Trial Outcomes & Findings for Reach Out: Emergency Department-Initiated Hypertension Behavioral Intervention Connecting Multiple Health Systems (NCT NCT03422718)

NCT ID: NCT03422718

Last Updated: 2024-06-20

Results Overview

Change in 12-month Systolic Blood Pressure (SBP)

Recruitment status

COMPLETED

Study phase

Target enrollment

488 participants

Primary outcome timeframe

12 months

Results posted on

2024-06-20

Participant Flow

This trial was conducted in Flint, Michigan, an urban, low-income, predominately Black community. Participants were recruited from the city's only safety-net ED (i.e., hospitals where over 25% of patients are Medicaid recipients). Enrollment occurred between March 2019 and March 2020.

Participants entered a run-in phase of 3 weeks to determine whether a participant had persistently elevated BP. During this time, participants were prompted to text their BP once per week to the study team. Participants responding at least once and with at least one systolic BP ≥ 140 or a diastolic BP ≥ 90 were randomized.

Participant milestones

Participant milestones
Measure	Arm 1 No healthy behavior texts BP Monitoring Weekly Via Text Messaging No physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 2 Healthy Behavior Texts BP Monitoring Weekly Via Text Messaging No physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 3 No healthy behavior texts BP Monitoring Daily Via Text Messaging No physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 4 Healthy Behavior Texts BP Monitoring Daily Via Text Messaging No physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 5 No healthy behavior texts BP Monitoring Weekly Via Text Messaging Physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments	Arm 6 Healthy Behavior Texts BP Monitoring Weekly Via Text Messaging Physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments	Arm 7 No healthy behavior texts BP Monitoring Daily Via Text Messaging Physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments	Arm 8 Healthy Behavior Texts BP Monitoring Daily Via Text Messaging Physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments
12 Month Interventional Trial Period STARTED	62	60	63	61	58	61	64	59
12 Month Interventional Trial Period 6 Month Outcome	26	35	30	29	31	32	29	28
12 Month Interventional Trial Period COMPLETED	25	31	25	22	30	31	24	23
12 Month Interventional Trial Period NOT COMPLETED	37	29	38	39	28	30	40	36
Optional Six Month Follow-Up Period STARTED	25	31	25	22	30	31	24	23
Optional Six Month Follow-Up Period Opted in to Optional Follow Up Phase	17	20	9	8	13	17	10	13
Optional Six Month Follow-Up Period COMPLETED	1	1	1	2	2	2	5	3
Optional Six Month Follow-Up Period NOT COMPLETED	24	30	24	20	28	29	19	20

Reasons for withdrawal

Reasons for withdrawal
Measure	Arm 1 No healthy behavior texts BP Monitoring Weekly Via Text Messaging No physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 2 Healthy Behavior Texts BP Monitoring Weekly Via Text Messaging No physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 3 No healthy behavior texts BP Monitoring Daily Via Text Messaging No physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 4 Healthy Behavior Texts BP Monitoring Daily Via Text Messaging No physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 5 No healthy behavior texts BP Monitoring Weekly Via Text Messaging Physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments	Arm 6 Healthy Behavior Texts BP Monitoring Weekly Via Text Messaging Physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments	Arm 7 No healthy behavior texts BP Monitoring Daily Via Text Messaging Physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments	Arm 8 Healthy Behavior Texts BP Monitoring Daily Via Text Messaging Physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments
12 Month Interventional Trial Period Lost to Follow-up	26	16	23	27	21	22	36	25
12 Month Interventional Trial Period Withdrawal by Subject	11	13	15	12	7	8	4	11
Optional Six Month Follow-Up Period Chose Not to start 6 month extension	8	11	16	14	17	14	14	10
Optional Six Month Follow-Up Period Withdrawal by Subject	0	3	0	0	1	2	0	0
Optional Six Month Follow-Up Period ineligible	8	5	2	2	1	5	2	4
Optional Six Month Follow-Up Period Lost to Follow-up	8	11	6	4	9	8	3	6

