Current Centers for Population Health and Health Disparities
Johns Hopkins University
Hopkins Center To Eliminate Cardiovascular Health Disparities
Lisa A. Cooper, MD, MPH, FACP
Johns Hopkins Medical Institutions
2024 E. Monument Street, Suite 2-500
Baltimore, MD 21287
Lisa Cooper, MD, MPH Contact Principal Investigator
Abstract: Our goal is to create a transdisciplinary research center that improves cardiovascular outcomes and reduces racial and ethnic disparities in health care in Baltimore, Maryland. We will use community-based participatory research principles to build strong ties among researchers, health care provider networks, community members, and policy-makers. We are building on prior work and established relationships with the large African-American population in Baltimore, and we will initially focus on hypertension (HTN). The Center will include three separate but related intervention studies to improve the identification, treatment, and outcomes of African Americans with HTN; three integrated and complimentary cores; an internal Steering Committee; and a Community and Provider Advisory Board. Study 1 is a pragmatic clinical trial that examines the implementation of a multi-method quality improvement intervention in six community-based primary care practices. Study 2 is a randomized controlled trial to test the effectiveness and long-term sustainability of self-management and problem-solving training for patients, family, and community members. Study 3 is a three-arm randomized controlled trial of culturally tailored nutritional advice and a mineral supplement containing potassium, magnesium, and vitamin C. Primary outcomes for all three studies are systolic and diastolic blood pressure and blood pressure control. The Administrative Core will carry out the overall administration of the grant, guiding and coordinating shared resources and training activities and managing the Center's studies. The Shared Resources Core will provide infrastructure and support for study design, database development, data management and analysis, patient recruitment and retention, intervention development, standardization of measurements, and dissemination of results for the Center's projects and Administrative and Training Cores. The Training Core will provide transdisciplinary training, mentorship, and summer research experiences in health disparities for undergraduates, predoctoral and postdoctoral trainees, and for junior and established faculty in the Schools of Medicine, Public Health, and Nursing.
- Test comprehensive, multilevel interventions that will speed the translation of evidence-based approaches to HTN management into clinical and public health practice in Baltimore, Maryland, and create a model for subsequent cardiovascular disease (CVD) interventions;
- Train a new generation of scholars who are engaged in observational and interventional research to better understand causes, and identify sustainable solutions, to cardiovascular health disparities;
- Facilitate the translation and dissemination of evidence generated from the Center's research into clinical and public health practice and policy by creating, maintaining, and further enhancing partnerships with stakeholders, health care provider organizations, health departments, community organizations, and policy-makers, and by using community-based participatory research principles to guide the research through all phases including planning, implementation, evaluation, translation, and dissemination.
Project 1 will demonstrate that a comprehensive, multi-faceted strategy for HTN detection and control will improve blood pressure (BP) care and reduce HTN health disparities in an urban primary care network based in a predominantly African-American community. In addition, it is expected that an in-depth understanding of the organizational context and implementation process will help maximize the potential for dissemination.
- Perform a multi-method, staged quality improvement (QI) intervention (better BP measurement; patient case management; provider education including audit and feedback and communication skills training) in order to increase guideline concordant HTN care and to reduce racial disparities in BP control;
- Determine the association of organizational functioning and organizational cultural competence with guideline concordant HTN care and racial disparities in BP control;
- Determine the association between organizational functioning and organizational cultural competence at the clinic and system level with the implementation and success of the QI interventions.
Project 2 will develop and rigorously test the effectiveness of an intervention that simultaneously engages patient, family, and community-level strengths to improve African-American hypertensive patients' BP by enhancing their sustained performance of HTN self-management behaviors.
- Develop a patient, family, and community-level intervention to improve African-American hypertensive patients' engagement in self-management behaviors using principles of community-based participatory research;
- Study the effectiveness of the patient, family, and community-level intervention to improve patient self-management behaviors and BP;
- Assess the long-term sustainability of the patient, family, and community-level intervention.
Project 3 will test whether dietitian-delivered recommendations for healthy food choices, tailored to availability of foods from local neighborhood stores relevant to individual patients, and the use of a mineral supplement (potassium, magnesium, and vitamin C) will help in achieving dietary goals, improve BP control, reduce insulin resistance, and lower uric acid in African-American patients receiving regular care for treatment of HTN.
- Test the hypothesis that the tailored Dietary Approaches to Stop Hypertension (DASH) diet advice differs from mineral supplements in reducing BP;
- Compare the effects of the three groups (each pairwise contrast in specific aims 1-3) on the following set of selected CVD-related clinical outcomes:
- uric acid, and
- homeostasis model assessment of insulin resistance (HOMA-IR) index, glucose, and insulin (among non-diabetics)
- Conduct exploratory analyses related to:
- effects of the interventions in subgroups defined by gender, age, and other baseline variables, and
- effects of potential mediator variables, such as self-monitoring and type of antihypertensive medication.
- Estimate the direct costs of implementing the two interventions and conduct a cost analysis;
- Disseminate the results of the trial through shared resources.