Project ReD CHiP

Project ReD CHiP (Reducing Disparities and Controlling Hypertension in Primary Care) used interventions targeting behavior change at three levels—patient, clinician, and health system—to improve blood pressure control in six clinics.

Using a pragmatic trial, (a clinical study that informs a clinical or policy decision by providing evidence for adoption of the intervention into real-world clinical practice), we implemented three complementary multi-level interventions designed to 1) improve blood pressure measurement, 2) provide patient care management services, and 3) offer expanded provider education resources in six Baltimore area primary care clinics that are part of a large health system in Maryland. To facilitate project implementation and improve sustainability, we incorporated health system and community stakeholder input and tailored components of the interventions to meet the specific needs of the involved clinics and communities. We staggered the introduction of the interventions and will use a method called Statistical Process Control (SPC) charting to determine if there are changes in outcomes at each clinic after implementation of each intervention.

Project ReD CHiP’s main hypothesis was that each intervention would have an additive effect on improvements in care consistent with treatment guidelines (% of patients with uncontrolled BP with a medication titration in the last three months) and in hypertension control (the percent of patients with controlled BP) and on reductions in hypertension disparities (the racial disparity in controlled BP), but the combination of all three interventions would result in the greatest impact, followed by blood pressure measurement with care management support, blood pressure measurement with provider education, and blood pressure measurement only. The study also aimed to examine organizational functioning and cultural competence in the clinics and their effects on the success of the interventions.

Outcomes

The project succeeded in cost-effectively reducing racial disparities in blood pressure control among patients who participated in care management, but as a clinic-based program, not all persons in need could benefit.