The role of care management as a population health intervention to address disparities and contr ol hypert ension: A quasi-experimental observational study

Tanvir Hussain, Whitney Franz, Emily Brown, Athena Kan, Mekam Okoye, Katherine Dietz, Kara Taylor, Kathryn A. Carson, Jennifer Halbert, Arlene Dalcin, Cheryl A.M. Anderson, Romsai T. Boonyasai, Michael Albert, Jill A. Marsteller, Lisa A. Cooper

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Objective: We studied whether care management is a pragmatic solution for improving population blood pressure (BP) control and addressing BP disparities between Blacks and Whites in routine clinical environments. Design: Quasi-experimental, observational study. Setting and Participants: 3,964 uncontrolled hypertensive patients receiving primary care within the last year from one of six Baltimore clinics were identified as eligible. Intervention: Three in-person sessions over three months with registered dietitians and pharmacists who addressed medication titration, patient adherence to healthy behaviors and medication, and disparitiesrelated barriers. Main Measures: We assessed the population impact of care management using the RE-AIM framework. To evaluate effectiveness in improving BP, we used unadjusted, adjusted, and propensity-score matched differences-in-differences models to compare those who completed all sessions with partial completers and non-participants. Results: Of all eligible patients, 5% participated in care management. Of 629 patients who entered care management, 245 (39%) completed all three sessions. Those completing all sessions on average reached BP control (mean BP 137/78) and experienced 9 mm Hg systolic blood pressure (P<.001) and 4 mm Hg DBP (P=.004) greater improvement than non-participants; findings did not vary in adjusted or propensity-score matched models. Disparities in systolic and diastolic BP between Blacks and Whites were not detectable at completion. Conclusion: It may be possible to achieve BP control among both Black and White patients who participate in a few sessions of care management. However, the very limited reach and patient challenges with program completion should raise significant caution with relying on care management alone to improve population BP control and eliminate related disparities.

Original languageEnglish (US)
Pages (from-to)285-294
Number of pages10
JournalEthnicity and Disease
Volume26
Issue number3
DOIs
StatePublished - Jun 1 2016

Keywords

  • Care Management
  • Disparities
  • Hypertension
  • Population Health
  • Primary Care
  • Quality Improvement

ASJC Scopus subject areas

  • Epidemiology

Fingerprint Dive into the research topics of 'The role of care management as a population health intervention to address disparities and contr ol hypert ension: A quasi-experimental observational study'. Together they form a unique fingerprint.

Cite this