ReMOTE-BP: Research and Mentorship for Optimizing Treatment and Evaluation of Blood Pressure - SUMMARY Controlling chronic hypertension reduces a patient’s risk of developing life-threatening conditions over time. Traditionally, measures like home blood pressure monitoring and ongoing clinical support to provide counseling or medication adjustments are used to keep hypertension under control. However, the time, resources, and expertise required for such measures are often out of reach for patients of low socioeconomic status for whom financial and/or logistical challenges present challenges to frequent in-person care. One solution is to develop a chronic care model that includes team-based care that is primarily accessed remotely for patients with hypertension. I am currently conducting a large PCORI-funded clinical trial called Comparing Hypertension Remote Monitoring Evaluation Redesign (CHARMED, HM-2022C2-28339) to test the impact of one such model on patient engagement and outcomes. The current proposal complements this work by conducting systematic economic analyses of the costs associated with implementing that care model within the 25 safety net health systems involved in the trial. The majority of patients cared for at safety net health systems are of low socioeconomic status; thus, a focus on the costs incurred and challenges faced by these systems is more likely to inform improvements in caring for the patient populations most in need of such advances. In Aim 1, the project team, led by Dr. Elaine Khoong, one of my direct mentees, as well as Dr. Dhruv Kazi, will collect data on costs associated with equipment and utilization changes, including time-driven activity-based costing to account for personnel time spent learning and implementing the interventions. Dr. Khoong will compare bottom-line costs across all arms of the CHARMED trial (PCORI HM-2022C2-28339). In Aim 2, Drs. Lina Tieu and Lisa Ochoa- Frongia, also my mentees, will lead a study of the relationship between behavioral health care—to treat conditions like depression or anxiety, which are associated with higher risks of hypertension and related morbidity—and the clinical outcomes of hypertension patients in the ongoing clinical trial. Again, results will be compared across arms of the CHARMED trial (PCORI HM-2022C2-28339). Together, this work promises to advance patient-oriented research toward interventions that effectively control chronic hypertension within the context of safety net health systems. In leading this work, I continue my commitment to mentoring the next generation of scientists focused on patient-oriented research, including numerous opportunities for trainees to build and implement skills in implementation science, informatics, health communication, embedded/learning health systems research in safety-net health systems, pragmatic clinical trials, and gain experience in robust, longitudinal patient, family, and community engagement approaches.
