Effectiveness of a Population Health Intervention on Disparities in Hypertension Control: A Stepped Wedge Cluster Randomized Clinical Trial.

ABSTRACT

BACKGROUND: Disparities in hypertension control across race, ethnicity, and language have been a long-standing problem in the United States. OBJECTIVE: To assess whether a multi-pronged intervention can improve hypertension control for a target population and reduce disparities. DESIGN: This stepped wedge cluster randomized trial was conducted at 15 adult primary care clinics affiliated with Massachusetts General Hospital. PCPs were randomized to receive the intervention in twelve groups. PARTICIPANTS: The target population was patients who met one of the following criteria based on self-identification (1) Asian, Black, Indigenous, multi-racial, or other race; (2) Hispanic ethnicity; or (3) preferred language other than English. Reference population was White, English-speaking patients. INTERVENTIONS: PCPs were given access to an online equity dashboard that displays disparities in chronic disease management and completed an equity huddle with population health coordinators (PHCs), which involved reviewing target patients whose hypertension was not well controlled. In addition, community health workers (CHWs) were available in some practices to offer additional support. MAIN MEASURES: The primary outcome was change in the proportion of target patients meeting the hypertension control goal when comparing intervention and control periods. KEY RESULTS: Of the 365 PCPs who were randomized, 311 PCPs and their 10,865 target patients were included in the analysis. The intervention led to an increase in hypertension control in the target population (RD 0.9%; 95% CI [0.3,1.5]) and there was a higher intervention effect in the target population compared to the reference population (DiD 2.1%; 95% CI [1.1, 3.1]). CONCLUSIONS: Utilizing data on disparities in quality outcome measures in routine clinical practice augmented by clinical support provided by PHCs and CHWs led to modest, but statistically significant, improvement in hypertension control among BIPOC, Hispanic, and LEP patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT05278806.