Reach Out: Randomized Clinical Trial of Emergency Department-Initiated Hypertension Behavioral Intervention Connecting Multiple Health Systems

a MiCDA Research Project Description

Investigators: William J. Meurer, Rebecca Cunningham, Devin L. Brown, Lesli E. Skolarus, Kelley Kidwell, Lorraine R. Buis, Sacha Maximilien Montas

Funding: National Institute on Minority Health and Health Disparities, 2017-2021 (1 R01 MD 011516 01)

Hypertension is the most important modifiable risk factor for cardiovascular disease, the leading cause of mor-tality in the United States. African Americans have the highest prevalence of hypertension of any race/ethnic group in the United States which largely contributes to their increased burden of stroke compared to non-Hispanic whites. In addition, uncontrolled hypertension is more common among socioeconomically disadvan-taged populations than their counterparts. To improve health equity, new approaches to hypertension treatment focusing on health care systems and difficult-to-reach populations are needed.

The Emergency Department (ED) represents a missed opportunity to identify and treat hypertension in difficult ?to-reach populations. Currently, there are 136 million ED visits per year ? nearly all have at least one blood pressure measured and recorded. African Americans and socioeconomically disadvantaged patients are dis-proportionally represented in the ED patient population and are increasing. In this age of electronic health rec-ords and mobile health, the ED can feasibly become an active partner in chronic disease management by pro-gramming the electronic health record to identify hypertensive patients and dispense a mobile health behavioral intervention. Facilitating ED follow up at primary care clinics is a key feature of the proposed intervention. Leveraging the strengths of the ED, large patient volume of uncontrolled, difficult-to-reach, hypertensive pa-tients, with the strengths of the primary care clinics, continuity of care, is the key to improving community wide utilization of health services and receipt of guideline concordant medical care.

We propose, Reach Out, a health system focused, multicomponent, health theory based, mobile health behav-ioral intervention to reduce blood pressure among hypertensive patients evaluated in a safety net ED. This trial will take place in Flint, Michigan, an urban, under-resourced, predominately African American community with which the researchers have long-standing partnerships. Reach Out consists of three components, each with two levels; healthy behavior text messaging (yes vs. no), prompted home blood pressure self-monitoring (weekly vs. every other day) and primary care provider appointment scheduling and transportation (yes vs. no). Subjects will be randomized into one of the eight experimental arms and followed for 12 months. Reach out will determine which behavioral intervention components or `dose? of the components contribute to a reduction in systolic blood pressure at one year (Aim 1). We will also determine the effect of primary care provider ap-pointment scheduling and transportation on primary care follow up of hypertensive patients treated in an urban, safety net ED (Aim 2). Reach Out may revolutionize hypertension management in safety net health systems. By connecting ED patients to primary care providers, Reach Out can serve as a model for safety net hospitals and Federally Qualified Health Centers to improve chronic disease management in underserved communities

Research Signature Theme:

Health and well-being in later life: Chronic Disease