Care Management to Reduce Disparities and Control Hypertension in Primary Care

Hong, Jonathan; Padula, William V.; Hollin, Ilene L.; Hussain, Tanvir; Dietz, Katherine B.; Halbert, Jennifer P.; Marsteller, Jill A.; Cooper, Lisa A.

doi:10.1097/mlr.0000000000000852

Cited by 7 publications

(5 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…17,18 One was Project ReDCHiP (Reducing Disparities and Controlling Hypertension in Primary Care), a cost-effective care-management intervention that took place from 2012 to 2015 and achieved substantial improvements in blood pressure 19 among African American and white patients. 20 Another is an ongoing, large, pragmatic clinical trial comparing the effectiveness of enhanced usual care plus audit, feedback, and education with care provided by a collaborative care team. The collaborative care intervention incorporates community health worker support and/or specialist consultation and is expected to reduce racial/ethnic disparities in hypertension control among patient participants at 30 clinics in Maryland and Pennsylvania.…”

Section: Collaborations Among Practitioners Researchers and Educatorsmentioning

confidence: 99%

Progress on Major Public Health Challenges: The Importance of Equity

et al. 2018

Self Cite

View full text Add to dashboard Cite

Health disparities are "avoidable inequalities in health between groups of people within countries and between countries." 1 In the United States, these differences among population groups in the attainment of full health potential are reflected in shorter life expectancy and higher rates of heart disease, stroke, diabetes, cancer, trauma and violence, substance use, infant mortality, and low birth weight among socially disadvantaged groups compared with socially advantaged groups. Disparities exist across many dimensions, including race, ethnicity, gender, sexual orientation, disability status, socioeconomic status, refugee or migrant status, and geographic location-even between neighborhoods in close proximity to one another. Health disparities reflect social injustice because these differences in health across groups are unnecessary, avoidable, and unfair. 2 Health equity is "when every person has the opportunity to 'attain his or her full health potential' and no one is 'disadvantaged from achieving this potential because of social position or other socially determined circumstances.'" 3 Achieving equity in health requires a societal willingness to address challenges associated with the social determinants of health, including racism and bigotry, poverty, residential segregation, substandard housing, low-quality education, limited employment opportunities, lack of public safety, unequal access to and quality of health care, and the lack of neighborhood amenities and resources that enable people to maintain and improve their health. 3,4 During the past 30 years, dramatic improvements in health status and reductions in infant and premature mortality have been achieved in the United States. However, differences in life expectancy among educational and income groups have increased. 3,5,6 Rates of morbidity and mortality among some minority groups, including African American,

show abstract

Section: Collaborations Among Practitioners Researchers and Educatorsmentioning

confidence: 99%

Progress on Major Public Health Challenges: The Importance of Equity

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…and address the history of discrimination and social determinants impacts a person's ability to participate in and improve their health outcomes (Henize et al, 2015). Hong et al (2018) conclude that interventions, such as evidencedbased care coordination, help patients improve health, attend more care visits and reduce cost of care. Identifying care coordination models that create bridges between healthcare providers, patients and their caregivers reduces barriers and leads to higher health outcomes (Francis et al, 2018;Cramm and Nieboer, 2015) .…”

Section: What This Paper Addsmentioning

confidence: 99%

“…Incorporating comprehensive SDOH into the risk stratification process has potential to improve the accuracy of predicting cost of care, pharmacy cost and hospitalisation risk for patients targeted for care coordination (Kharrazi et al., 2017; Pinto et al., 2016). Interventions incorporating SDOH considerations have been shown to support positive health outcomes, improve appointment adherence and reduce cost of care (Hong et al., 2018).…”

Section: Introductionmentioning

confidence: 99%

Improving patient well‐being in the United States through care coordination interventions informed by social determinants of health

Singer

Porta

2022

Health Social Care Comm

View full text Add to dashboard Cite

Health and well‐being are promoted when primary care teams partner with patients and provide care coordination to mitigate risks and promote optimal health. Identification of patients for care coordination is typically based on claim‐driven risk assessments. Evidence shows that social determinants of health (SDOH) drive risk for adverse health outcomes but are omitted from existing risk tools. Missed opportunities for care coordination contribute to increased healthcare costs, poorer health outcomes and reduced patient well‐being. To address the gap of risk‐informed care coordination that includes SDOH, the aim of this project was to implement process improvement of a system's care coordination program through refined patient selection and customised engagement in intensive care coordination. A non‐randomised care coordination quality improvement project was conducted at a community health centre in 2020. Inclusion criteria (i.e. presence of risk attribution score, SDOH questionnaire completed) resulted in 540 patients being offered care coordination services; Patients having at least one month of care coordination were included in the analysis (N = 216). Analysis included the 216 patients that chose participation and the 324 patients that maintained usual care. Descriptive statistics were generated to distinguish patient demographics, frequency of care coordination contact, and specific SDOH insecurities for both the study and comparison groups. Paired t‐tests were incorporated to evaluate statistical significance of the intervention group. Impact on well‐being, SDOH barriers, appointment adherence and health outcomes were assessed in both conditions. Intervention condition patients reported improvement in well‐being [feeling anxious (t = 4.051; p < 0.000)] and reduced SDOH barriers [food access (t = 4.662; p < 0.000); housing (t = 2.203; p = 0.008)] that were significantly different from the usual care condition in the expected directions. Care coordination based on factors including SDOH risks shows promise in improving patient well‐being. Future research should refine this approach for comprehensive risk assessment to intervene and support patient health and well‐being.

