# ACCTiVATE: Achieving Chronic Care equiTy by leVeraging the Telehealth Ecosystem

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2024 · $634,527

## Abstract

PROJECT SUMMARY/ABSTRACT
Chronic diseases such as hypertension, diabetes and chronic kidney disease cause significant mortality, with
stark inequities impacting racially and ethnically minoritized populations. The COVID-19 pandemic prompted a
rapid shift in chronic disease management to telehealth-based care, including patient portals, telemedicine
video visits, and remote patient monitoring. However, there are substantial racial/ethnic and socioeconomic
disparities in health IT access for chronic disease management in the United States. This is due to patient-level
barriers such as inequitable device and internet access and lower digital literacy, as well as clinic-level barriers
such as inadequate support to access digital technologies and skills, inequitable offering of health IT, and a
lack of equity-focused, stratified telehealth data. Increasing telehealth use among minority populations has the
potential to lessen disparities in chronic disease health outcomes.
We propose a 2x2 randomized controlled trial entitled “Achieving Chronic Care equiTy by leVerAging the
Telehealth Ecosystem” (ACCTiVATE), in which we will examine the impact of a multi-level intervention that
tackles patient-level and clinic-level barriers to increase the equitable use of health IT for chronic disease
management. The patient-level intervention combines the role of digital health navigator and chronic disease
health coach to facilitate access to devices and broadband, offer digital skills training, and provide chronic
disease health coaching focused on telehealth modalities. The clinic-level intervention includes Practice
Facilitation with a learning collaborative, clinic-specific Community Advisory Boards, and electronic “Telehealth
Equity Dashboards” that display telehealth utilization stratified by race/ethnicity.
We will randomize 600 English- and Spanish-speaking adults with uncontrolled hypertension across 10
federally qualified health centers to digital coaching versus usual care. The 10 health centers will be
randomized to Practice Facilitation versus usual care. In Aim 1, we will assess the impact of the multi-level
intervention (coaching combined with practice facilitation, and each arm alone) on systolic blood pressure
(primary outcome), hemoglobin A1c, and microalbuminuria overall, and among Black and Latinx patients. In
Aim 2, we will assess impacts on process measures of telehealth disease management (digital literacy,
medication adherence, engagement with health IT). In Aim 3, we will conduct a mixed methods evaluation of
implementation by applying the RE-AIM framework to identify key features needed for successful adoption and
dissemination by healthcare networks. A multidisciplinary Stakeholder Advisory Board will advise on all Aims.
The proposed intervention recognizes the multilevel determinants that have perpetuated the digital divide,
worsening chronic disease care during the pandemic. The impact of this intervention will result in an efficient,
u...

## Key facts

- **NIH application ID:** 10934542
- **Project number:** 5R01MD019042-02
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Delphine Tuot
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $634,527
- **Award type:** 5
- **Project period:** 2023-09-25 → 2028-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10934542

## Citation

> US National Institutes of Health, RePORTER application 10934542, ACCTiVATE: Achieving Chronic Care equiTy by leVeraging the Telehealth Ecosystem (5R01MD019042-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10934542. Licensed CC0.

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