Trial Outcomes & Findings for Reducing Inequities in Care of Hypertension, Lifestyle Improvement for Everyone (RICH LIFE Project) (NCT NCT02674464)

NCT ID: NCT02674464

Last Updated: 2022-07-01

Results Overview

Number of participants with Controlled Blood Pressure (\<140/90 mm Hg).

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

1820 participants

Primary outcome timeframe

12 months

Results posted on

2022-07-01

Participant Flow

Using eligibility criteria, the study biostatistician screened participating health systems' electronic medical record (EMR) data to identify potentially eligible patients. Only patients seen within 6 months prior to the recruitment data pull were assessed for eligibility. Trained study staff recruited participants between August 1, 2017, and October 31, 2019. The baseline blood pressure measurement was included in the recruitment data.

Participants were considered enrolled upon completing the baseline survey. Whenever possible, trained study staff administered the baseline survey immediately after obtaining consent to participate.

Unit of analysis: Clusters

Participant milestones

Participant milestones
Measure
Standard of Care Plus
Practices in the Standard of Care Plus (SCP) comparator group received interventions designed to reinforce and standardize evidence-based hypertension care best practices across both intervention and comparator practices. The "plus" in the standard care arm included integration of proper BP measurement techniques, hypertension care best practices, and audit and feedback of hypertension control performance, as "usual care" at each practice. Additionally, health-system- and practice-level leaders at SCP practices participated in a system-level leadership engagement intervention consisting of quarterly, one-hour calls.
Collaborative Care/Stepped Care (CC/SC)
The intensive Collaborative Care/Stepped Care (CC/SC) arm includes all components of the SCP arm and plus the establishment of a practice-based collaborative care team with a stepped-care approach; quarterly hypertension dashboard education and training; and twice quarterly "coaching calls" for system- and practice-level leaders, care managers (CM), and community health workers (CHWs) the CC/SC arm to discuss the interventions during their active intervention phase. In the CC/SC approach, treatment for patients with prolonged uncontrolled hypertension is enhanced by adding a care manager and a community health worker (CHW) to deliver community-based contextualized care, or consultation with a panel of sub-specialists, or both, as necessary, to improve patient-centered outcomes and reduce disparities in hypertension control.
Overall Study
STARTED
927 15
893 15
Overall Study
6 Month Follow-up
771 15
806 15
Overall Study
COMPLETED
790 15
733 15
Overall Study
NOT COMPLETED
137 0
160 0

Reasons for withdrawal

Reasons for withdrawal
Measure
Standard of Care Plus
Practices in the Standard of Care Plus (SCP) comparator group received interventions designed to reinforce and standardize evidence-based hypertension care best practices across both intervention and comparator practices. The "plus" in the standard care arm included integration of proper BP measurement techniques, hypertension care best practices, and audit and feedback of hypertension control performance, as "usual care" at each practice. Additionally, health-system- and practice-level leaders at SCP practices participated in a system-level leadership engagement intervention consisting of quarterly, one-hour calls.
Collaborative Care/Stepped Care (CC/SC)
The intensive Collaborative Care/Stepped Care (CC/SC) arm includes all components of the SCP arm and plus the establishment of a practice-based collaborative care team with a stepped-care approach; quarterly hypertension dashboard education and training; and twice quarterly "coaching calls" for system- and practice-level leaders, care managers (CM), and community health workers (CHWs) the CC/SC arm to discuss the interventions during their active intervention phase. In the CC/SC approach, treatment for patients with prolonged uncontrolled hypertension is enhanced by adding a care manager and a community health worker (CHW) to deliver community-based contextualized care, or consultation with a panel of sub-specialists, or both, as necessary, to improve patient-centered outcomes and reduce disparities in hypertension control.
Overall Study
Death
10
21
Overall Study
Withdrawal by Subject
24
44
Overall Study
Lost to Follow-up
97
92
Overall Study
Outside survey window
6
3

Baseline Characteristics

Reducing Inequities in Care of Hypertension, Lifestyle Improvement for Everyone (RICH LIFE Project)

