IMPORTANCE Mobile applications (apps) may help improve hypertension self-management. OBJECTIVE To investigate the effect of an artificial intelligence smartphone coaching app to promote home monitoring and hypertension-related behaviors on systolic blood pressure level compared with a blood pressure tracking app. DESIGN, SETTING, AND PARTICIPANTS This was a 2-group, open, randomized clinical trial.

Background: Effective quality improvement (QI) strategies are needed for small practices. Objective: The objective of this study was to compare practice facilitation implementing point-of-care (POC) QI strategies alone versus facilitation implementing point-of-care plus population management (POC+PM) strategies on preventive cardiovascular care. Design: Two arm, practice-randomized, comparative effectiveness study. Participants: Small and mid-sized primary care practices. Interventions: Practices worked with facilitators on QI for 12 months to implement POC or POC+PM strategies. Measures: Proportion of eligible patients in a practice meeting “ABCS” measures: (Aspirin) Aspirin/antiplatelet therapy for ischemic vascular disease, (Blood pressure) Controlling High Blood Pressure, (Cholesterol) Statin Therapy for the Prevention and Treatment of Cardiovascular Disease, and (Smoking) Tobacco Use: Screening and Cessation Intervention, and the Change Process Capability Questionnaire. Measurements were performed at baseline, 12, and 18 months. Results: A total of 226 practices were randomized, 179 contributed follow-up data. The mean proportion of patients meeting each performance measure was greater at 12 months compared with baseline: Aspirin 0.04 (95% confidence interval: 0.02–0.06), Blood pressure 0.04 (0.02–0.06), Cholesterol 0.05 (0.03–0.07), Smoking 0.05 (0.02–0.07); P<0.001 for each. Improvements were sustained at 18 months. At 12 months, baseline-adjusted difference-in-differences in proportions for the POC+PM arm versus POC was: Aspirin 0.02 (−0.02 to 0.05), Blood pressure −0.01 (−0.04 to 0.03), Cholesterol 0.03 (0.00–0.07), and Smoking 0.02 (−0.02 to 0.06); P>0.05 for all. Change Process Capability Questionnaire improved slightly, mean change 0.30 (0.09–0.51) but did not significantly differ across arms. Conclusion: Facilitator-led QI promoting population management approaches plus POC improvement strategies was not clearly superior to POC strategies alone.

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Rheumatoid arthritis (RA) increases cardiovascular disease (CVD) risk. However, CVD risk factor identification and treatment is often inadequate. The authors implemented a multifaceted rheumatology practice intervention to improve CVD risk factor measurement, assessment, and management. The intervention included clinician education, point-of-care decision support, feedback, and care management. The authors measured quality indicators from electronic health records and assessed impact with interrupted time series. Following the intervention, more RA patients had all major CVD risk factors assessed (53% vs 72.2%), and the rate of increase was greater during the intervention period than baseline (difference of 0.74% per month, P = .0016). Moderate- or high-intensity statin prescribing increased (21.6% to 28.2%), but the rate of change was not different from baseline. Several other quality measures did not increase. Although CVD risk factor assessment improved, the intervention did not affect risk factor management and control. Other strategies are needed to optimize CVD prevention in RA.

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Objective Rheumatoid arthritis (RA) confers a 1.5‐ to 2.0‐fold increased risk of cardiovascular disease (CVD). A prior multifaceted quality improvement approach to improving CVD preventive care increased CVD risk factor assessments, but there was no significant effect on the management of risk factors. We tested the impact of adding a proactive outreach strategy promoting primary care treatment of CVD risk factors among patients with RA through their rheumatology practice. Methods Through electronic health record searches, we identified patients with RA who were potential candidates for hypertension treatment initiation or intensification, statin therapy, or a smoking‐cessation intervention. A nonclinician care manager contacted patients by phone and mail on behalf of the rheumatologists, provided information about the identified risk factor(s), recommend follow‐up with primary care physicians (PCPs), sent correspondence to PCPs, and followed up with patients to see what actions had been taken. We measured preventive cardiology quality indicators and compared preintervention and intervention time periods using interrupted time series methods. Results During the 6‐month intervention period, the proportion of patients prescribed at least moderate‐intensity statin treatment for primary prevention rose from 18.4% to 23.8%. The rate of increase was 1.06% greater per month than during the preceding period (P < 0.001). Rates of increase in hypertension diagnosis and control improved more rapidly during this phase (P < 0.001 for each) and reversed preceding negative trends. Conclusion Implementing proactive nonclinician outreach to encourage primary care–based treatment of CVD risk factors was associated with increases in statin prescribing and in hypertension diagnosis and control. Smoking was not affected.

Objectives: There has been a strong presence of African immigrants in Chicago, especially since 1996. According to an assessment by United African Organization (UAO), a major hub to provide social services for African Americans in the Chicago area, more than 70 percent of these immigrants arrived between the years of 1996 and 2008. Colorectal cancer affects every 62 of 100,000 African Americans according to CDC, and is the third leading cause of cancer death in America according to the American Cancer Society. Yet, there is no such data to study how the disease affects African immigrants, or an educational blueprint to create awareness to the health risk among African immigrants. The purpose of this study is to document colorectal cancer baseline data among African immigrants in Illinois in an effort to identify some of the barriers, risks and screening behaviors that exposes the priority population to colorectal cancer. Methods: This study was based on a convenience sample of 68 participants response to quantitative survey tool, which was administered over the course of three months at a church that served the congregation in Chicago, and three semi-structured interviews of community leaders from United African Organization, Ghana National Council and ACUMC to document baseline data and to serve as a guideline to designing the survey. Demographic questions such as age, family income, place of birth, marital status etc, was asked to assess demographic status. Other questions such as overall health rating, insurance coverage, having a primary physician, most recent visit to the doctor etc were also asked to understand the priority population's utilization of the healthcare system upon immigrating to America. Furthermore, questions regarding risk and overall health ratings, knowledge of colorectal, breast and lung cancers etc were asked as a step to understanding the priority population's perceived risk of colorectal cancer compared to other popularly known cancers and how they may be at risk of colorectal cancer in particular. Results: Majority of the participants (n = 66) were born in Africa and even though majority of participants also reported to having completed college in their respective African countries (45.2%), majority earned only between $25,000 and $50,000 (35.5%). Despite reports of low earnings, majority reported having some health insurance (58.1%), majority of the sample had been living in the United States for at least 20 years (38.7%), and believed they are at no risk of colorectal cancer (32.3%). Analysis suggested that 67.7% of the participants either heard about colorectal cancer from a doctor visit or in the news. Majority (78%) of the participants who had lived in the U.S. for more than 10 years had heard about CRC. Moreover, Nearly 41% of the participants believed that they had zero risk of CRC on a 0 (no risk at all) to 10 (extremely high risk) scale. The other 38.3% considered themselves with very low risk, 1 or 2 on the 10-point scale. Results from data analysis suggest income, among other factors plays a significant role in the priority population's knowledge of colorectal cancer (p = 0.011). Conclusion: Although there was a small sample of people surveyed, results suggest the potential many members of the priority population believe they are at no risk of colorectal cancer. However, the literature point to western diets as the main risk of colorectal cancer for African immigrants. Data collected allowed for the creation of an educational brochure that seeks to educate the priority population and create awareness in an effort to promote screening for colorectal cancer. Citation Format: Yaw Amofa Peprah, Karen E. Kim, Helen Lam. Researching the perception of risk about colorectal cancer among African immigrants in the Chicago metropolitan area: A preliminary study. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B90. doi:10.1158/1538-7755.DISP13-B90