CENTER TO ELIMINATE CARDIOVASCULAR HEALTH Volume 2, Issue 1 Spring 2012 The Center s Beat Walking the Walk: The ACT Study Plans for Intervention Sustainability The Center s Project 2 is excited to have an official name, The Achieving blood pressure Control Together (ACT) Study. This new name describes the core of the project: patients acting together with community health workers, clinicians, family, and the community to achieve blood pressure control. As the name suggests, our main study goal is to improve patient s blood pressure control. Patients at East Baltimore Medical Jessica Ameling, MPH Center () who participate will be randomized (put in a group by chance) to receive either usual care or at least one of the following interventions: 1. Community health worker support, a blood pressure cuff, and training to use the cuff 2. Communication with health care provider training 3. Problem solving peer group sessions The second study goal is intervention sustainability. If the intervention works and is cost effective, our goal is that it will stay in the clinic even after the study leaves. To make this a real possibility, we spent the last year talking and working with professionals, patients, and families from as well as with community members. We asked questions like: Patients: What helps you take care of your blood pressure? What gets in the way? Clinic Administrators: Would your clinic be willing to adopt this intervention, if it were feasible and effective? Healthcare Payers: What financial thresholds will this program need to meet to be integrated? This input greatly influenced the intervention and even changed our study design. For example, patients felt everyone with high blood pressure should receive a free blood pressure cuff. And clinic providers wanted to see patient s home blood pressure readings from these cuffs. We adapted to these concerns by obtaining electronic blood pressure cuffs to give patients which provide electronic reports for both patients and providers. Another example is that community members, clinic staff, and patients stressed the importance of helping patients access local resources to help with blood pressure control. In response, we developed a local resource guide as part of the community health worker intervention. Other feedback such as decreasing the amount of time clinic staff and patients will spend on study activities, integrating study with existing clinic programs, and developing consistent relationships with patients was suggested and integrated. Our next steps are to pilot test the revised intervention (April 2012), make any needed changes, and then launch the full intervention (September 2012 March 2014 ). Our hope is that by walking the walk we have improved both the intervention s effectiveness and potential sustainability. Inside this Issue: By Jessica Ameling, MPH Senior Research Program Coordinator, ACT Study Trainee & Community Perspectives 2 Community Celebration 3 Care Management Implementation 5 Research Timeline 6
Hopkins Center Celebrates the Heart of the Community On April 21st, the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities hosted Celebrate the Heart of the Community, a kick off event at Sojourner Douglass College in East Baltimore to create community awareness of the Center and to promote the importance of cardiovascular health. THE CENTER S BEAT Page 3
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Post-Doctoral Fellowship Tanyka Sam, MD, MPH Greetings! My name is Tanyka Sam and I am one of the center fellows. My broad research interest lies in how the physical and social environments that we live in affect our ability to manage our health. The physical environment refers to the actual characteristics of a setting, e.g., housing and services. The social environment, on the other hand, refers to the social settings that we live in and can include the culture we grew up in as well as the people we interact with. When people live in areas that are disinvested, which is the case for many African American and Hispanic populations across the United States, their neighborhoods may have limited resources from which people can avail themselves. Applying this to hypertension, we know that hypertension is a chronic medical condition on which lifestyle modifications such as physical activity and healthier food intake can have a positive impact. We also know that 82.5% of Baltimore City residents have hypertension, only 53% of people report meeting physical activity recommendations, and there is a 16 minute disparity ratio in supermarket access in neighborhoods with significant deprivation. How do we reconcile what we know has benefit with the circumstances that some of us may live in? Community health workers (CHWs) have been increasingly recommended for helping patients with chronic medical conditions navigate their environments and access resources because studies have shown improvement in such things as physical activity and dietary food intake. The literature is limited however in exploring the process of communication between CHWs and the clinical care team and the impact that CHW input has on the response of the clinical care team to identified social and physical environmental vulnerabilities. Through the ACT Study, a multilevel intervention to improve blood pressure control through hypertension self management, improved communication between providers and patients, and CHW assistance, my goal is to begin to shed light on these gaps in the literature using Tanyka Sam, MD, MPH primarily qualitative methods like in depth interviews coupled with CHW assessments of the social and physical environments of participants. My hope is that as we begin to understand how information is communicated about the environment to those involved in patient care, we can create ways to more systematically address and intervene on these issues and improve self management behaviors in hypertension and other chronic conditions. Postdoctoral Trainee, Tanyka Sam, MD, MPH is a GIM Fellow at the Welch Center. Dr. David Levine is her primary mentor The Importance of Community Participation in Research Barbara Bates-Hopkins Community Advisory Board Member As a native East Baltimorean, I find community participation in research to be both rewarding and essential. For me, when I participate on a community advisory board a culture is created that many times produces a bidirectional learning experience wherein the researchers learn from the community as the community learns from