The goal of this observational pragmatic study is to learn about how evidence-based interventions and best practices for management of uncontrolled hypertension can be integrated across a large healthcare system through the use of virtual and clinic-based care approaches. The primary outcome for this work is the sustained change over time in patients' reported blood pressure readings relative to guidelines-based thresholds for treatment. Measures in all domains of the RE-AIM (reach, effectiveness, adoption, Implementation and Maintenance) implementation science framework will be used.
The overall purpose of this project is to study the implementation of the organization's PCORI Hypertension Care Management (PHCM) program and evaluate its impact on patients' health and experiences with care. Patients will be offered two different clinical pathways to manage their uncontrolled hypertension (hybrid \[telehealth + in-person clinic visits\], or telehealth only). Both of these approaches are evidence-based. Their effectiveness in relation to health outcomes will be examined. Data will be analyzed to provide context to the quantitative RE-AIM findings and to capture information on outcomes that cannot be collected by other means. This protocol includes both program evaluation activities conducted by the health system and research activities conducted by the study team to generate generalizable knowledge about patient experiences and outcomes. Part 1: Program Evaluation Aims: 1\. Conduct an evaluation of the reach, effectiveness, adoption, implementation, and maintenance of the telehealth care and clinic-based care interventions using a mixed-methods, real-world approach supported by the RE-AIM framework. Part 2: Qualitative Component of Study (Anticipated enrollment numbers on this site reflect this portion of the study) Research Aims: 1. Identify how patients describe changes in their self-management behaviors, confidence, health beliefs, and relationships with care teams as they engage in the care approaches. 2. Examine how patients and healthcare staff describe their experiences with the implementation strategies used to deliver the PCHM program across diverse settings.
Study Type
OBSERVATIONAL
Enrollment
130
OSF HealthCare System
Peoria, Illinois, United States
Systolic Blood Pressure Change
Average change in systolic blood pressure between baseline, 12 Months and 24 months (mm Hg)
Time frame: Trajectory over 12 months and 24 months
Diastolic Blood Pressure Change
change in patient diastolic blood pressure change from baseline
Time frame: Trajectory over 12 months and 24 months
Symptom Reporting (Side effects of Antihypertensive Medication)
• Number of Participants Reporting Dizziness, Hypotension or fainting as a Side Effect of Antihypertensive Medication at Six Months
Time frame: Baseline to 6 months
Patient Care Experience
Number of Participants Who Report High Level of Satisfaction With Hypertension Care at Six Months.
Time frame: baseline to 6 months
Self-monitoring/Confidence in Self-Care
Number of patients reporting confidence in managing hypertension (Blood Pressure Care Survey) at Six Months
Time frame: baseline to 6 months
Qualitive Interviews with Patients
Patients' experiences over time in program (longitudinal interviews) - purposive sample
Time frame: baseline to 6 months, 12, months, 18 months, and 24 months
Provider and Staff Interviews
Qualitative interviews will provide descriptions of experiences pre-, mid- and later phase implementation to provide insights into staff and organizational factors influencing uptake and success of PHCM interventions.
Time frame: baseline, 6 months, 12 months, 18 months, and 24 months.
Unplanned Care Visits
Unplanned care visits due to high blood pressure, change in blood pressure, blood pressure control rate
Time frame: baseline to 6 months
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