CaRDIOMETABOLIC dISPARITIES

Overview

According to the CDC, chronic diseases are responsible for 6 in 10 deaths annually, and account for 90% of the nation’s health care costs. Cardiometabolic diseases, including diabetes, hypertension, heart disease, and stroke, represent a significant portion of this burden. Diabetes, a chronic disease that affects the pancreas and the body’s glucose levels, afflicts more than 38 million people in the U.S. with approximately 1.4 million new cases each year. Hypertension, a precursor to heart disease and one of the most prominent chronic diseases in the U.S., afflicts approximately 119.9 million people or 48.1% of the U.S. population. These conditions, often compounded by socioeconomic disparities, contribute to substantial health inequities nationwide.

Supporting patients with cardiometabolic diseases between visits is crucial for improving health outcomes and reducing preventable complications. Our lab is committed to advancing health equity by identifying and addressing barriers to effective cardiometabolic disease management. Through community partnerships and innovative research, we aim to develop scalable interventions that improve health outcomes for all patients living with cardiometabolic diseases.

Current Projects

CHARMED

This goal of the Comparing Hypertension Remote Monitoring Evaluation Redesign (CHARMED) study is to evaluate different ways to use home blood pressure checking. The study team will offer patients different ways of checking blood pressure at home and offer primary care clinics different types of training and support to help teams of nurses, pharmacists, medical assistants and doctors treat high blood pressure. The study team will include 2500 adults with hypertension in this study. This will be achieved by recruiting participants from primary care clinics at three large safety-net health systems. It is expected that the study will identify effective strategies to implement, maintain and scale home blood pressure monitoring for diverse patients.

INSPIRED

The purpose of this trial is to evaluate patient-level and clinic-level strategies to increase implementation of self-measured blood pressure (SMBP) monitoring programs with clinical support. SMBP monitoring is an evidence-based, guideline-recommended practice that is most effective when combined with clinical support. However, SMBP monitoring with clinical support has had limited adoption in many safety net clinical settings due to multi-level barriers. In response, Dr. Elaine Khoong and her team are working with patients and clinics to co-design implementation strategies to increase SMBP monitoring tailored with safety net patients and clinicians. The trial will take place at two SF clinics and four Alameda Health System-based clinics. Patients will be enrolled and use cellular-enabled BP monitors for 12 months. Clinical champions at each clinic site will be trained as well.

REACH

The goal of the Remote Monitoring for Equity in Advancing Control of Hypertension (REACH) study is to support patients with hypertension self-management using both home blood pressure monitors and digital messaging programs. REACH seeks to mobilize patients with hypertension through myChart training and at-home blood pressure monitoring with a text messaging assistance platform that encourages self-management of hypertension. REACH emphasizes equity and accessibility of technology programs for English or Spanish speaking patients with hypertension in a safety net healthcare system.