the research being shared. This co learning atmosphere enriches my ability to connect and engage the greater East Baltimore community in which I grew up with research and research findings. It is important to have a means for researchers to get research findings back to the greater community. Another way is the Day at the Market program which has been successful and extremely instrumental in this course of action. On the last Wednesday of each month, the Day at the Market program permits researchers and community members to come together in a public venue, the Northeast Market, to have informal conversations about current research studies. This program provides an excellent op VOLUME 2, ISSUE 1 portunity for the researchers to increase awareness, enhance recruitment and build trusting relationships. The Day at the Market program also offers health screenings, health education materials, community resources, and fresh fruit to the diverse population that filters through this public locale. This community centered Barbara Bates-Hopkins program was developed by the Center in Urban Environmental Health Community Outreach and Education Core under the leadership of Dr. Michael Trush. The Center seeks to establish partnerships with credible community agencies so as to create the opportunity to respond to specific concerns identified by community leaders and residents. To learn more about the Day at the Market Program, please contact me at 410 502 5651 or email bbatesho@jhsph.edu Page 2
Care Management Rolls out at Katie Dietz, MPH Research Program Manager (ReDCHiP) Project 1 is now Project ReDCHiP (Reducing Disparities & Controlling Hypertension in Primary care). Along with the new name, the Center is excited to announce that the Care Management intervention of ReDCHiP starts at in May! The Care Management intervention is the second of the three Project ReDCHiP interventions implemented at JHCP. The first intervention, the Blood Pressure Measurement, which placed automated BP devices in the 6 participating JHCP clinics, has been going strong for over a year thanks to your continued support and commitment to improving blood pressure readings! As part of the Care Management intervention, two Registered Dieticians (RDs), Emily Brown and Whitney Franz, and two pharmacists, Tricia Ross and Jessica Wellman, will be available in clinic to see patients with uncontrolled hypertension (BP over 140/90). The RDs will focus on lifestyle changes that may improve blood pressure control like following a DASH diet eating plan, increasing physical activity, and losing weight. The pharmacists will primarily target patients with blood pressure readings over 160/100, addressing challenges in adhering to prescribed blood pressure medications. Each patient participating in Project ReDCHiP care management will have the opportunity to attend 3 care management sessions, totaling 2 hours in time over the course of 3 months, at no additional cost to the patient. Patients are eligible to receive Project ReDCHiP Care Management services if they are 18 years of age or older and have a blood pressure reading over 140/90. Providers can refer patients that meet these eligibility criteria to the care managers for free services. Additionally, the Project ReDCHiP care managers will be reaching out by telephone to eligible patients to Katie Dietz, MPH offer care management services. The Care Management intervention starts at in May and follows a staggered roll out to all the participating JHCP clinics over the course of the next 3 years (please see the CM timeline). We have a great Care Management team that is eager to begin seeing JHCP patients. Please let our team know if you have any questions about Project RedCHiP s care management intervention. Welcome our Registered Dieticians to the Care Management Team As the Hopkins Center to Eliminate Cardiovascular Health Disparities prepares to roll out Care Management activities, we would like to welcome Emily Brown and Whitney Franz to our team. Emily and Whitney are registered dieticians (RDs) who will team up with pharmacists at the six JHCP clinics with which the Center is implementing Project ReDCHiP. The Center is extremely fortunate to have these two professionals join us in our quality improvement endeavors. Please help us welcome Emily and Whitney to our team. Emily Brown received her Master of Science in Human Nutrition from The Ohio State University. In 2010, Emily was awarded an NIH Dietetic Internship based in a 240 bed research hospital in Bethesda, MD. Emily s training and experience has focused on nutrition research and nutrition therapy. Additionally, Emily has developed a number of nutrition related patient education materials. Emily has authored five articles on various topics, including Low Histamine Diet and Hypomagnesemia. Emily Brown, MS, RD Whitney Franz comes to the Center from the University of North Carolina at Chapel Hill where she earned a Master in Public Health with a focus in Nutrition. While at UNC, she worked on the SEARCH for Diabetes in Youth research study. Whitney also provided medical nutrition therapy for in patients at an 800 bed facility in Chapel Hill with advanced placement in pediatrics. Whitney s expertise includes clinical nutrition management for adults and children. Whitney Franz, MPH, RD VOLUME 2, ISSUE 1 Page 5
CENTER TO ELIMINATE CARDIOVASCULAR HEALTH DISPARITIES Johns Hopkins School of Medicine 2024 E. Monument Street Suite 2-500 Baltimore, Maryland 21287 Phone: 410-614-2412 Fax: 410-614-0588 We are on the web! www.jhsph.edu/cardiodisparities Creating healthy hearts for all Baltimore residents. Center Core Faculty & Staff: Lisa A Cooper, MD, MPH Center Director; PI, Project ReDCHiP Jill Marsteller, PhD Co PI, Project ReDCHiP L. Ebony Boulware, MD, MPH PI, ACT Study Edgar Pete Miller, MD, PhD PI, Five Plus Nuts & Beans Study Sherita Hill Golden, MD, MHS Training Director Richard W. Matens, MDiv Administrative Director Kathryn Kit Carson, ScM Shared Resources Director Gary Noronha, MD Director of Research, JHCP Joy Mays Research Program Coordinator Center Research Timeline Legend: Clinical Sites: CC = = = Development Implementation Canton Crossing = East Baltimore Medical Center GD = GSS = WM = WP = = Pilot Greater Dundalk Green Spring Station White Marsh Wyman Park ReDCHiP BP Measurement Initiative ReDCHiP Provider Education Initiative ReDCHiP Care Management Initiative Achieving Blood Pressure Control Together Study 5 Plus Nuts & Beans Study CC,, GD, GSS, WM, WP WP GD, CC