show abstract

“…5 Incorporating the patient, caregiver, and societal benefits of dementia prevention into future cost effectiveness studies of hypertension diagnosis and management will improve the already overwhelming health economic evidence for the prevention, diagnosis, and management of hypertension.…”

Section: Urray and Colleaguesmentioning

confidence: 99%

“…4 Furthermore, patient-oriented education programs aimed at addressing health system, patient, and provider barriers have demonstrated both effectiveness (average of 9 mmHg greater reduction in systolic blood pressure) and cost effectiveness. 5 Incorporating the patient, caregiver, and societal benefits of dementia prevention into future cost effectiveness studies of hypertension diagnosis and management will improve the already overwhelming health economic evidence for the prevention, diagnosis, and management of hypertension.…”

Section: Urray and Colleaguesmentioning

confidence: 99%

Capsule Commentary on Murray et al. Antihypertensive Medication and Dementia Risk in Older Adult African-Americans with Hypertension: a Prospective Cohort Study

Cipriano

2018

J GEN INTERN MED

View full text Add to dashboard Cite

M urray and colleagues1 present a prospective, observational study on 1236 community-dwelling AfricanAmericans with hypertension and no dementia at baseline with longitudinal follow-up of up to 24 years. In models that did not adjust for the effectiveness of hypertension control, being prescribed any hypertension medication was protective against dementia, but this finding was not statistically significant (HR = 0.65,). An analysis incorporating the effectiveness of hypertension control indicated that optimal blood pressure control (< 140 mmHg systolic and < 90 mmHg diastolic) significantly decreases the risk of dementia (HR = 0.46, 95%CI 0.25-0.82). This work adds to a growing and compelling literature indicating that effective control of hypertension prevents cognitive impairment and dementia.This study is unique in focusing on African-Americans, who are under-represented in other prospective cohort studies. While hypertension rates are concerningly high in all groups, African-Americans are nearly 50% more likely to be affected with an (unadjusted) relative risk of approximately 1.46 (95%CI 1.3-1.6).2 Recent NHANES analysis indicated that although African-Americans are as likely to be prescribed antihypertensives (70.8% [95%CI 68.6-73.0%] vs. 73.9% [95%CI 71.6-76.2%]), they are less likely than white Americans to achieve hypertension control (OR 0.73, 95%CI 0.63-0.83).3 For all racial groups, blood pressure control (by JNC7 standards) is low: 42.9, 36.9, and 31.2% for white, African-Americans, and Hispanic-Americans, respectively, 3 and these numbers have barely improved over the last decade. Patient health can be improved through hypertension prevention, as well as improvements in diagnosis rates, treatment initiation, and treatment monitoring to ensure treatment adherence and disease control. Treatment of hypertension in individuals over 45 years of age for the prevention of cardiovascular events is cost-saving in men and highly cost-effective in women.4 Furthermore, patient-oriented education programs aimed at addressing health system, patient, and provider barriers have demonstrated both effectiveness (average of 9 mmHg greater reduction in systolic blood pressure) and cost effectiveness. 5 Incorporating the patient, caregiver, and societal benefits of dementia prevention into future cost effectiveness studies of hypertension diagnosis and management will improve the already overwhelming health economic evidence for the prevention, diagnosis, and management of hypertension.

show abstract

Care Management to Reduce Disparities and Control Hypertension in Primary Care

Abstract: ReD CHiP care management is cost-effective to prevent negative consequences of hypertension. African American and elderly patients have more favorable ICERs, recommending targeted interventions to improve health equity among vulnerable patient populations.

Cited by 7 publications

References 32 publications

Progress on Major Public Health Challenges: The Importance of Equity

Progress on Major Public Health Challenges: The Importance of Equity

Improving patient well‐being in the United States through care coordination interventions informed by social determinants of health

Capsule Commentary on Murray et al. Antihypertensive Medication and Dementia Risk in Older Adult African-Americans with Hypertension: a Prospective Cohort Study

Contact Info

Product

Resources

About