Baseline Characteristics

Reach Out: Emergency Department-Initiated Hypertension Behavioral Intervention Connecting Multiple Health Systems

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Arm 1 n=62 Participants No healthy behavior texts BP Monitoring Weekly Via Text Messaging No physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 2 n=60 Participants Healthy Behavior Texts BP Monitoring Weekly Via Text Messaging No physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 3 n=63 Participants No healthy behavior texts BP Monitoring Daily Via Text Messaging No physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 4 n=61 Participants Healthy Behavior Texts BP Monitoring Daily Via Text Messaging No physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 5 n=58 Participants No healthy behavior texts BP Monitoring Weekly Via Text Messaging Physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments	Arm 6 n=61 Participants Healthy Behavior Texts BP Monitoring Weekly Via Text Messaging Physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments	Arm 7 n=64 Participants No healthy behavior texts BP Monitoring Daily Via Text Messaging Physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments	Arm 8 n=59 Participants Healthy Behavior Texts BP Monitoring Daily Via Text Messaging Physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments	Total n=488 Participants Total of all reporting groups
Age, Continuous	45.6 years STANDARD_DEVIATION 12.6 • n=5 Participants	47.7 years STANDARD_DEVIATION 11.8 • n=7 Participants	49 years STANDARD_DEVIATION 11.4 • n=5 Participants	45.3 years STANDARD_DEVIATION 11.7 • n=4 Participants	45.5 years STANDARD_DEVIATION 12.5 • n=21 Participants	46.5 years STANDARD_DEVIATION 12.2 • n=10 Participants	45.6 years STANDARD_DEVIATION 12.6 • n=115 Participants	45.3 years STANDARD_DEVIATION 12.2 • n=24 Participants	45.5 years STANDARD_DEVIATION 12.4 • n=42 Participants
Sex: Female, Male Female	37 Participants n=5 Participants	37 Participants n=7 Participants	38 Participants n=5 Participants	37 Participants n=4 Participants	36 Participants n=21 Participants	38 Participants n=10 Participants	39 Participants n=115 Participants	37 Participants n=24 Participants	299 Participants n=42 Participants
Sex: Female, Male Male	25 Participants n=5 Participants	23 Participants n=7 Participants	25 Participants n=5 Participants	24 Participants n=4 Participants	22 Participants n=21 Participants	23 Participants n=10 Participants	25 Participants n=115 Participants	22 Participants n=24 Participants	189 Participants n=42 Participants
Ethnicity (NIH/OMB) Hispanic or Latino	3 Participants n=5 Participants	1 Participants n=7 Participants	3 Participants n=5 Participants	2 Participants n=4 Participants	3 Participants n=21 Participants	2 Participants n=10 Participants	2 Participants n=115 Participants	1 Participants n=24 Participants	17 Participants n=42 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	59 Participants n=5 Participants	59 Participants n=7 Participants	60 Participants n=5 Participants	59 Participants n=4 Participants	55 Participants n=21 Participants	59 Participants n=10 Participants	62 Participants n=115 Participants	58 Participants n=24 Participants	471 Participants n=42 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants	0 Participants n=10 Participants	0 Participants n=115 Participants	0 Participants n=24 Participants	0 Participants n=42 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants n=5 Participants	2 Participants n=7 Participants	0 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants	0 Participants n=10 Participants	0 Participants n=115 Participants	0 Participants n=24 Participants	2 Participants n=42 Participants
Race (NIH/OMB) Asian	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants	0 Participants n=10 Participants	0 Participants n=115 Participants	0 Participants n=24 Participants	0 Participants n=42 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants n=5 Participants	0 Participants n=7 Participants	1 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants	0 Participants n=10 Participants	0 Participants n=115 Participants	0 Participants n=24 Participants	1 Participants n=42 Participants
Race (NIH/OMB) Black or African American	29 Participants n=5 Participants	29 Participants n=7 Participants	34 Participants n=5 Participants	31 Participants n=4 Participants	35 Participants n=21 Participants	39 Participants n=10 Participants	35 Participants n=115 Participants	30 Participants n=24 Participants	262 Participants n=42 Participants
Race (NIH/OMB) White	28 Participants n=5 Participants	27 Participants n=7 Participants	27 Participants n=5 Participants	29 Participants n=4 Participants	19 Participants n=21 Participants	19 Participants n=10 Participants	27 Participants n=115 Participants	25 Participants n=24 Participants	201 Participants n=42 Participants
Race (NIH/OMB) More than one race	5 Participants n=5 Participants	2 Participants n=7 Participants	1 Participants n=5 Participants	1 Participants n=4 Participants	4 Participants n=21 Participants	3 Participants n=10 Participants	2 Participants n=115 Participants	4 Participants n=24 Participants	22 Participants n=42 Participants
Race (NIH/OMB) Unknown or Not Reported	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants	0 Participants n=10 Participants	0 Participants n=115 Participants	0 Participants n=24 Participants	0 Participants n=42 Participants
Region of Enrollment United States	62 participants n=5 Participants	60 participants n=7 Participants	63 participants n=5 Participants	61 participants n=4 Participants	58 participants n=21 Participants	61 participants n=10 Participants	64 participants n=115 Participants	59 participants n=24 Participants	488 participants n=42 Participants
Prior medication for hypertension within the last 6 months	35 Participants n=5 Participants	35 Participants n=7 Participants	34 Participants n=5 Participants	34 Participants n=4 Participants	33 Participants n=21 Participants	33 Participants n=10 Participants	36 Participants n=115 Participants	33 Participants n=24 Participants	273 Participants n=42 Participants
Currently have a primary care provider	51 Participants n=5 Participants	50 Participants n=7 Participants	45 Participants n=5 Participants	48 Participants n=4 Participants	47 Participants n=21 Participants	47 Participants n=10 Participants	49 Participants n=115 Participants	43 Participants n=24 Participants	380 Participants n=42 Participants

