Improving Hypertension Control in Safety-Net Settings: The Boston Hypertension Equity Alliance in Treatment

A hybrid type 1 effectiveness-implementation study will be implemented to evaluate the comparative impact of each intervention on clinical outcomes while also assessing implementation at each site. The multi-site cluster randomized stepped-wedge design allows for feasible resource allocation and sequential roll out of the interventions for comparison, ensuring each site has the opportunity to benefit from both approaches. Data will be collected for multiple patient reported outcomes (PROs) to understand the range of impacts of the interventions from the patient perspective.

The specific aims are to:

* Assess comparative effectiveness of remote BP monitoring (RBPM) versus RBPM + multilevel intensification intervention (MII) on HTN control and quality of care. Prior research has demonstrated the effectiveness of each of these interventions yet the optimal approach to achieve equity in HTN control in safety net practices remains unknown. * Use mixed methods, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, to assess implementation of the two comparators as measured by reach, adoption, implementation (fidelity) and maintenance. Using a convergent parallel design, the investigators will use concurrent quantitative and qualitative data to obtain perspectives across multiple levels to understand the reasons for success or failure of implementation of each comparator. By merging these data, integration can be achieved by using qualitative themes related to implementation to support or refute quantitative findings of reach and fidelity. * Evaluate the comparative impacts of each intervention on PROs assessed with validated measures of patient activation, medication adherence, and trust in medical settings. The study intervention approaches were informed by direct feedback from the targeted diverse patients and clinical providers to address patient-reported barriers to HTN control: lack of activation, adherence to medications, and trust in their care providers.

• Blood pressure control [Срок оценки: Baseline, 18 months, 30 months, 36 months, 42 months, 54 months]
• Medication intensification [Срок оценки: Baseline, 18 months, 30 months, 36 months, 42 months, 54 months]
• BP monitoring [Срок оценки: Baseline, 18 months, 30 months, 36 months, 42 months, 54 months]
• Fidelity of interventions [Срок оценки: Baseline, 18 months, 30 months, 36 months, 42 months, 54 months]
• Medication adherence [Срок оценки: Baseline, 18 months, 30 months, 36 months, 42 months, 54 months]
• Trust in primary care [Срок оценки: Baseline, 18 months, 30 months, 36 months, 42 months, 54 months]