Health System Strategies to Address Disparities in Hypertension Management & Control -- Cycle 2 2022

The Patient-Centered Outcomes Research Institute (PCORI) is seeking to fund high-quality comparative effectiveness research (CER) that compares health system strategies to address disparities in hypertension management and control.

Hypertension affects almost half of US adults, with the highest prevalence among non-Hispanic Black men and women. High blood pressure is a major risk factor for heart attack, heart failure, stroke, chronic kidney disease and early mortality. Despite hypertension’s treatability, most US adults with hypertension do not have their blood pressure under control, especially people of color, those without access to care or health insurance, and individuals living in rural areas. Health systems factors that may serve as barriers to blood pressure control include delayed identification of high-risk patients, insufficient linkage to treatment and services, or a failure to initiate or intensify treatment when needed. Implicit bias among health care providers may contribute to treatment inertia, inhibit timely, appropriate care delivery, and encumber patient-provider communication further contributing to poor health outcomes for patients.

National organizations have identified several effective health systems strategies -- including practice facilitation, team-based care, health coaching and home blood pressure monitoring -- to improve hypertension control when implemented as part of multicomponent multilevel health systems strategies. Although the evidence base for these strategies is robust, questions remain about the optimal evidence-based strategies to eliminate disparities in hypertension control: the most effective way for health systems to integrate and communicate with community-based team members (nurses, pharmacist, community health worker); models for the provision of simplified pharmacotherapy regimens or free or low cost medications; strategies to improve provider-patient communication and address implicit bias, racism and discrimination in care delivery including e.g., population-based health equity interventions (e.g., patient/clinical registries or dashboards); and the impact of remote care delivery on the initiation and intensification of treatment, patient engagement and experience, and clinical outcomes, especially in historically excluded, under-researched, and/or under-resourced populations and safety net healthcare settings.

Research Initiative Highlights

PCORI’s Targeted PFA is soliciting applications that respond to the following question:

What is the comparative effectiveness of health system strategies to improve hypertension control for populations experiencing disparities in hypertension control and associated health outcomes, e.g., Black, Hispanic, rural, and/or uninsured individuals?

PCORI is particularly interested in multi-site cluster randomized trials in community, primary care, or safety net settings (i.e., providers that organize and deliver a significant level of health care to uninsured, Medicaid, and other vulnerable patients). Studies should conduct periodic outcome assessment, including long term follow-up periods at or greater than 18 months. Studies should be powered to allow for conclusions regarding the populations of interest.