PRIMARY outcome

Timeframe: 12 months

Population: numbers analyzed in each row show all the participants at the two timepoints (baseline and 12 month) for which data exists.

Change in 12-month Systolic Blood Pressure (SBP)

Outcome measures

Outcome measures
Measure	Arm 1 n=62 Participants No healthy behavior texts BP Monitoring Weekly Via Text Messaging No physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 2 n=60 Participants Healthy Behavior Texts BP Monitoring Weekly Via Text Messaging No physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 3 n=63 Participants No healthy behavior texts BP Monitoring Daily Via Text Messaging No physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 4 n=61 Participants Healthy Behavior Texts BP Monitoring Daily Via Text Messaging No physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 5 n=58 Participants No healthy behavior texts BP Monitoring Weekly Via Text Messaging Physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments	Arm 6 n=61 Participants Healthy Behavior Texts BP Monitoring Weekly Via Text Messaging Physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments	Arm 7 n=64 Participants No healthy behavior texts BP Monitoring Daily Via Text Messaging Physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments	Arm 8 n=59 Participants Healthy Behavior Texts BP Monitoring Daily Via Text Messaging Physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments
Change in Mean Systolic Blood Pressure Mean @ Baseline	142.8 mmHg Interval 138.7 to 146.9	146.8 mmHg Interval 142.1 to 151.6	143.9 mmHg Interval 139.6 to 148.2	144.7 mmHg Interval 140.0 to 149.5	148 mmHg Interval 142.5 to 153.5	145.8 mmHg Interval 140.4 to 151.1	147.4 mmHg Interval 142.6 to 152.1	149 mmHg Interval 143.5 to 154.5
Change in Mean Systolic Blood Pressure Mean of Median SBP @ 12 months	135.1 mmHg Interval 127.7 to 142.4	136.8 mmHg Interval 130.7 to 143.0	138.2 mmHg Interval 129.7 to 146.7	135.4 mmHg Interval 130.0 to 140.9	136.9 mmHg Interval 130.5 to 143.2	138.8 mmHg Interval 131.3 to 146.4	139 mmHg Interval 131.6 to 146.4	138.5 mmHg Interval 129.3 to 147.6
Change in Mean Systolic Blood Pressure Mean Change from Baseline	-8.8 mmHg Interval -15.0 to -2.6	-8 mmHg Interval -15.3 to -0.7	-3.2 mmHg Interval -10.1 to 3.7	-8.8 mmHg Interval -18.1 to 0.5	-7.3 mmHg Interval -15.6 to 1.1	-5.4 mmHg Interval -12.3 to 1.6	-6 mmHg Interval -15.7 to 3.7	-4.9 mmHg Interval -15.8 to 5.9

