title: A multi-level system quality improvement intervention to reduce racial disparities in hypertension care and control: study protocol.
abstract: BACKGROUND
  Racial disparities in blood pressure control have been well documented in the United States. Research suggests that many factors contribute to this disparity, including barriers to care at patient, clinician, healthcare system, and community levels. To date, few interventions aimed at reducing hypertension disparities have addressed factors at all of these levels. This paper describes the design of Project ReD CHiP (Reducing Disparities and Controlling Hypertension in Primary Care), a multi-level system quality improvement project. By intervening on multiple levels, this project aims to reduce disparities in blood pressure control and improve guideline concordant hypertension care.
  
  
  METHODS
  Using a pragmatic trial design, we are implementing three complementary multi-level interventions designed to improve blood pressure measurement, provide patient care management services and offer expanded provider education resources in six primary care clinics in Baltimore, Maryland. We are staggering the introduction of the interventions and will use Statistical Process Control (SPC) charting to determine if there are changes in outcomes at each clinic after implementation of each intervention. The main hypothesis is that each intervention will have an additive effect on improvements in guideline concordant care and reductions in hypertension disparities, but the combination of all three interventions will result in the greatest impact, followed by blood pressure measurement with care management support, blood pressure measurement with provider education, and blood pressure measurement only. This study also examines how organizational functioning and cultural competence affect the success of the interventions.
  
  
  CONCLUSIONS
  As a quality improvement project, Project ReD CHiP employs a novel study design that specifically targets multi-level factors known to contribute to hypertension disparities. To facilitate its implementation and improve its sustainability, we have incorporated stakeholder input and tailored components of the interventions to meet the specific needs of the involved clinics and communities. Results from this study will provide knowledge about how integrated multi-level interventions can improve hypertension care and reduce disparities.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01566864.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, 2024 East Monument Street, Suite 2-515, Baltimore, Maryland 21287, USA. lisa.cooper@jhmi.edu
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cooper
authors.forename: Jill A
authors.initials: JA
authors.lastname: Marsteller
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Noronha
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Flynn
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Carson
authors.forename: Romsai T
authors.initials: RT
authors.lastname: Boonyasai
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Anderson
authors.forename: Hanan J
authors.initials: HJ
authors.lastname: Aboumatar
authors.forename: Debra L
authors.initials: DL
authors.lastname: Roter
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Dietz
authors.forename: Edgar R
authors.initials: ER
authors.lastname: Miller
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Prokopowicz
authors.forename: Arlene T
authors.initials: AT
authors.lastname: Dalcin
authors.forename: Jeanne B
authors.initials: JB
authors.lastname: Charleston
authors.forename: Michelle
authors.initials: M
authors.lastname: Simmons
authors.forename: Mary Margaret
authors.initials: MM
authors.lastname: Huizinga
mesh_terms: D001741:Black or African American / Q000208:ethnology; D015142:Baltimore; D001795:Blood Pressure Determination / Q000379:methods; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D006973:Hypertension / Q000208:ethnology / Q000517:prevention & control*; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement