[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]

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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

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

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