SECONDARY outcome

Timeframe: Baseline ED visit (in days)

Population: 211 is all of the participants in each of the eight arms who completed

Utilizing multivariable Cox regression analysis, the relationship between mHealth components and attendance at initial Primary Care Physician (PCP) appointment after Emergency Department visit is explored. The analysis adjusts for age, sex, race, presence of a primary care provider, and usage of blood pressure medications. The Hazard Ratio in this context is a measure indicating the relative risk of experiencing the event of interest (time to first PCP visit). A Hazard Ratio greater than 1 implies a greater risk of receipt of a first PCP appointment, and a Hazard Ratio less than 1 implies a lower risk of receipt of a first PCP appointment within 12-month follow-up. The use of Hazard Ratio in this context allows for the assessment of the impact of mHealth components on the timing of primary care engagement while accounting for potential confounding variables. This allows more valuable insights into the effectiveness of these components in facilitating access to primary care visits.

Outcome measures

Outcome measures
Measure	Arm 1 n=211 Participants No healthy behavior texts BP Monitoring Weekly Via Text Messaging No physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 2 n=211 Participants Healthy Behavior Texts BP Monitoring Weekly Via Text Messaging No physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 3 n=211 Participants No healthy behavior texts BP Monitoring Daily Via Text Messaging No physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 4 Healthy Behavior Texts BP Monitoring Daily Via Text Messaging No physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff No physician appointment and transportation scheduling: Participants do not receive assistance scheduling physician appointment or transportation	Arm 5 No healthy behavior texts BP Monitoring Weekly Via Text Messaging Physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments	Arm 6 Healthy Behavior Texts BP Monitoring Weekly Via Text Messaging Physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Weekly Via Text Messaging: Weekly text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments	Arm 7 No healthy behavior texts BP Monitoring Daily Via Text Messaging Physician appointment and transportation scheduling No healthy behavior texts: Participants do not receive healthy behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments	Arm 8 Healthy Behavior Texts BP Monitoring Daily Via Text Messaging Physician appointment and transportation scheduling Healthy Behavior Texts: Participants receive motivational health behavior texts BP Monitoring Daily Via Text Messaging: Daily text messages will prompt participants for BP by home cuff Physician appointment and transportation scheduling: Participants receive assistance scheduling physician appointment and transportation to those appointments
Hazard Ratio Analysis of Participant Time From Enrollment Emergency Department Visit to the First PCP Visit	0.9 hazard ratio Interval 0.7 to 1.3	1.2 hazard ratio Interval 0.9 to 1.6	1.2 hazard ratio Interval 0.9 to 1.6	—	—	—	—	—

SECONDARY outcome

Timeframe: 12 months

Utilizing logistic regression analysis, the probability of participants attending 2 or more primary care visits within a 12-month period is explored. The analysis adjusts for age, sex, race, presence of a primary care provider, and usage of blood pressure medications. The Odds Ratio in this context indicates the likelihood of an event occurring. A higher Odds Ratio suggests an increased likelihood of attending multiple primary care visits, while a lower Odds Ratio indicates a decreased likelihood. The use of Odds Ratio in this context is justified as it allows for the comparison of the likelihood of attending two or more primary care while accounting for covariates. This is useful in logistic regression analysis, where the outcome variable is binary (i.e., attending two or more primary care visits or not) and the focus is on understanding the association between predictor variables and the probability of the outcome.