Reducing Inequities in Care of Hypertension, Lifestyle Improvement for Everyone (RICH LIFE Project)



Status:Enrolling by invitation
Conditions:High Blood Pressure (Hypertension)
Therapuetic Areas:Cardiology / Vascular Diseases
Healthy:No
Age Range:21 - 100
Updated:11/3/2018
Start Date:September 1, 2016
End Date:August 31, 2020

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Comparative Effectiveness of Health System vs. Multilevel Interventions to Reduce Hypertension Disparities

The investigators refined research aim is to determine if a clinic-based collaborative care
team, including a community health worker (CHW) to deliver community-based contextualized
care, reduces disparities in blood pressure control rates, lowers cardiovascular disease
(CVD) risk, and improves outcomes among patients with hypertension and other common comorbid
conditions when compared to standard of care health system approaches to CVD risk management,
including audit and feedback and staff and provider training.

Collaborative care includes care coordination and care management; regular and proactive
monitoring and treatment to target specific patient needs using validated clinical tools and
rating scales; and regular systematic caseload reviews by the care team and consultation with
experts for patients who do not show clinical improvement. A typical collaborative care team
includes the primary care provider, nurse care manager or coordinator, and other members of
the clinic staff involved in patient care.

Intervention protocols are designed to address common comorbidities (diabetes,
hyperlipidemia, depression and coronary heart disease), lifestyle factors (dietary intake,
physical activity, and smoking) and medication adherence. The investigators intensive
intervention treats the "whole" patient, driven by individual patient goals and priorities,
as opposed to the standard of care, which typically focuses on individual conditions. This
proposed study responds directly to patient desires to feel more equipped to be involved in
their care and manage multiple conditions that contribute to CVD. The investigators have
worked successfully in the past with a broad range of stakeholders, including community
members, patients, providers, and payors, and will continue to engage them through the
research and dissemination process.

See "Arms and Interventions."

Inclusion Criteria:

1. Adult patients (≥21 years of age) obtaining primary care from a provider at a
participating practice

2. A diagnosis of hypertension or SBP≥140mmHg or DBP≥90mmHg twice in the past year or on
antihypertensive medications plus at least one of the following CVD risk factors:

- Diabetes mellitus (fasting blood sugar> 125mg/dl or hemoglobin A1c>6.5 or on a
hypoglycemic medication);

- Dyslipidemia (LDL >130 mg/dl, HDL<40 or total cholesterol >200 or on a lipid
lowering agent);

- Coronary heart disease

- Current tobacco smokers

- Depression by International Classification of Disease, 9th edition (ICD-9), codes
or Patient Health Questionnaire (PHQ) score >9

Exclusion Criteria:

1. Cardiovascular event (unstable angina, myocardial infarction) within the past 6 months

2. Serious medical condition which either limits life expectancy or requires active
management (e.g., certain cancers)

3. Condition which interferes with outcome measurement (e.g., dialysis)

4. Pregnant or planning a pregnancy during study period. Nursing mothers would need
approval from physician.

5. Alcohol or substance use disorder if not sober/abstinent for ≥30 days

6. Planning to leave clinic within 6 months or move out of geographic area within 18
months

7. Individuals with cognitive impairment or other condition which makes them unable to
participate in the intervention

8. Participating in another lifestyle modification, weight reduction, or treatment trial
We found this trial at
1
site
733 North Broadway
Baltimore, Maryland 21205
(410) 955-3182
Johns Hopkins University School of Medicine Johns Hopkins Medicine (JHM), headquartered in Baltimore, Maryland, is...
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mi
from
Baltimore, MD
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