1. Project Summary/Abstract
Hypertension affects 1 in every 3 adults in the US and contributes to 410,000 deaths annually. Hypertension and
its associated complications disproportionately affect minority populations living in urban areas. In Chicago,
health status indicators show worsening disparities between black and white residents, with the highest rates of
hypertension, heart disease, and stroke clustering in the predominantly black South and West Sides. Kaiser
Permanente demonstrated that a bundle of evidence-based interventions implemented within a large, integrated
health system in Northern California significantly increased blood pressure control rates. However, it is unclear
whether a health system centered intervention can be adapted to other settings, particularly under-resourced
urban communities. Therefore, our overall goal is to support a community-centered design and adaptation of the
Kaiser bundle. Our adaptation shifts the Kaiser bundle to be centered within churches within the South Side of
Chicago, one of the most medically underserved communities in the United States. The proposed interventions
are the same as in the Kaiser bundle (e.g., registry/audit and feedback, simplified treatment regimens, accurate
Blood Pressure measurement) but implementation of the components of the bundle will be adapted for delivery
in the community. The intervention will be carried out by local community health workers and ministry facilitators,
with health clinics and hospitals in the community as support, all connected through a common data platform.
Thus, our proposed project will identify the best strategies to support adoption, implementation with fidelity, and
sustainability of the Kaiser bundle in the community setting. The proposed study will follow the Exploration,
Preparation, Implementation and Sustainment (EPIS) process model and implementation is rigorously evaluated
using a multimethod approach to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-
AIM) evaluation framework. Our specific aims are: Aim 1: Convene community stakeholders in order to adapt
implementation strategies using the Dynamic Adaptation Process model. Aim 2: Design, implement, and
evaluate pilot projects in order to optimize implementation strategies within our community. Aim 3: Implement,
test and evaluate an adapted implementation strategy to control hypertension through faith-based organizations
in the South Side of Chicago. Our overall implementation is a hybrid Type 2 effectiveness–implementation design
based within one primary community area (South Side Chicago) and in two settings (church and clinic). The
overall study outcome is the Public Health Impact metric (reach * effect size of the intervention). Aim 4:
Disseminate findings internally to community stakeholders and externally through creation of community
implementation toolkits.