Development of an integrated culturally-tailored CHW-led coaching and EHR-based physician decision-support intervention to improve hypertension control among NYC South Asians

Background:

South Asians (SAs) have disproportionately high rates of cardiovascular disease (CVD) and associated risk factors including hypertension, and face cultural, linguistic, and social barriers to accessing care. Million Hearts^® (MH) is a national initiative co-led by the Centers for Disease Control and Prevention (CDC) and Centers for Medicare & Medicaid Services (CMS) to prevent one million heart attacks and strokes by 2017. Studies have demonstrated that community health worker (CHW) and electronic health record (EHR) interventions can be independently effective in advancing MH goals, but few have examined the impact of integrating the two interventions, and how best to engage physician and non-physician members of the healthcare team, including CHWs, in effectively integrating EHR-based interventions into care planning.

Methods:

A partnership between two academic institutions, a payor organization and a network of primary care practices (PCPs) are collaborating to improve hypertension control for NYC SA patients.  Using a stepped-wedge design, the study will engage fifteen PCP sites through integration of EHR-based physician decision-support tools with CHW-led coaching, promotion of team-based care, and use of culturally-tailored education. A mixed-methods evaluation will assess the implementation process and identify factors influencing feasibility, acceptability, adoption, sustainability, and scalability of the intervention.

Results & Conclusion:

We will share the process of developing EHR-based tools, adaptation and translation of provider- and patient-directed MH materials, and integration of CHWs into clinical care teams in the first three study sites.  Challenges and lessons learned regarding CHW training and integration, EHR data access, and sustainability will be discussed.