title: The Role of Care Management as a Population Health Intervention to Address Disparities and Control Hypertension: A Quasi-Experimental Observational Study.
abstract: 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.
  
  
  
  Quasi-experimental, observational study.
  
  
  
  3,964 uncontrolled hypertensive patients receiving primary care within the last year from one of six Baltimore clinics were identified as eligible.
  
  
  
  Three in-person sessions over three months with registered dietitians and pharmacists who addressed medication titration, patient adherence to healthy behaviors and medication, and disparities-related barriers.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Medicine, University of Nebraska Medical Center; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities.
authors.forename: Tanvir
authors.initials: T
authors.lastname: Hussain
authors.affiliation: Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Johns Hopkins Healthcare.
authors.forename: Whitney
authors.initials: W
authors.lastname: Franz
authors.affiliation: Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Johns Hopkins Healthcare.
authors.forename: Emily
authors.initials: E
authors.lastname: Brown
authors.affiliation: Johns Hopkins Center to Eliminate Cardiovascular Health Disparities.
authors.forename: Athena
authors.initials: A
authors.lastname: Kan
authors.affiliation: Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Driscoll Children's Hospital, Texas A & M University.
authors.forename: Mekam
authors.initials: M
authors.lastname: Okoye
authors.affiliation: Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Medicine, Johns Hopkins University School of Medicine.
authors.forename: Katherine
authors.initials: K
authors.lastname: Dietz
authors.affiliation: Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Johns Hopkins Healthcare.
authors.forename: Kara
authors.initials: K
authors.lastname: Taylor
authors.affiliation: Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Department of Medicine, Johns Hopkins University School of Medicine.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Carson
authors.affiliation: Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Medicine, Johns Hopkins University School of Medicine.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Halbert
authors.affiliation: Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Medicine, Johns Hopkins University School of Medicine.
authors.forename: Arlene
authors.initials: A
authors.lastname: Dalcin
authors.affiliation: Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Family Medicine and Public Health, University of California San Diego.
authors.forename: Cheryl A M
authors.initials: CA
authors.lastname: Anderson
authors.affiliation: Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Medicine, Johns Hopkins University School of Medicine.
authors.forename: Romsai T
authors.initials: RT
authors.lastname: Boonyasai
authors.affiliation: Johns Hopkins Community Physicians.
authors.forename: Michael
authors.initials: M
authors.lastname: Albert
authors.affiliation: Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Marsteller
authors.affiliation: Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Department of Medicine, Johns Hopkins University School of Medicine; Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cooper
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015142:Baltimore; D044383:Black People; D001794:Blood Pressure; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D000075485:Population Health; D011320:Primary Health Care; D044465:White People; D001741:Black or African American
chemical_list: D000959:Antihypertensive Agents
keywords: Care Management; Disparities; Hypertension; Population Health; Primary Care; Quality Improvement