Planning grant for clinical trial of REACH-Hypertension curriculum for clinicians.

Hypertension is a leading cardiovascular disease risk factor in the US and a leading cause of stroke, kidney disease, and heart failure. It is more prevalent, severe, and uncontrolled in Black individuals, who have almost two-fold higher age-adjusted mortality for hypertension-related cardiovascular deaths. Clinician unconscious assumptions contribute to disparate health outcomes, including hypertension. Because hypertension is most often treated by primary care clinicians, this group is a high priority for intervention to mitigate impacts of unconscious assumptions. Therefore, to address disparate cardiovascular health outcomes, it is crucial to mitigate the impact of unconscious assumptions among primary care clinician providing hypertension care. We have developed and pilot-tested an evidence-based curriculum designed to teach practicing clinicians mitigation skills. Preliminary data in a group of non-primary care clinicians indicated that clinicians are motivated to address unconscious assumptions in health care, that the evidence-based curriculum is feasible and acceptable, and that clinician confidence in providing care increased. In order to proceed to a definitive clinical trial to test the hypothesis that the curriculum will increase use of mitigation skills by primary care clinicians and address disparate hypertension outcomes, further work is needed and will be accomplished in the proposed project. We will refine and standardize the curriculum, and additionally develop and standardize protocols for a) clinician enrollment and engagement; b) patient enrollment and engagement; c) implementation of patient-initiated audio-recording of clinical encounters; d) analysis of recorded encounters; e) extraction of blood pressure and other data from the EHR; and f) data management and analysis. We will pilot these protocols in two primary care clinics, enrolling 20 primary care clinicians and 100 patients. Outcomes will include an objective measure of mitigation skills immediately after completing intervention and EHR-generated assessment of hypertension control 3 and 6 months after intervention. In addition, we will obtain qualitative feedback from clinicians on study procedures, curriculum content/format, and ways to sustain learning. The proposed work is necessary and sufficient for the conduct of a subsequent full-scale randomized trial to test the hypothesis that the evidence-based curriculum will increase use of mitigation skills by clinicians and ensure that all patients have the same opportunities to fully pursue their goals for hypertension treatment and control.