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 Natalie Spicyn, MD, MHS Chidinma A. Ibe, PhD Associate Director, Stakeholder Engagement Chief of Adult Medicine, Johns Hopkins Center for Health Equity Park West Health System @JHhealthequity @nataliespicyn November 1, 2018 #PCORI2018

Disclosures • Neither Chidinma Ibe nor Natalie Spicyn have any conflicts of interest to disclose. 2 • November 21, 2018

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 3 • November 21, 2018

Reducing Inequities in Care of Hypertension: Lifestyle Improvement For Everyone 4 • November 21, 2018

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 5 • November 21, 2018

Health System Partners 6 • November 21, 2018

Multi-tiered Stakeholder Engagement Approach PCOR PRINCIPLES STAKEHOLDER ENGAGEMENT ACTIVITIES Reciprocal • The Center’s Community Advisory Board (CAB) is co-led by a patient with Relationships hypertension and leader of a local community-based organization and one of 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. 7 • November 21, 2018

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. 8 • November 21, 2018

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 9 • November 21, 2018

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 10 • November 21, 2018

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 11 • November 21, 2018

Barriers and Facilitators to Engagement Competing health system Health system leadership Difficulties with intervention priorities and limited and staff turnover uptake at RICH LIFE practices resources Conduct frequent meetings • Leverage recurring meetings Engage with multiple leaders • • with individual health system (HELN sessions, coaching at each health system to leaders, providers, MAs, and calls, and CAB meetings) to minimize effect of turnover RICH LIFE frontline staff to maximize time available to on RICH LIFE Study and its review study features, address issues as they occur patients reinforce protocol and Maintain flexibility with Maintain frequent • • address implementation schedules to be available to engagement with health barriers address questions and system leaders and frontline Produce and disseminate • concerns as quickly as staff, to stay abreast of short, easy-to-read materials possible potential staff changes about the study 12 • November 21, 2018

Impact of Health System Leadership Engagement on the RICH LIFE Study • Participated in the development of CM & CHW job descriptions Staffing Model • Recommended modifying the collaborative care team from requiring multiple health professionals to a simplified version of a PCP + RN CM + CHW team Clinical Workflows • Determined patient intake process for CM & CHW appointments & Documentation • Set requirements for CM & CHW documentation of RICH LIFE activities for the health system • Provided guidance on selecting practices for inclusion in the study based on patients’ sociodemographic Practice attributes and the study’s goals Recruitment • Shared insights on practices unsuitable for inclusion due to unique practice challenges or flux in staffing Framing of the CHW • Identified RN CM perceptions that RNs could address social determinants of health and may be “Stepped-Care” reluctant to “step-up” to a CHW Intervention • Identified CHWs’ need for more training on how to support patients’ health related goals 13 • November 21, 2018

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 14 • November 21, 2018

Learn More • www.pcori.org • info@pcori.org • #PCORI2018 • http://www.healthequityhub.com • http://www.parkwestmed.org 15 • November 21, 2018

Thank You! Chidinma Ibe, PhD Natalie Spicyn, MD, MHS Assistant Professor of Medicine Chief of Adult Medicine Johns Hopkins University School of Medicine Park West Health System @nataliespicyn Associate Director, Stakeholder Engagement Johns Hopkins Center for Health Equity @JHhealthequity 16 • November 21, 2018