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Standard of Care Plus (SCP)
n=927 Participants
Practices in the Standard of Care Plus (SCP) comparator group received interventions designed to reinforce and standardize evidence-based hypertension care best practices across both intervention and comparator practices. The "plus" in the standard care arm included integration of proper BP measurement techniques, hypertension care best practices, and audit and feedback of hypertension control performance, as "usual care" at each practice. Additionally, health-system- and practice-level leaders at SCP practices participated in a system-level leadership engagement intervention consisting of quarterly, one-hour calls.
Collaborative Care/Stepped Care (CC/SC)
n=893 Participants
The intensive Collaborative Care/Stepped Care (CC/SC) arm includes all components of the SCP arm and plus the establishment of a practice-based collaborative care team with a stepped-care approach; quarterly hypertension dashboard education and training; and twice quarterly "coaching calls" for system- and practice-level leaders, care managers (CM), and community health workers (CHWs) the CC/SC arm to discuss the interventions during their active intervention phase. In the CC/SC approach, treatment for patients with prolonged uncontrolled hypertension is enhanced by adding a care manager and a community health worker (CHW) to deliver community-based contextualized care, or consultation with a panel of sub-specialists, or both, as necessary, to improve patient-centered outcomes and reduce disparities in hypertension control.
Total
n=1820 Participants
Total of all reporting groups
Age, Continuous
60.7 years
STANDARD_DEVIATION 12.1 • n=5 Participants
59.9 years
STANDARD_DEVIATION 11.7 • n=7 Participants
60.3 years
STANDARD_DEVIATION 11.9 • n=5 Participants
Sex: Female, Male
Female
534 Participants
n=5 Participants
547 Participants
n=7 Participants
1081 Participants
n=5 Participants
Sex: Female, Male
Male
393 Participants
n=5 Participants
346 Participants
n=7 Participants
739 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
130 Participants
n=5 Participants
42 Participants
n=7 Participants
172 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
797 Participants
n=5 Participants
851 Participants
n=7 Participants
1648 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=5 Participants
4 Participants
n=7 Participants
4 Participants
n=5 Participants
Race (NIH/OMB)
Asian
1 Participants
n=5 Participants
0 Participants
n=7 Participants
1 Participants
n=5 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Black or African American
463 Participants
n=5 Participants
566 Participants
n=7 Participants
1029 Participants
n=5 Participants
Race (NIH/OMB)
White
359 Participants
n=5 Participants
279 Participants
n=7 Participants
638 Participants
n=5 Participants
Race (NIH/OMB)
More than one race
30 Participants
n=5 Participants
25 Participants
n=7 Participants
55 Participants
n=5 Participants
Race (NIH/OMB)
Unknown or Not Reported
74 Participants
n=5 Participants
19 Participants
n=7 Participants
93 Participants
n=5 Participants
Region of Enrollment
United States
927 Participants
n=5 Participants
893 Participants
n=7 Participants
1820 Participants
n=5 Participants
Education, highest degree
Less than high school diploma
156 Participants
n=5 Participants
177 Participants
n=7 Participants
333 Participants
n=5 Participants
Education, highest degree
High school diploma/GED
434 Participants
n=5 Participants
428 Participants
n=7 Participants
862 Participants
n=5 Participants
Education, highest degree
Some college
113 Participants
n=5 Participants
105 Participants
n=7 Participants
218 Participants
n=5 Participants
Education, highest degree
Bachelor's degree
115 Participants
n=5 Participants
103 Participants
n=7 Participants
218 Participants
n=5 Participants
Education, highest degree
Graduate degree
105 Participants
n=5 Participants
77 Participants
n=7 Participants
182 Participants
n=5 Participants
Education, highest degree
Missing (refused)
4 Participants
n=5 Participants
3 Participants
n=7 Participants
7 Participants
n=5 Participants
Medicaid
Yes
218 Participants
n=5 Participants
264 Participants
n=7 Participants
482 Participants
n=5 Participants
Medicaid
No
703 Participants
n=5 Participants
624 Participants
n=7 Participants
1327 Participants
n=5 Participants
Medicaid
Missing
6 Participants
n=5 Participants
5 Participants
n=7 Participants
11 Participants
n=5 Participants
Systolic Blood Pressure
151.9 mm Hg
STANDARD_DEVIATION 11.7 • n=5 Participants
152.7 mm Hg
STANDARD_DEVIATION 12.9 • n=7 Participants
152.3 mm Hg
STANDARD_DEVIATION 12.1 • n=5 Participants
Diastolic Blood Pressure
84.4 mm Hg
STANDARD_DEVIATION 11.7 • n=5 Participants
86.6 mm Hg
STANDARD_DEVIATION 12.9 • n=7 Participants
85.5 mm Hg
STANDARD_DEVIATION 12.3 • n=5 Participants
Diabetes
429 Participants
n=5 Participants
392 Participants
n=7 Participants
821 Participants
n=5 Participants
Hyperlipidemia
700 Participants
n=5 Participants
646 Participants
n=7 Participants
1346 Participants
n=5 Participants
Coronary heart disease
149 Participants
n=5 Participants
110 Participants
n=7 Participants
259 Participants
n=5 Participants
Depression
263 Participants
n=5 Participants
256 Participants
n=7 Participants
519 Participants
n=5 Participants
Smoker
267 Participants
n=5 Participants
280 Participants
n=7 Participants
547 Participants
n=5 Participants
Patient Activation Measure (PAM-13)
65.4 score on a scale
STANDARD_DEVIATION 16.2 • n=5 Participants
66.7 score on a scale
STANDARD_DEVIATION 15.9 • n=7 Participants
66.0 score on a scale
STANDARD_DEVIATION 16.1 • n=5 Participants

