Evaluating the Impact of an Equity Focused Dashboard and Clinical Support
Condition: Hypertension; Diabetes; Breast Cancer
MeSH terms: Hypertension
Study type: Interventional

Summary: 
      In this project, the impact of providing a practice-level equity dashboard that displays
      ambulatory quality outcome metrics stratified by race and language to primary care providers
      at Massachusetts General Hospital (MGH) will be evaluated. Provision of the dashboard data
      will be paired with additional clinical support focused on hypertension control among Black,
      Indigenous and People of Color (BIPOC) and patients with limited English proficiency (LEP).

      The investigators hypothesize that there will be a improvement in hypertension control
      (primary outcome), diabetes control and breast cancer screening (secondary outcomes) among
      Black, Indigenous and People of Color (BIPOC) and patients with limited English proficiency
      (LEP) in the intervention period compared to the control period.
    

Detailed description: 
      A clinical program will be implemented to utilize the equity dashboard in routine clinical
      practice augmented by clinical support to address current disparities in hypertension control
      among MGH primary care patients who are Black, Indigenous and People of Color (BIPOC) as well
      as patients with limited English proficiency (LEP). The clinical support will be provided by
      population health coordinators (PHCs) and/or community health workers (CHWs).

      To evaluate the program, the investigators propose a stepped wedge design that will randomize
      the primary care providers to the provision of the equity dashboard and additional clinical
      support at different intervals. The primary reason to randomize the primary care providers is
      because the PHCs and CHWs have limited capacity to contact and assist the patients in our
      primary care practices with poorly controlled hypertension and can only engage a limited
      number of patients at a time.

      The stepped wedge cluster-randomized study design will randomize providers in all 15 MGH
      primary care practices to receiving the intervention (i.e. equity dashboard with additional
      clinical support) in twelve groups. Each step will be a one-month period. Providers
      randomized to Group 1 will receive the equity dashboard data as well as additional clinical
      support starting in Step 1 while providers randomized to Group 12 will receive the same
      intervention at the beginning of Step 12 but receive usual care in Steps 0-11. We will match
      Providers in the opposite steps (e.g. Group 1 vs. Group 12, Group 2 vs. Group 11, etc.) by
      practice, baseline hypertension control rate, and the number of patients in their panel who
      are eligible for the intervention to ensure balance between data collected from the
      intervention periods and control periods. The stepped wedge design will allow for an open
      cohort (i.e. new patients of the providers allocated to the intervention can enter in
      subsequent steps) and a repeated measures data analysis with the same patients experiencing
      both control and intervention conditions.
    

Intervention name(s): Equity Dashboard, Population Health Coordinator and Community Health Worker Support; Equity Dashboard and Population Health Coordinator Support
Intervention type(s): Other; Other
Intervention description(s): Providers will be given access to an equity dashboard that displays their practice's performance on ambulatory quality metrics stratified by race and language.
Population health coordinators (PHCs) will lead equity huddles with providers to review list of patients who are not at goal for their hypertension control and meet the inclusion criteria. Providers will formulate a follow up plan for each patient that the PHCs will help implement. For example, PHCs may contact patient via the online patient portal or phone to obtain recent home blood pressure readings, facilitate scheduling of follow up visits, etc.
In addition, patients may be referred to the community health worker (CHW) hypertension management program. Patients will work with the CHW for 3-6 months. During this time the CHW will focus their efforts on patient education/coaching, remote blood pressure monitoring, addressing psychosocial and socioeconomic barriers to care and care coordination.; Providers will be given access to an equity dashboard that displays their practice's performance on ambulatory quality metrics stratified by race and language.
In addition, population health coordinators (PHCs) will lead disparities focused huddles with providers. During the huddle, they will review list of patients who are not at goal for their hypertension control and meet the inclusion criteria. Providers will then formulate a follow up plan for each patient that the Population Health Coordinators will help implement. For example, PHCs may contact patient via the online patient portal or phone to obtain recent home blood pressure readings, facilitate scheduling of follow up visits, etc.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Equity; Health Disparities