Friday, April 4, 2025
4/4/2025
Understanding and addressing the lack of and delayed screening for primary Aldosteronism - PROJECT SUMMARY/ABSTRACT Primary aldosteronism (PA) is the most common cause of secondary hypertension, accounting for up to 15% of cases. Compared to primary hypertension, PA is linked to a 12-fold increased risk of adverse cardiovascular and renal events and increased mortality. Despite guideline recommendations for screening and the availability of screening tests and effective treatments, only 2% of at-risk individuals undergo PA screening. Further, the small proportion of individuals who are evaluated for PA often undergo screening too late, after they have already developed preventable cardiovascular and renal complications. However, the factors driving low and delayed PA screening rates, as well as potential racial and ethnic disparities in screening, have not been thoroughly investigated, despite known disparities in hypertension outcomes in these groups. This project will identify patient, clinician, health care system, and societal factors contributing to inadequate and delayed screening following the Health Equity Implementation Framework to inform the development of future interventions that can improve the frequency, timeliness, and equity of PA screening. The long-term objective of this project is to ensure timely, evidence-based, and equitable care for all individuals at risk of PA. In Aim 1, we will establish current patterns of PA screening and racial-ethnic disparities by leveraging linked datasets, encompassing insurance claims and electronic health records of enrollees in private and Medicare Advantage health plans within the OptumLabs Data Warehouse (OLDW), connected to a 100% sample of Medicare fee-for-service beneficiaries (M-FFS). Significantly, the OLDW-M-FFS data originates from primary care practices (~70%), and non-academic institutions (~80%), mirroring real-world practices. Innovative machine learning techniques will be employed to model and identify factors associated with the frequency of PA screening and the duration of hypertension before testing. In Aim 2, we'll use a mixed-methods approach to explore factors behind the underutilization of evidence- based PA screening. Surveys and interviews with patients, clinicians, and practice leaders will be conducted across three large healthcare systems (University of Florida, Mayo Clinic, University of Michigan) and 10 regional sites, with significant representation of primary care and rural practices. Finally, Aim 3 will use a Delphi-based implementation mapping approach to identify feasible and acceptable strategies targeting specific factors related to PA screening through collaboration with representatives from patient groups, clinicians, and health systems. By the end of the study, we'll have identified factors contributing to inadequate and delayed PA screening, offering a comprehensive, multilevel understanding of barriers and facilitators. Moreover, we'll propose mitigation strategies that are acceptable and feasible to important stakeholder groups from different settings. These findings will lay the foundation for developing and testing interventions to support evidence-based PA screening, improving health outcomes and reducing the burden of preventable morbidity and mortality associated with PA.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).