PRIMARY outcome

Timeframe: 12 months

Population: We received BP data on 750 patients in the SCP arm and on 754 patients in the CC/SC arm from EMR's.

Number of participants with Controlled Blood Pressure (\<140/90 mm Hg).

Outcome measures

Outcome measures
Measure
Standard of Care Plus (SCP)
n=750 Participants
Practices in the Standard of Care Plus (SCP) comparator group received interventions designed to reinforce and standardize evidence-based hypertension care best practices across both intervention and comparator practices. The "plus" in the standard care arm included integration of proper BP measurement techniques, hypertension care best practices, and audit and feedback of hypertension control performance, as "usual care" at each practice. Additionally, health-system- and practice-level leaders at SCP practices participated in a system-level leadership engagement intervention consisting of quarterly, one-hour calls.
Collaborative Care/Stepped Care (CC/SC)
n=754 Participants
The intensive Collaborative Care/Stepped Care (CC/SC) arm includes all components of the SCP arm and plus the establishment of a practice-based collaborative care team with a stepped-care approach; quarterly hypertension dashboard education and training; and twice quarterly "coaching calls" for system- and practice-level leaders, care managers (CM), and community health workers (CHWs) the CC/SC arm to discuss the interventions during their active intervention phase. In the CC/SC approach, treatment for patients with prolonged uncontrolled hypertension is enhanced by adding a care manager and a community health worker (CHW) to deliver community-based contextualized care, or consultation with a panel of sub-specialists, or both, as necessary, to improve patient-centered outcomes and reduce disparities in hypertension control.
Number of Participants With Controlled Blood Pressure
462 Participants
442 Participants

PRIMARY outcome

Timeframe: Baseline, 12 months

Population: 790 patients in the SCP arm completed the follow-up survey at 12-months, but 1 patient did not complete the PAM-13 (primary patient-reported outcome) questions in the survey resulting in 789 patients in the sample. 733 patients in the CC/SC arm competed the follow-up survey at 12-months, but 2 patients did not complete the PAM-13 (primary patient-reported outcome) questions in the survey resulting in 731 patients in the sample.

The Patient Activation Measure assesses knowledge, skills, and confidence in the management of one's health. It is comprised of 13 items and each item is on a 1-5 scale. Insignia health scores on a standardized overall score of 0-100 where higher scores indicate a better outcome.

Outcome measures

Outcome measures
Measure
Standard of Care Plus (SCP)
n=789 Participants
Practices in the Standard of Care Plus (SCP) comparator group received interventions designed to reinforce and standardize evidence-based hypertension care best practices across both intervention and comparator practices. The "plus" in the standard care arm included integration of proper BP measurement techniques, hypertension care best practices, and audit and feedback of hypertension control performance, as "usual care" at each practice. Additionally, health-system- and practice-level leaders at SCP practices participated in a system-level leadership engagement intervention consisting of quarterly, one-hour calls.
Collaborative Care/Stepped Care (CC/SC)
n=731 Participants
The intensive Collaborative Care/Stepped Care (CC/SC) arm includes all components of the SCP arm and plus the establishment of a practice-based collaborative care team with a stepped-care approach; quarterly hypertension dashboard education and training; and twice quarterly "coaching calls" for system- and practice-level leaders, care managers (CM), and community health workers (CHWs) the CC/SC arm to discuss the interventions during their active intervention phase. In the CC/SC approach, treatment for patients with prolonged uncontrolled hypertension is enhanced by adding a care manager and a community health worker (CHW) to deliver community-based contextualized care, or consultation with a panel of sub-specialists, or both, as necessary, to improve patient-centered outcomes and reduce disparities in hypertension control.
Patient Activation Measure (PAM-13)
Baseline
65.4 score on a scale
Interval 63.4 to 67.4
66.1 score on a scale
Interval 64.6 to 68.7
Patient Activation Measure (PAM-13)
12 months
66.7 score on a scale
Interval 64.6 to 68.7
67.9 score on a scale
Interval 65.8 to 70.0

SECONDARY outcome

Timeframe: Baseline, 12 months

Population: We received BP data on 750 patients in the SCP arm and on 754 patients in the CC/SC arm from EMR's.

