# Actions to Decrease Disparities in Risk and Engage in Shared Support for Blood Pressure Control (ADDRESS-BP) in Blacks

> **NIH NIH UG3** · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · 2021 · $96,113

## Abstract

PROJECT SUMMARY/ABSTRACT: Hypertension (HTN) control in Blacks is sub-optimal due to barriers at
the patient, health systems, provider, and community-levels of care. Although the efficacy of nurse case
management (NCM) and home blood pressure monitoring (HBPM) is well-proven; these strategies do not
address community-level barriers (unstable housing, transportation) to adequate HTN control, thus limiting
their impact in Blacks. Integration of community health worker (CHWs) into primary care to help patients
navigate community resources is effective for HTN control in patients experiencing community-level barriers.
Despite their efficacy, implementation of these multi-level evidence-based interventions (NCM, HBPM, and
use of CHWs) into routine care in real world primary care practices, where a majority of minority patients
receive care, is suboptimal. This proposal harnesses practice facilitation (PF)- a theoretically sound and
sustainable implementation strategy to evaluate the implementation of NCM, HBPM, and CHWs delivered as
an integrated community-clinic linkage model [Practice support And Community Engagement (PACE)] to
address patient-, physician-, health system-, and community-level barriers to HTN control in Blacks. We will
test the implementation of PACE across a network of 20 primary practices within NYU Langone Health in
NYC, in partnership with an established Community-Clinic-Academic Advisory Board and HealthFirst (NYC's
largest Medicaid payer). Practice facilitators will assist practices to integrate NCM and HBPM into the clinic
workflow for 6 months, after which the patients' BP control status are re-evaluated; and for those who remain
uncontrolled, the facilitators will assist practices to develop processes for the addition of a CHW to the care
team to help patients navigate community resources and address community-level barriers to optimal HTN
control. NCM comprises home BP telemonitoring, behavioral counseling, and medication adjustment/titration
by trained Nurses. Trained CHWs work in partnership with Nurses to enhance care coordination, and provide
health coaching and bi-directional referrals between the practices and community resources. We will conduct
the proposed study in two phases: 1) a UG3 phase that will use principles of Community-Based Participatory
Research and the Consolidated Framework of Implementation Research to develop a context-specific PF
strategy and; 2) a UH3 implementation phase that will use Proctor's Implementation Outcomes Framework to
evaluate, in a stepped-wedge cluster RCT of 20 primary care practices in 500 Black patients with uncontrolled
HTN, the effect of the PF strategy on clinical and cost-effectiveness of PACE. We will also examine adoption
and implementation fidelity as potential mechanisms that may explain the impact of PF on BP control. Primary
outcome is BP control from baseline to 18 months. Secondary outcome is cost-effectiveness of PACE. The
study's findings will provide a practical a...

## Key facts

- **NIH application ID:** 10470504
- **Project number:** 3UG3HL151310-02S2
- **Recipient organization:** NEW YORK UNIVERSITY SCHOOL OF MEDICINE
- **Principal Investigator:** NADIA S ISLAM
- **Activity code:** UG3 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $96,113
- **Award type:** 3
- **Project period:** 2020-09-10 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10470504

## Citation

> US National Institutes of Health, RePORTER application 10470504, Actions to Decrease Disparities in Risk and Engage in Shared Support for Blood Pressure Control (ADDRESS-BP) in Blacks (3UG3HL151310-02S2). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10470504. Licensed CC0.

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