Comparing Ways to Reduce High Blood Pressure in People from - - PowerPoint PPT Presentation

Comparing Ways to Reduce High Blood Pressure in People from Different Backgrounds: The RICH LIFE Project

Chidinma A. Ibe, PhD

Associate Director, Stakeholder Engagement Johns Hopkins Center for Health Equity @JHhealthequity

November 1, 2018

Natalie Spicyn, MD, MHS

Chief of Adult Medicine, Park West Health System @nataliespicyn

#PCORI2018

2 • November 21, 2018

Disclosures

• Neither Chidinma Ibe nor Natalie Spicyn have any conflicts of

interest to disclose.

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Objectives

At the conclusion of this activity, the participant should be able to:

• Summarize the core components of the RICH LIFE Study’s

interventions

• Describe participatory approaches to engage health leaders and

frontline staff

• Identify best practices associated with multilevel stakeholder

engagement

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Reducing Inequities in Care of Hypertension: Lifestyle Improvement For Everyone

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Overview of the RICH LIFE Study

• Design: Cluster randomized trial
• Setting: 30 primary care practices in Maryland and Pennsylvania
• Participants: 1,890 patients (63 per site)
• Interventions:
• Collaborative Care/Stepped Care (CC/Stepped Care)
• Standard of Care Plus (SCP)
• Main Outcomes (analyzed at patient level; subgroup analyses by race and

ethnicity):

• Biomedical outcomes: BP control (<140/90 mm Hg) and average systolic BP at 12

months

• Patient reported outcomes: Patient activation; health related quality of life, chronic

disease self-management behaviors; attainment of goals; and experiences of care

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Health System Partners

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Multi-tiered Stakeholder Engagement Approach

PCOR PRINCIPLES STAKEHOLDER ENGAGEMENT ACTIVITIES Reciprocal Relationships

• The Center’s Community Advisory Board (CAB) is co-led by a patient with

hypertension and leader of a local community-based organization and one

• f the RICH LIFE study’s Co-Principal Investigators
• System, administrative, and practice champions attend RICH LIFE meetings

and actively participate in CAB meetings, Health Equity Learning Network (HELN) sessions, and coaching calls. Co-Learning

• Health system, administrative, and practice champions co-present Health

Equity Learning Network (HELN) sessions.

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Multi-tiered Stakeholder Engagement Approach

PCOR PRINCIPLES STAKEHOLDER ENGAGEMENT ACTIVITIES Partnerships

• RICH LIFE Study personnel are in constant communication (via phone calls,

face-to-face meetings, and emails) with health system, administrative, and practice champions, as well as RICH LIFE frontline staff, to collaboratively identify and address implementation issues as they emerge. Transparency

• Research study team meetings are open to involvement from all CAB

members, including health system leaders, patients, and RICH LIFE frontline staff

• CAB meetings, HELN sessions, and coaching calls provide opportunities for

study updates and stakeholder feedback on implementation.

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Engaging RICH LIFE’s Health System Leaders

• Meetings and telephone calls with key stakeholders at each system
• Health Equity Learning Network
• Quarterly webinars featuring brief didactic, interactive exercises and

discussions on broad topic areas such as:

• Deciphering Health Disparities and Health Equity
• Situational Leadership
• Psychological Safety
• Integrating Health Equity in the Culture of Health.
• Ongoing Leadership Collaborative Learning Network (Coaching Calls)
• Monthly conference calls with system leaders, RICH LIFE practice champions,

and RICH LIFE frontline staff to collaboratively address emerging implementation issues

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Partnership with Park West: Rationale for Involvement

• Concern around hypertension outcomes among Park West’s

patients

• Interest in supporting creation of new knowledge
• Desire to receive additional support (hiring a Care Manager and a

Community Health Worker) to enhance institutional capacity

• Aspirations to use learnings from the RICH LIFE Project to

successfully appeal for additional resources for similar patients

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Partnership with Park West: Challenges and Successes

• Challenges:
• Convincing the Board of Directors of an FQHC to get

involved with the study

• Level of compensation not commensurate with

considerable time commitment

• Fragmenting care by disease process due to nature of

the study

• Successes
• Overall level of staff education provided
• Additional services available to patients in the

collaborative care sites

• IT capabilities enhanced through dashboard

development process

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Barriers and Facilitators to Engagement

Competing health system priorities and limited resources

• Leverage recurring meetings

(HELN sessions, coaching calls, and CAB meetings) to maximize time available to address issues as they occur

• Maintain flexibility with

schedules to be available to address questions and concerns as quickly as possible

Health system leadership and staff turnover

• Engage with multiple leaders

at each health system to minimize effect of turnover

• n RICH LIFE Study and its

patients

• Maintain frequent

engagement with health system leaders and frontline staff, to stay abreast of potential staff changes

Difficulties with intervention uptake at RICH LIFE practices

• Conduct frequent meetings

with individual health system leaders, providers, MAs, and RICH LIFE frontline staff to review study features, reinforce protocol and address implementation barriers

• Produce and disseminate

short, easy-to-read materials about the study

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Impact of Health System Leadership Engagement on the RICH LIFE Study

Staffing Model

• Participated in the development of CM & CHW job descriptions
• Recommended modifying the collaborative care team from requiring multiple health professionals to a

simplified version of a PCP + RN CM + CHW team

Clinical Workflows & Documentation

• Determined patient intake process for CM & CHW appointments
• Set requirements for CM & CHW documentation of RICH LIFE activities for the health system

Practice Recruitment

• Provided guidance on selecting practices for inclusion in the study based on patients’ sociodemographic

attributes and the study’s goals

• Shared insights on practices unsuitable for inclusion due to unique practice challenges or flux in staffing

Framing of the CHW “Stepped-Care” Intervention

• Identified RN CM perceptions that RNs could address social determinants of health and may be

reluctant to “step-up” to a CHW

• Identified CHWs’ need for more training on how to support patients’ health related goals

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Acknowledgements

• Lisa A. Cooper, MD, MPH, Co-Principal Investigator, RICH LIFE Study
• Jill Marsteller, PhD, MPP, Co-Principal Investigator, RICH LIFE Study
• Katie Dietz, MPH, Senior Research Program Manager, RICH LIFE Study
• Lawrence Johnson, MD, Chief Medical Officer, Park West Health

System

• This research is supported by a grant from Patient-Centered

Outcomes Research Institute and the National Heart, Lung, and Blood Institute: UH3HL130688.

• Clinicaltrials.gov Registration: NCT02674464

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Learn More

• www.pcori.org
• info@pcori.org
• #PCORI2018
• http://www.healthequityhub.com
• http://www.parkwestmed.org

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Thank You!

Assistant Professor of Medicine Johns Hopkins University School of Medicine Associate Director, Stakeholder Engagement Johns Hopkins Center for Health Equity @JHhealthequity

Chidinma Ibe, PhD Natalie Spicyn, MD, MHS

Chief of Adult Medicine Park West Health System @nataliespicyn