Mean Systolic Blood Pressure in mm Hg at baseline and 12 months.

Outcome measures

Outcome measures
Measure
Standard of Care Plus (SCP)
n=750 Participants
Practices in the Standard of Care Plus (SCP) comparator group received interventions designed to reinforce and standardize evidence-based hypertension care best practices across both intervention and comparator practices. The "plus" in the standard care arm included integration of proper BP measurement techniques, hypertension care best practices, and audit and feedback of hypertension control performance, as "usual care" at each practice. Additionally, health-system- and practice-level leaders at SCP practices participated in a system-level leadership engagement intervention consisting of quarterly, one-hour calls.
Collaborative Care/Stepped Care (CC/SC)
n=754 Participants
The intensive Collaborative Care/Stepped Care (CC/SC) arm includes all components of the SCP arm and plus the establishment of a practice-based collaborative care team with a stepped-care approach; quarterly hypertension dashboard education and training; and twice quarterly "coaching calls" for system- and practice-level leaders, care managers (CM), and community health workers (CHWs) the CC/SC arm to discuss the interventions during their active intervention phase. In the CC/SC approach, treatment for patients with prolonged uncontrolled hypertension is enhanced by adding a care manager and a community health worker (CHW) to deliver community-based contextualized care, or consultation with a panel of sub-specialists, or both, as necessary, to improve patient-centered outcomes and reduce disparities in hypertension control.
Mean Systolic Blood Pressure
Baseline
151.8 mm Hg
Interval 150.3 to 153.3
152.5 mm Hg
Interval 151.0 to 154.0
Mean Systolic Blood Pressure
12 months
137.1 mm Hg
Interval 135.5 to 138.7
138.7 mm Hg
Interval 137.1 to 140.2

SECONDARY outcome

Timeframe: Baseline, 12 months

Population: We received BP data on 750 patients in the SCP arm and on 754 patients in the CC/SC arm from EMR's.

Mean Diastolic Blood Pressure in mm Hg at baseline and 12 months.

Outcome measures

Outcome measures
Measure
Standard of Care Plus (SCP)
n=750 Participants
Practices in the Standard of Care Plus (SCP) comparator group received interventions designed to reinforce and standardize evidence-based hypertension care best practices across both intervention and comparator practices. The "plus" in the standard care arm included integration of proper BP measurement techniques, hypertension care best practices, and audit and feedback of hypertension control performance, as "usual care" at each practice. Additionally, health-system- and practice-level leaders at SCP practices participated in a system-level leadership engagement intervention consisting of quarterly, one-hour calls.
Collaborative Care/Stepped Care (CC/SC)
n=754 Participants
The intensive Collaborative Care/Stepped Care (CC/SC) arm includes all components of the SCP arm and plus the establishment of a practice-based collaborative care team with a stepped-care approach; quarterly hypertension dashboard education and training; and twice quarterly "coaching calls" for system- and practice-level leaders, care managers (CM), and community health workers (CHWs) the CC/SC arm to discuss the interventions during their active intervention phase. In the CC/SC approach, treatment for patients with prolonged uncontrolled hypertension is enhanced by adding a care manager and a community health worker (CHW) to deliver community-based contextualized care, or consultation with a panel of sub-specialists, or both, as necessary, to improve patient-centered outcomes and reduce disparities in hypertension control.
Mean Diastolic Blood Pressure
Baseline
84.7 mm Hg
Interval 82.8 to 86.5
86.7 mm Hg
Interval 84.9 to 88.6
Mean Diastolic Blood Pressure
12 months
78.9 mm Hg
Interval 77.1 to 80.8
79.8 mm Hg
Interval 77.9 to 81.7

SECONDARY outcome

Timeframe: Baseline, 12, 24 months

Clinical Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: Baseline, 12, 24 months

Clinical Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: Baseline, 12, 24 months

Clinical Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: Baseline, 12, 24 months

Clinical Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: Baseline

Clinical Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: 12 months

Clinical Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: 24 months

Clinical Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: Baseline, 12, 24 months

