NEmours Move to Enhance Systemic hypertension confirmation in primary care Sites (NEMESIS)

Hypertension (HTN) is among the leading causes of cardiovascular disease (CVD)-related morbidity and mortality in the world, estimated to affect more than 50% of all adults and 5% of all children and adolescents. However, approximately 74% of children and adolescents who meet in-office blood pressure criteria for HTN do not receive a diagnosis. Lack of access to ambulatory blood pressure monitoring (ABPM) - the current gold standard for confirming the diagnosis of HTN in youth - can lead to low rates of diagnosis confirmation. Limited parental knowledge of HTN, ABPM, and ways to access ABPM may also contribute to a lack of recommended ABPM device wear, further contributing to undiagnosed HTN.

This proposal aims to examine these factors. First, we will utilize geospatial cluster visualization techniques to identify geographic areas that could benefit from more proximal access to ABPM. This will be done by extracting from health records the home addresses of youth who: a) meet the criteria for ABPM wear; b) receive an order for ABPM; and c) completed ABPM device wear. We will then identify geographic areas with a high need for ABPM but low rates of ABPM completion and determine whether they have poor local access to ABPM.

Second, models suggest that multi-level interventions are critical to achieving ideal health. Thus, we will leverage stakeholder engagement to create educational materials addressing HTN and ABPM knowledge, as well as an ABPM access protocol. Youth (and their parents) for whom ABPM was recommended will contribute to the design of these materials. Then, we will evaluate the education tool by asking a separate set of parents whose children were referred for ABPM (N=75) to complete a Likert scale knowledge assessment before and after using the tool.

We will also ask focus groups of parents with referred children (N=30 participants) to provide feedback on the ABPM access protocol. We believe that identifying those at high risk for HTN but lack of access to ABPM will enable the development of more effective resource allocation plans and that improving health knowledge regarding HTN, ABPM and ABPM access will improve health outcomes via the broader adoption of ABPM. In summary, we propose two complementary approaches for improving health related to ABPM access and adoption in youth: (1) the development and use of a multilevel dataset for depicting the extent of unmet need for ABPM in Delaware communities to guide resource allocation plans and (2) the development of youth and parent-informed education tools to improve health knowledge related to HTN and ABPM and ways to access ABPM for diagnosis confirmation.

Grant Number: 5P20GM144270-05
NIH Institute/Center: NIH
Principal Investigator: CARISSA BAKER-SMITH