, and 3) usual care strategies. Provider-focused strategies center on increasing provider knowledge of evidence-based blood pressure management, increasing cultural awareness of barriers to and facilitators of control, increasing access to medications, and integrating gained knowledge into practice. Patient-focused strategies include using culturally tailored materials and reminders to improve patient understanding of hypertension, how to manage the condition, and the available resources; increasing access to home blood pressure monitors; and social needs screening with linkage to community resources.

The UCLA DECIPHeR Team employs the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to guide the implementation process. The team will use the RE-AIM framework to test the effectiveness of their implementation strategies.

Primary implementation aim:

To test the effectiveness of the implementation strategies (usual care, patient-focused strategies, and provider-focused strategies) on change in adoption of culturally tailored evidence-based practices (at the end of Year 1).

研究类型

介入性

注册 (估计的)

540

阶段

  • 不适用

联系人和位置

本节提供了进行研究的人员的详细联系信息，以及有关进行该研究的地点的信息。

学习地点

  • 美国
    • California
      • Sylmar、California、美国、91342
        • Olive View-UCLA Medical Center

参与标准

研究人员寻找符合特定描述的人，称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。

资格标准

适合学习的年龄

18年 及以上 (成人、年长者)

接受健康志愿者

不

有资格学习的性别

全部

描述

Inclusion Criteria:

  • Hypertension code in EHR ((ICD-9 codes: 401, 402, 403, 404, 405, 437.2 and ICD-10 codes: I10, I11.0, I11.9. I12.0, I12.9, I13.0, I13.10, I13.11, I13.2, I15.0, I15.8, I67.4)
  • Accessing primary care at participating clinic in LAC DHS
  • 18 years or older.

Exclusion Criteria:

  • No hypertension codes in EHR
  • Primary care outside of participating clinic or LAC DHS
  • Under 18 years old

学习计划

本节提供研究计划的详细信息，包括研究的设计方式和研究的衡量标准。

研究是如何设计的？

设计细节

  • 主要用途：卫生服务研究
  • 分配：随机化
  • 介入模型：交叉作业
  • 屏蔽：单身的

武器和干预

参与者组/臂
干预/治疗
实验性的：Usual Strategies - Year1

Usual strategies implemented in year 1, patient-focused and provider-focused strategies implemented in year 2, and sustainment in year 3.
行为的：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.
实验性的：Patient-Focused Strategies - Year1

Patient-focused strategies implemented in year 1, provider-focused strategies implemented in year 2, and sustainment in year 3.
行为的：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
行为的：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
实验性的：Provider-Focused Strategies - Year1

Provider-focused strategies implemented in year 1, patient-focused strategies implemented in year 2, and sustainment in year 3.
行为的：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
行为的：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

研究衡量的是什么？

主要结果指标

结果测量
措施说明
大体时间
Overall provider adoption of evidence based practices
大体时间：Yearly

A composite score, at the DHS provider level, to evaluate the adoption of nine culturally tailored EBP components [home blood pressure (BP) monitor documented or acquired, home BP readings uploaded into patient portal, primary care visit attended within 1-12 weeks of uncontrolled BP reading, hypertension clinic nurse visit within 1-12 weeks of uncontrolled BP reading. patient referral to DHS hypertension resources, social needs screening conducted, CHW assigned and met with patient, provider uptake of hypotension education and training and combination medications prescribed]. The score for a provider ranges from 0 to 9, a higher score indicates higher level of adoption of EBPs.
Yearly

次要结果测量

结果测量
措施说明
大体时间
Provider/Care Team EBP Acceptability, Appropriateness, Feasibility
大体时间：Yearly

Implementation Outcome: Provider EBP Acceptability, Appropriateness, Feasibility
Yearly
Blood Pressure (BP) Control
大体时间：Yearly

BP control is defined by a representative systolic BP of <140 mm Hg and a representative diastolic BP of <90 mm Hg.. A Representative BP is defined as the most recent BP reading during the measurement year or, if multiple BP measurements occur on the same date or noted in the chart on the same date, use the lowest systolic and lowest diastolic BP reading. If there is no recorded BP during the measurement year, and the participant is still empaneled at LAC DHS, we will identify the member as "not controlled" per the HEDIS guidelines.
Yearly

合作者和调查者

在这里您可以找到参与这项研究的人员和组织。

赞助

University of California, Los Angeles

合作者

National Heart, Lung, and Blood Institute (NHLBI)

调查人员

  • 首席研究员：Arleen F Brown, MD, PhD、University of California, Los Angeles

出版物和有用的链接

负责输入研究信息的人员自愿提供这些出版物。这些可能与研究有关。

一般刊物

研究记录日期

这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查，以确保它们在发布到公共网站之前符合特定的质量控制标准。

研究主要日期

学习开始 (实际的)

2024年8月8日

初级完成 (估计的)

2027年12月1日

研究完成 (估计的)

2027年12月1日

研究注册日期

首次提交

2024年4月8日

首先提交符合 QC 标准的

2024年4月8日

首次发布 (实际的)

2024年4月11日

研究记录更新

最后更新发布 (实际的)

2026年9月30日

上次提交的符合 QC 标准的更新

2026年9月25日

最后验证

2026年9月1日

更多信息

与本研究相关的术语

关键字

其他相关的 MeSH 术语

其他研究编号

  • 4UH3HL154302 (美国 NIH 拨款/合同)

计划个人参与者数据 (IPD)

计划共享个人参与者数据 (IPD)？

不

药物和器械信息、研究文件

研究美国 FDA 监管的药品

不

研究美国 FDA 监管的设备产品

不

此信息直接从 clinicaltrials.gov 网站检索，没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求，请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改，我们的网站上也会自动更新.

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