Clinical Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: Baseline

Clinical Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: 12 months

Clinical Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: 24 months

Clinical Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: Baseline, 12, 24 months

Patient Reported Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: 24 months

Clinical Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: 12 months

Clinical Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: 24 months

Clinical Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: 12 months

Clinical Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: 24 months

Clinical Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: Baseline, 12, 24 months

Patient Reported Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: Baseline 12, 24 months

Patient Reported Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: Baseline, 12, 24 months

Patient Reported Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: Baseline, 12, 24 months

Patient Reported Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: Baseline, 12, 24 months

Patient Reported Outcome

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: Baseline, 12, 24 months

Patient Reported Outcome

Outcome measures

Outcome data not reported

Adverse Events

Standard of Care Plus (SCP)

Serious events: 0 serious events
Other events: 515 other events
Deaths: 21 deaths

Collaborative Care/Stepped Care (CC/SC)

Serious events: 0 serious events
Other events: 499 other events
Deaths: 34 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Other adverse events
Measure
Standard of Care Plus (SCP)
n=927 participants at risk
Practices in the Standard of Care Plus (SCP) comparator group received interventions designed to reinforce and standardize evidence-based hypertension care best practices across both intervention and comparator practices. The "plus" in the standard care arm included integration of proper BP measurement techniques, hypertension care best practices, and audit and feedback of hypertension control performance, as "usual care" at each practice. Additionally, health-system- and practice-level leaders at SCP practices participated in a system-level leadership engagement intervention consisting of quarterly, one-hour calls.
Collaborative Care/Stepped Care (CC/SC)
n=893 participants at risk
The intensive Collaborative Care/Stepped Care (CC/SC) arm includes all components of the SCP arm and plus the establishment of a practice-based collaborative care team with a stepped-care approach; quarterly hypertension dashboard education and training; and twice quarterly "coaching calls" for system- and practice-level leaders, care managers (CM), and community health workers (CHWs) the CC/SC arm to discuss the interventions during their active intervention phase. In the CC/SC approach, treatment for patients with prolonged uncontrolled hypertension is enhanced by adding a care manager and a community health worker (CHW) to deliver community-based contextualized care, or consultation with a panel of sub-specialists, or both, as necessary, to improve patient-centered outcomes and reduce disparities in hypertension control.
Cardiac disorders
Self-reported stroke
2.5%
22/875 • Adverse events data were collected up to 1 year.
2.9%
24/835 • Adverse events data were collected up to 1 year.
Cardiac disorders
Myocardial infarction
1.0%
9/875 • Adverse events data were collected up to 1 year.
2.3%
19/835 • Adverse events data were collected up to 1 year.
General disorders
Fall precipitating medical treatment
9.6%
84/875 • Adverse events data were collected up to 1 year.
9.8%
82/835 • Adverse events data were collected up to 1 year.
General disorders
Hospitalizations
25.9%
227/875 • Adverse events data were collected up to 1 year.
25.4%
212/835 • Adverse events data were collected up to 1 year.
Cardiac disorders
Hypotension
22.6%
197/873 • Adverse events data were collected up to 1 year.
22.1%
186/842 • Adverse events data were collected up to 1 year.
Cardiac disorders
Hypertension
16.8%
147/873 • Adverse events data were collected up to 1 year.
17.8%
150/842 • Adverse events data were collected up to 1 year.
Cardiac disorders
Bradycardia
0.34%
3/873 • Adverse events data were collected up to 1 year.
0.00%
0/842 • Adverse events data were collected up to 1 year.
General disorders
Hyponatremia
0.65%
6/927 • Adverse events data were collected up to 1 year.
1.3%
12/893 • Adverse events data were collected up to 1 year.
General disorders
Hypernatremia
0.11%
1/927 • Adverse events data were collected up to 1 year.
0.22%
2/893 • Adverse events data were collected up to 1 year.
General disorders
Hypokalemia
0.65%
6/927 • Adverse events data were collected up to 1 year.
0.90%
8/893 • Adverse events data were collected up to 1 year.
General disorders
Hyperkalemia
2.3%
21/927 • Adverse events data were collected up to 1 year.
3.2%
29/893 • Adverse events data were collected up to 1 year.
Renal and urinary disorders
Serum creatinine increase by at least 50% since previous measure
0.97%
9/927 • Adverse events data were collected up to 1 year.
1.7%
15/893 • Adverse events data were collected up to 1 year.

Additional Information

Dr. Lisa Cooper, Principal Investigator

Johns Hopkins University School of Medicine

Phone: 4106143659

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place