Insights for Community Health (New York)

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Summary:

Poor blood pressure (BP) control is a major contributor to the racial disparity in hypertension (HTN) among African American and black individuals. Improving BP control leads to significant cardiovascular risk reduction; however, evidence-based interventions targeting self-management behaviors are not widely disseminated to community-based settings. The challenge for local health departments is to redesign these evidence-based approaches to function sustainably at the level of resources and skills available in typical community-based organizations.

This study assessed the feasibility of implementing a personal health record (PHR) at three predominately black churches in New York City. The PHR was customized to enable lay health workers (LHWs) to track individual and aggregate changes in BP and health behaviors using a Congregational Dashboard among black congregants with HTN. The impact of the PHR system was then evaluated from baseline to 9 months.

The specific aims of this project were as follows:

  • Assess the feasibility of implementing a customized PHR system to support a church-based BP monitoring program in two predominately black churches in New York City. 
  • Evaluate the effect of implementing the PHR system on changes in systolic and diastolic BP from baseline to 9 months. 
  • Evaluate the effect of implementing the PHR system on changes in daily servings of fruits and vegetables, level of physical activity, within-participant weight loss, and number of visits to a primary care physician from baseline to 9 months. 

LHWs were trained to facilitate recruitment, retention, and adoption of the PHR. A pre-post study design was used to track and compare individual and aggregate changes in BP and health behaviors before and after PHR implementation. Analysis of utilization data showed that participants had an average of 11 BP readings in the PHR over the 9-month study. Overall, there was a significant increase in fruit and vegetable intake, as well as in the mean number of physician visits. While change in BP was not significant for the total study sample, participants aged 65 years and older with greater than 10 BP readings exhibited a significant reduction in BP. Qualitative interviews showed that the dashboard was regarded as a valuable resource to the church and offered many advantages over the traditional paper-based record system.

Insights for Community Health - 2012

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Quality through Health Information (IT) (R21)
  • Grant Number: 
    R21 HS 020982
  • Project Period: 
    September 2012 – August 2014
  • AHRQ Funding Amount: 
    $176,950
  • PDF Version: 
    (PDF, 269.84 KB)

Summary: Hypertension is the leading cause of death among African Americans and is a driver of racial disparities in cardiovascular morbidity and mortality. Poor blood pressure (BP) control is a major reason for this disproportionate burden. Despite the proven efficacy of reducing cardiovascular risk through self-management behaviors, dissemination of these interventions beyond clinical settings is limited. The New York City Department of Health and Mental Hygiene (DOHMH) developed Keep on Track (KOT), a program that aims to lower BP in older adults by utilizing lay health workers (LHW) at faith-based organizations. KOT was tested in a 12-week preliminary pilot study at two churches. LHWs used a paper- based system to track BP readings and conduct counseling and health education sessions. A reduction in BP was seen in all 13 participants. Despite this success, the paper-based system presented a challenge for the management of the high volume of participant BP data, as well as the analysis of collected data for feedback, decisionmaking, and reporting. This project is improving KOT information management by implementing an electronic personal health record (PHR) and a church data dashboard that will be managed by trained LHWs. The PHR will display health information and health education materials to congregants with hypertension from two predominately African American churches and will allow them to enter and track their own measurements and observations of their BP and health behaviors. In addition, a congregational dashboard feature will be implemented at each church for use by LHWs and congregation leadership, a design innovation that will allow tracking of both individual and aggregate changes in participants’ BP and health behavior. The trained LHWs will provide targeted outreach and brief lifestyle counseling based on this data. The project will also explore the role of church-based social support in reducing barriers—which frequently include low computer literacy, inconvenience, and time burden—to PHR use among underserved and elderly populations.

Specific Aims:

  • Assess the feasibility of implementing a customized PHR system to support a church-based BP monitoring program to two predominately African American churches in New York City. (Ongoing)
  • Evaluate the effect of implementing the PHR system on: 1) changes in systolic and diastolic BP from baseline to 9 months; and 2) changes in daily servings of fruits and vegetables; level of physical activity; within-participant weight loss; and number of visits to the primary care physician from baseline to 9 months. (Upcoming)

2012 Activities: Dr. Schoenthaler and her team conducted focus groups with five church health ministries to elicit their views on the most important ways to improve the Web application for the PHR and the congregational dashboard. Findings from focus groups provided valuable information for study implementation, including the customization of the PHR and dashboard with the vendor, level of detail required in the training manuals (e.g., simple explanations of icons), and specific privacy preferences (reluctance to enter birth dates). In early 2013, the project team will begin recruiting churches to participate in the study. In preparation, the team has developed and implemented an application process for church selection to ensure that chosen sites will be best able to conduct the research. The project team has experienced some delays in working with the PHR vendor but anticipates that the study timeline will recover once the PHR is delivered. As last self-reported in the AHRQ Research Reporting System, project progress and activities are mostly on track. The project budget is somewhat underspent due to the delay in delivery of the PHR.

Preliminary Impact and Findings: This project has no findings to date.

Target Population: Adults, Chronic Care*, Elderly*, Hypertension, Racial or Ethnic Minorities*: Black and African Americans

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Implementation and Use

* This target population is one of AHRQ’s priority populations.

Insights for Community Health - Final Report

Citation:
Schoenthaler A. Insights for Community Health - Final Report. (Prepared by New York University School of Medicine under Grant No. R21 HS020982). Rockville, MD: Agency for Healthcare Research and Quality, 2015. (PDF, 590.45 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
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