Penny Hollander Feldman, Ph.D., Principal Investigator
Margaret McDonld, M.S.W., Investigator
Jennifer Mongoven, M.P.H., Research Project Manager
Timothy R. Peng, Ph.D., Research Associate
Lori King, BA, Research Analyst
Paula Wilson, RN, M.B.A., Home Support Clinical Coordinator
Nicole Fraser, M.P.H.[01/03/06 - 02/21/09], Health Educator
Ernesto Henriquez, B.A.[11/08/04 - 10/03/09], Research Assistant

Medical College of Wisconsin
Liliana Pezzin, Ph.D., Investigator/Econometrician

Weill Medical College, Cornell University
Linda Gerber, Ph.D., Investigator/Epidemiologist
Samuel Mann, M.D., Investigator/Physician Consultant

Background: Home health patients are clinically diverse. Individuals with conditions of the circulatory system comprise the single largest share (about 22 percent in 1996), while heart failure (HF), diabetes, chronic obstructive pulmonary disease and essential hypertension (HTN) are patients’ most frequent primary diagnoses. Management of HTN has not been a high priority for guideline adoption or quality improvement activities in home health care, even though approximately 8 percent of home care patients are admitted with essential HTN as a first, second or third diagnosis. In the words of one Clinical Nurse Specialist, home health nurses tend to see elevated blood pressure (BP) readings as “a set of numbers rather than a condition to be managed,” despite the fact that their patients may be at high risk of future HTN-related complications by virtue of their comorbidities and history of prior hospitalization. Teaching patients about their conditions, promoting patient self-management, helping patients adhere to medical regimens established by their physicians and linking them to community resources are central to the role of the home health nurse. However, with the advent of a home health prospective payment system, nurses are working under heightened pressure to constrain service use and reduce time in the patient’s home. This pressure, in turn, may provide a disincentive to focus on HBP management issues, particularly when HTN is a second or third diagnosis and not the primary reason for which a person has been admitted to home care. Thus home health care represents a segment of the health care system where a significant number of high-risk HTN patients are served, where HTN practice likely requires significant improvement, and where nursing personnel are uniquely positioned to mobilize their care management and patient-education skills to increase the proportion of treated HTN patients who achieve adequate BP control.

Purpose: The goal of the study is to conduct a randomized trial to examine the effectiveness and cost-effectiveness of two organizational interventions aimed at improving BP control among a high-risk, African American home care population.

Study Design: This is a randomized study testing a basic and an augmented intervention. The basic group will receive information about hypertension management. The home support program will extend hypertension support services to a patient for a 12-month period. Patient interviews will be conducted upon entry to home care and then at 3-, 12- and 18- months. The analysis will estimate the impact of the basic and augmented interventions on home care practices, on patient hypertension management (e.g. medication adherence) and BP outcomes, and on costs.

Sponsor: The National Heart, Lung, and Blood Institute