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Thomas KL, Shah BR, Elliot-Bynum S, Thomas KD, Damon K, Allen LaPointe NM, Calhoun S, Thomas L, Breathett K, Mathews R, Anderson M, Califf RM, Peterson ED. Check it, change it: a community-based, multifaceted intervention to improve blood pressure control. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES 2014; 7:828-34. [PMID: 25351480 DOI: 10.1161/circoutcomes.114.001039] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although home blood pressure (BP) monitoring interventions have shown potential in selected populations, it is unclear whether such strategies can be generalized. We sought to determine whether a multifaceted BP control program that uses a web-based health portal (Heart360), community health coaches, and physician assistant guidance could improve hypertension control in a diverse community setting. METHODS AND RESULTS Between September 12, 2010, and November 11, 2011 Check It, Change It, a community-based hypertension quality improvement program, enrolled 1756 patients with hypertension from 8 clinics in Durham County, NC. The Check It, Change It community intervention was evaluated using a prepost study design without a concurrent control. Participants were stratified into 3 tiers according to their initial BP: tier 0 (BP <140/90 mm Hg)=51% of population, tier 1 (BP=140/90-159/99 mm Hg)=30% of total, and tier 2 (BP ≥159/99 mm Hg)=19% of total. Overall, median age was 59 years (interquartile range, 49-69), 67% were female, and 76% black. After 6 months, the mean overall systolic BP declined 4.7 mm Hg. Rates of achieving target BP control (<140/90) increased overall from 51% at baseline to 63% by 6 months, and 69% had either reached their BP target or had reduced their baseline systolic BP by 10 mm Hg or more. CONCLUSIONS A multicomponent-tiered hypertension program was associated with improved BP control in a diverse community-based population.
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Affiliation(s)
- Kevin L Thomas
- From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.).
| | - Bimal R Shah
- From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.)
| | - Sharon Elliot-Bynum
- From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.)
| | - Kristin D Thomas
- From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.)
| | - Katrina Damon
- From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.)
| | - Nancy M Allen LaPointe
- From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.)
| | - Sarah Calhoun
- From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.)
| | - Laine Thomas
- From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.)
| | - Khadijah Breathett
- From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.)
| | - Robin Mathews
- From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.)
| | - Monique Anderson
- From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.)
| | - Robert M Califf
- From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.)
| | - Eric D Peterson
- From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.)
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