Collaboration-Oriented Approach to Controlling High Blood Pressure (COACH)

Uncontrolled high blood pressure (BP) may lead to heart attacks, strokes, and kidney failure. Blood pressure management includes a combination of medications and behavioral changes such as weight loss, diet modification, increased activity, and tobacco cessation. The use of mobile applications (apps) that focus on medication compliance and improvements in behaviors hold promise to engage and empower patients in the self-management of their hypertension and improve health outcomes. However, to take advantage of these apps, improvements in the use of clinical decision support (CDS) standards and patient engagement are needed. Combining these apps with shareable, interoperable, and scalable decision support tools may allow for greater applicability and use of these patient tools.

This research will modify the Collaboration Oriented Approach to Controlling High Blood Pressure (COACH), a patient-facing standards-based CDS app that engages and assists patients in the self-management of their high BP. COACH uses Fast Healthcare Interoperable Resource (FHIR) standards, allowing it to be interoperable and shareable. Once modified and refined, COACH will be implemented in three diverse clinical settings using implementation science methods to maximize effectiveness and evaluate implementation issues.

The specific aims of the research are as follows:

• Refine and implement a patient-facing, adaptable BP control CDS system in three diverse settings.
• Evaluate the effectiveness of the application at lowering BP.
• Develop robust, sharable, interoperable mechanisms, leveraging collaborations and synthesis of the implementation experience to aid in further dissemination and implementations of patient-facing CDS.

A mixed methods study with a randomized clinical trial will use social cognitive theory to engage patients and evaluate COACH’s effectiveness at lowering BP. Social cognitive theory is a framework informed by four key sources and mediators of behavior and behavioral change: self-efficacy, social support, outcome expectations, and self-regulation. When applied to COACH, these four components will be: 1) a training module to improve patient confidence in monitoring their own BP; 2) weekly data visualizations to show patients their progress toward controlling their BP; 3) goal setting for patients to set a hypertension goal range decision support recommended lifestyle changes that are specific to the individual; and 4) integration of a patients’ collected data: medication adherence, exercise patterns, smoking, and alcohol use. During the clinical trial, each of these components will be automatically turned on for the intervention group versus the control group, where these components will be made available for selection but not automatically turned on. Following the clinical trial and study evaluation, the researchers will disseminate their work, with a goal of providing patients with tools to better manage their BP and improve their health outcomes.