[Download]Reducing ethnic and racial disparities by improving undertreatment, control, and engagement in blood pressure management with health information technology (REDUCE-BP) hybrid effectiveness-implementation pragmatic trial: Rationale and design [pdf]

Racial disparities in hypertension control have been recognized for decades. 1-5 Despite modest improve- ments in treatment initiation, 6 , 7 blood pressure control among Black and Hispanic/Latino adults remains sub- stantially lower than non-Hispanic whites. 7-11 Many fac- tors contribute to these persistent care gaps. Racial dif- ferences in treatment intensiﬁcation alone contribute to more than 20% of observed racial/ethnic variation in blood pressure control. 2 Follow-up care is challenging for providers and health systems, in part because of in- ability to afford in-home blood pressure monitoring cuffs as well as differential recommendations by providers about self-monitor ing. 12 Fur ther, social determinants of health, such as ﬁnancial resource strain, are often more prevalent among Black and Hispanic/Latino patients and socially disadvantaged individuals and can compound is- sues of health system access. 13 , 14 A strategy to address some of these challenges is with the use of electronic health record (EHR)-embedded tools. 2 , 15 , 16 Their widespread use by providers already in their clinical workﬂow enhances the potential for scala- bility. 15 , 17 Many EHRs systems contain a range of possi- ble clinical decision support tools such as alerts, dash- boards, reminders, and defaults. 18 , 19 Despite evidence supporting the ability of these interventions to improve health care quality, in many cases they have only been modestly effective, attributed to issues with their timing within the clinical workﬂow, the salience of the informa- tion, and alert fatigue. 18 , 20-22 To date, very few trials have evaluated whether EHR-based interventions can reduce racial/ethnic disparities. 23 , 24