Our Projects

What is the Embrace Study?

Approximately 1 in 3 patients has elevated blood pressure (BP) when measured in the doctor’s office, but normal BP when measured out of the office setting, a phenomenon known as white coat hypertension. Misdiagnosing such patients with hypertension can lead to unnecessary treatment with blood pressure (BP) medications, wasteful healthcare utilization, and adverse psychological consequences due to labeling effects. In 2015, the United Services Preventive Services Task Force (USPSTF) updated their hypertension screening guidelines to recommend that patients with elevated office BP undergo out-of-office BP testing with 24-hour Ambulatory BP Monitoring (ABPM) or Home BP Monitoring (HBPM) to rule-out white-coat hypertension prior to a new diagnosis of hypertension.

Despite the USPSTF recommendation, ABPM and HBPM are infrequently utilized in the US. Accordingly, the investigators conducted focus groups with primary care providers, patients, and other key stakeholders to identify the major barriers to implementation of the new hypertension screening guidelines. The investigators then applied the Behavior Change Wheel, a trans-theoretical intervention development framework, to categorize barriers and select theory-informed intervention components that would address these barriers.

The investigators arrived at a theory-informed implementation strategy comprised of the following 7 components:

• educational activities for providers
• training registered nurses to teach patients how to conduct HBPM
• disseminating information on how to order ABPM and HBPM to clinicians
• creating a computerized electronic health record-embedded clinical decision support tool that prompts recall of the guideline and facilitates ABPM and HBPM test ordering
• creating and disseminating patient information materials on ABPM and HBPM
• providing periodic feedback about clinic-level success with adhering to the guideline
• developing an easily accessible, culturally-adapted and locally tailored ABPM service

The investigators conducted a 2-year cluster randomized trial that tested whether this multifaceted implementation strategy increases the uptake of the USPSTF hypertension recommendations in the Ambulatory Care network (ACN) of New York-Presbyterian Hospital (NYP), a network of primary care clinics serving 120,000 patients from underserved communities in New York City. Click here to view study results: https://clinicaltrials.gov/ct2/show/NCT03480217.

What is DepCare?

Sustainable models for integrating mental health in primary care have been limited by suboptimal mental health screening, lack of primary care provider time for quality discussions, limited resources/access and patient stigma and treatment misconceptions. In response, a multidisciplinary team of providers, patients, and mental health workers in the ACN created DepCare, a personalized, culturally tailored, web-based application aimed at improving depression screening, education and management in primary care settings. DepCare uses a crossover design to test a multi-level optimization strategy centered around a tool for improving screening, patient activation, and automated shared decision-making, as well as provider education/feedback, to improve the delivery of care for depression by internists in primary care clinics across NYPH. The intervention combines cutting edge implementation science methods, based on transtheoretical behavioral change frameworks and user-centered design principles, to design an intervention tailored to address patient-, provider- and clinic-level barriers to maximize depression treatment optimization (AHRQ Moise PI).