RICH LIFE Hypertension Treatment Study Building Momentum!

Rich_life_logo copy 3.png

The JHU Center for Health Equity’s RICH LIFE (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) Project, a study dedicated to exploring new approaches to high blood pressure management, saw excellent progress in 2019. This study compares the current clinical and at-home protocols for monitoring and treating this condition with the addition of a more team-based approach that considers the larger social context the patient is a part of, including their ethnicity, economic status, and place of residence. The goal is to improve the management and outcomes of hypertension treatment, particularly for ethnic minority patients and patients living in poverty.

BACKGROUND

The RICH LIFE study involves up to 63 patients from each of 30 primary care clinics across Maryland and Pennsylvania which are divided into two groups, one using current clinic-based treatment practices, and the other using a more collaborative and team-based approach that also includes non-clinical caregivers, called community health workers. The study team provides training to all clinics on how to correctly measure and care for high blood pressure and related conditions such as diabetes and heart disease, in order to create baseline standards for the participating clinics. The team-based clinics then get additional training in how to consider and adapt to the specific needs a patient may have, which may require one-on-one counseling, use of community health workers, and other interventions beyond those typically found in purely clinical approaches to disease management. This study examines the broader uptake and effectiveness of the kind of collaborative, patient-centered approaches that were used in previous, smaller JHU studies.

PROGRESS ACHIEVED TO DATE

Recruitment for the study concluded on October 31, 2019. We enrolled 1,822, or 96%, of the planned 1,890 patients across all five health systems participating in the RICH LIFE Project. The RICH LIFE team of recruiters and data collectors did a commendable job in achieving such a high percentage of the study’s planned enrollment! With recruitment wrapping up, the project focus can now shift to completing patient follow-up surveys.

Even as recruitment for the study was finishing, implementation of the study’s components was already well underway at all thirty participating primary care practices. All thirty practices are participating in the blood pressure measurement standardization process and general study trainings to bring basic practices into alignment for the study.

Care managers and community health workers have already been seeing patients at all fifteen of the practices in the innovative team-based arm of the study. Care managers are focused on finishing up first intervention visits with patients and conducting follow-up visits with patients. Making the patient a team member in their own care, the needs, preferences, and self-identified goals of the patient guides the frequency and content of the follow-up visits.

Regular case management meetings allow the team to discuss patient cases in-depth and brainstorm approaches to patient care, and to consider whether to bring in a community health worker to engage difficult to reach patients, and provide additional support to patients in achieving their health goals. Patients may need a community health worker’s support for a variety of different reasons. For example, patients may face issues related to transportation, financial or emotional stress, housing or employment instability, or lacking social support. To date, care managers have formally referred 215 patients to work with a community health worker. The RICH LIFE specialist core has reviewed 17 patient cases.

To strengthen the effectiveness of the various care providers in the study, various educational programs for health system practice leaders, care managers, and community health workers have also been deployed. This training includes Health Equity Learning Network (HELN) webinars and telephone calls, and face to face meetings about case management and documentation. The next HELN sessions are scheduled for February 27, 2020, and May 28, 2020..

Lastly, the care managers and community health workers are carefully documenting their role in the research to ensure we can accurately capture and describe all of their hard work in the field. This information will help future health system leaders, healthcare teams understand what is needed to deploy a similar program in their organizations and will help private and public insurance companies determine the resources they would need to provide in order to sustain such programs for patients covered by their plans.

As always, we are thankful for all of our partners’ continued dedication and support of the RICH LIFE Project!

RELEVANT LEARNING RESOURCES




RICHLife, BaltimoreKatie Dietz