title: A multicomponent quality improvement intervention to improve blood pressure and reduce racial disparities in rural primary care practices.
abstract: The Southeastern United States has the highest prevalence of hypertension and African Americans have disproportionately worse blood pressure control. The authors sought to evaluate the effect of a multicomponent practice-based quality improvement intervention on lowering mean systolic blood pressure (SBP) at 12 and 24 months compared with baseline among 525 patients, and to assess for a differential effect of the intervention by race (African Americans vs white). At 12 months, both African Americans (-5.0 mm Hg) and whites (-7.8 mm Hg) had a significant decrease in mean SBP compared with baseline, with no significant between-group difference. Similarly, at 24 months, mean SBP decreased in both African Americans (-6.0 mm Hg) and whites (-7.2 mm Hg), with no significant difference between groups. Notably, no significant racial disparity in mean SBP at baseline was shown. The intervention was effective in lowering mean SBP in both African Americans and whites but there was no differential effect of the intervention by race.
authors.affiliation: Department of Medicine, UNC Chapel Hill, Chapel Hill, NC, USA.|Cecil R. Sheps Center for Health Services Research, UNC Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Crystal W
authors.initials: CW
authors.lastname: Cené
authors.affiliation: Department of Family Medicine, UNC Chapel Hill, Chapel Hill, NC, USA.|Cecil R. Sheps Center for Health Services Research, UNC Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Jacqueline R
authors.initials: JR
authors.lastname: Halladay
authors.affiliation: Center for Health Promotion and Disease Prevention, UNC Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Ziya
authors.initials: Z
authors.lastname: Gizlice
authors.affiliation: Department of Family Medicine, UNC Chapel Hill, Chapel Hill, NC, USA.|Cecil R. Sheps Center for Health Services Research, UNC Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Katrina E
authors.initials: KE
authors.lastname: Donahue
authors.affiliation: Department of Family Medicine, East Carolina University, Greenville, NC, USA.
authors.forename: Doyle M
authors.initials: DM
authors.lastname: Cummings
authors.affiliation: Department of Medicine, UNC Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Hinderliter
authors.affiliation: Center for Health Promotion and Disease Prevention, UNC Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Miller
authors.affiliation: Center for Health Promotion and Disease Prevention, UNC Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Larry F
authors.initials: LF
authors.lastname: Johnson
authors.affiliation: Center for Health Promotion and Disease Prevention, UNC Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Beverly
authors.initials: B
authors.lastname: Garcia
authors.affiliation: Community Care Plan of Eastern North Carolina, Kinston, NC, USA.
authors.forename: Jim
authors.initials: J
authors.lastname: Tillman
authors.affiliation: Pink Hill Medicine Center, Pink Hill, NC, USA.
authors.forename: Edwin P
authors.initials: EP
authors.lastname: Little
authors.affiliation: The Clinic at Walgreens, Atlanta, GA, USA.
authors.forename: Marjorie R
authors.initials: MR
authors.lastname: Rachide
authors.affiliation: Department of Medicine, UNC Chapel Hill, Chapel Hill, NC, USA.|Center for Health Promotion and Disease Prevention, UNC Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Keyserling
authors.affiliation: Center for Health Promotion and Disease Prevention, UNC Chapel Hill, Chapel Hill, NC, USA.|Department of Nutrition, Gillings School of Global Public Health, Chapel Hill, NC, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Ammerman
authors.affiliation: Department of Biostatistics, UNC Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Haibo
authors.initials: H
authors.lastname: Zhou
authors.affiliation: School of Nursing, UNC Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Jia-Rong
authors.initials: JR
authors.lastname: Wu
authors.affiliation: Department of Medicine, UNC Chapel Hill, Chapel Hill, NC, USA.|Cecil R. Sheps Center for Health Services Research, UNC Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Darren
authors.initials: D
authors.lastname: DeWalt
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D011446:Prospective Studies; D058996:Quality Improvement; D063505:Racism / Q000208:ethnology*; D012424:Rural Population; D014481:United States / Q000208:ethnology; D044465:White People; D055815:Young Adult
keywords: Southeastern United States; disparities; hypertension; quality improvement; race/ethnicity