Implementation of Intensive Hypertension Management Approaches: Cleveland Clinic

Primary care providers will offer the program to patients in Northeast Ohio with a hypertension diagnosis and aged 18-85, except those who are pregnant, have stage 5 chronic kidney disease or end stage renal disease, or enrolled in hospice care. The project time frame is 48 months. Quantitative and qualitative methods will be used to evaluate implementation and effectiveness outcomes associated with the program. Electronic medical records and surveys will be the key data sources for the quantitative evaluation. Qualitative data collection methods will include semi-structured interviews, field observations, and periodic reflections.

Specific Aims Aim 1. To prepare for implementation of the intensive HTN management program across all Northeast Ohio Primary Care Practices (Pre-Implementation) Pre-Implementation Phase (12 months)

* Quantitative assessment of practice variation in HTN control. * Qualitative assessment of practice barriers and facilitators to HTN management. * Creation of a clinical decision support tool for program referral. * Creation of project-specific patient and employee Advisory Panel. * Pharmacist and advanced practice provider (APP) training for delivery of the program. * Practice facilitation training with the Cleveland Clinic continuous improvement team. * Community Health Worker/Primary Care Navigator Training for Patient Outreach. * Creation of presentations for primary care staff meetings. Aim 2. To implement the intensive HTN management program across all Northeast Ohio Primary Care Practices (Rollout and Active Implementation) Implementation Phase (24 months) * Stepped wedge rollout of intensive HTN management program. * Implementation of the clinical decision support tool at implementation sites. * Community Health Worker/Primary Care Navigator outreach to patients. * Delivery of Presentations at primary care staff meetings. * Practice Facilitation at Implementation Sites. * Qualitative data collection regarding patient and provider implementation outcomes of acceptability and feasibility. * Quantitative data collection of implementation outcomes of adoption, fidelity, effectiveness, implementation cost; provider surveys re: acceptability, appropriateness, feasibility. * Patient and employee advisory panel input into implementation evaluation. Aim 3. To monitor and evaluate the maintenance of the intensive HTN management program across all Northeast Ohio Primary Care Practices (Maintenance) Maintenance Phase (9 months) * Quantitative data collection of implementation outcomes-reach, adoption, fidelity, effectiveness, cost-compared to the active implementation phase. * Capture practice-level adaptations with comparison to the active implementation phase. * Complete final data collection and analyses.

• Diastolic Blood Pressure Change [Срок оценки: The patient's blood pressure will be measured for up to 33 months (24-month implementation/intervention period and 9-month maintenance period). Every 2-3 weeks during intervention, at 12 months, then every 6 months through maintenance.]
• Reach (Actual): Patients Offered, Initiated, Completed [Срок оценки: Measured every 3 months for up to 33 months.]
• Effectiveness: Equity in Outcomes (Race) [Срок оценки: Every 2-3 weeks during intervention, at 12 months, then every 6 months through maintenance: for up to 33 months.]
• Effectiveness: Equity in Outcomes (Ethnicity) [Срок оценки: Every 2-3 weeks during intervention, at 12 months, then every 6 months through maintenance: for up to 33 months.]
• Effectiveness: Equity in Outcomes (Gender) [Срок оценки: Every 2-3 weeks during intervention, at 12 months, then every 6 months through maintenance: for up to 33 months.]
• Effectiveness: Equity in Outcomes (Age) [Срок оценки: Every 2-3 weeks during intervention, at 12 months, then every 6 months through maintenance: for up to 33 months.]
• Effectiveness: Equity in Outcomes (Insurance) [Срок оценки: Every 2-3 weeks during intervention, at 12 months, then every 6 months through maintenance: for up to 33 months.]
• Effectiveness: Medication change [Срок оценки: Every 2-3 weeks during intervention then every 6 months through maintenance: for up to 33 months.]
• Effectiveness: Medication Adherence [Срок оценки: Every 2-3 weeks during intervention then every 6 months through maintenance: for up to 33 months.]
• Effectiveness: Cardiovascular outcomes [Срок оценки: Baseline, and every 6 months through maintenance: for up to 33 months.]
• Effectiveness: Acute Renal Failure - Change in glomerular filtration rate (GFR). [Срок оценки: Every 6 months through maintenance: for up to 33 months.]
• Effectiveness: PROMIS-10 Survey [Срок оценки: Baseline at intake visit then at 12 months: up to 24-months.]