Addressing Hypertension Outcomes Using Telehealth and Population Health Managers: Adaptations and Implementation Considerations.

Abstract

Purpose of review

There is a growing evidence base describing population health approaches to improve blood pressure control. We reviewed emerging trends in hypertension population health management and present implementation considerations from an intervention called Team-supported, Electronic health record-leveraged, Active Management (TEAM). By doing so, we highlight the role of population health managers, practitioners who use population level data and to proactively engage at-risk patients, in improving blood pressure control.

Recent findings

Within a population health paradigm, we discuss telehealth-delivered approaches to equitably improve hypertension care delivery. Additionally, we explore implementation considerations and complementary features of team-based, telehealth-delivered, population health management. By leveraging the unique role and expertise of a population health manager as core member of team-based telehealth, health systems can implement a cost-effective and scalable intervention that addresses multi-level barriers to hypertension care delivery. We describe the literature of telehealth-based population health management for patients with hypertension. Using the TEAM intervention as a case study, we then present implementation considerations and intervention adaptations to integrate a population health manager within the health care team and effectively manage hypertension for a defined patient population. We emphasize practical considerations to inform implementation, scaling, and sustainability. We highlight future research directions to advance the field and support translational efforts in diverse clinical and community contexts.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1007/s11906-022-01193-6

Publication Info

Drake, Connor, Allison A Lewinski, Abigail Rader, Julie Schexnayder, Hayden B Bosworth, Karen M Goldstein, Jennifer Gierisch, Courtney White-Clark, et al. (2022). Addressing Hypertension Outcomes Using Telehealth and Population Health Managers: Adaptations and Implementation Considerations. Current hypertension reports, 24(8). pp. 267–284. 10.1007/s11906-022-01193-6 Retrieved from https://hdl.handle.net/10161/29621.

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Scholars@Duke

Drake

Connor David Drake

Assistant Professor in Population Health Sciences

Connor Drake is a health services researcher and implementation scientist. His research interests are at the intersection of primary care, population health management, social determinants of health, chronic illness care redesign, and health equity. He has experience with policy analysis, electronic health record data, mixed and multi methods, community engaged research, and implementation and dissemination methods. 

Dr. Drake's current research projects include leveraging telemedicine and other clinical informatics to improve chronic illness care and population health management; developing and implementing behavioral interventions and 'whole-person' care models for patients with cardiovascular disease and metabolic disorders; and studying  social care interventions to respond to social risk factors including food insecurity, housing instability, and social isolation to improve health outcomes and equity.

Lewinski

Allison A. Lewinski

Assistant Research Professor in the School of Nursing

As a nurse scientist and health services researcher, with a joint appointment between the Duke University School of Nursing (DUSON) and the Durham Veterans Affairs Health Care System (VHA), I have acquired expertise in the areas of diabetes distress, qualitative research methods, and virtual care (e.g., telehealth, digital health) as a method of care delivery. My research focuses on the current and potential ability of virtual care interventions to reduce distress, improve self-management, increase access to evidence-based care delivery, and improve patient and population health outcomes. My collaborative and interdisciplinary research focuses on how patient-, provider-, and system-level factors influence virtual care use and outcomes. As evidence of its growing significance and impact at DUSON and the VHA, my work has been well funded, published in high-impact journals, presented at select conferences, and used to guide health system decision-making. I am a sought-after teacher and mentor because I connect my research interests to teaching students and mentees rigorous and systematic research approaches. I am frequently asked by local and national colleagues to provide guidance on distress, qualitative research methods, and virtual care approaches used in grants, projects, and manuscripts.  

My research contributions have focused on alleviating psychosocial distress, developing and implementing multi-level virtual care interventions, and enhancing qualitative methods. As a staff nurse, I witnessed the psychosocial distress of patients who experience challenges in obtaining care which led to my interest in diabetes distress. I aspire and work to improve health outcomes for individuals with chronic illness by developing equitable and sustainable multi-level virtual care interventions and assessing their implementation and adaptation. Virtual care describes any remote interaction between a patient and/or members of their care team. To achieve these goals, I use qualitative methods and implementation science approaches to enhance alignment between patient, modality, disease state, and social and environmental context; my collective assessments address for whom and what purposes, in what situations and contexts, when in a disease course or clinical activity, and in what specific ways such interventions are effective. My focus on the uptake and adoption of virtual care to address psychosocial distress considers interactions with patients, between patients and clinicians, and within health care systems and the larger population.

Goldstein

Karen M. Goldstein

Associate Professor of Medicine

Dr. Goldstein's research interests include women's health, cardiovascular risk reduction, evidence synthesis methodology and peer support.

Gierisch

Jennifer M. Gierisch

Associate Professor in Population Health Sciences

Jennifer Gierisch, PhD,  is behavioral scientist and health services researcher. She is an Associate Professor in the Department of Population Heath Sciences and the Department of Medicine at Duke University. She is a core investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)  where she serves as the leader of the Partnered Research Methods Core (PRESTO)  and Director of the VA OAA Health Services Research Postdoctoral Fellowship. Dr. Gierisch also is the Co-Director of the Evidence Synthesis Program (VA ESP) at the Durham Veteran Affairs Health Care System. She also served as a faculty director of the Duke Clinical Translational Science Institute's  Community Engaged Research Initiative (CeRi) for five years

Dr. Gierisch’s research focuses on three overarching areas: 1) behavioral research on the psychosocial factors that influence appropriate uptake and maintenance of complex health behaviors (eg., weight management, smoking cessation, cancer screening); 2) evidence synthesis on key health and healthcare topics to enhance uptake of evidence-based interventions to improve patient and health system outcomes; and 3) participatory and  community engaged research approaches.

Area of expertise: health behavior, community-engaged research, evidence synthesis, intervention development,  qualitative research

Zullig

Leah L Zullig

Professor in Population Health Sciences

Leah L. Zullig, PhD, MPH is a health services researcher and an implementation scientist. She is a Professor in the Duke Department of Population Health Sciences and an investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham Veterans Affairs Health Care System. Dr. Zullig’s overarching research interests address three domains: improving cancer care delivery and quality; promoting cancer survivorship and chronic disease management; and improving medication adherence. Throughout these three area of foci Dr. Zullig uses an implementation science lens with the goal of providing equitable care for all by implementing evidence-based practices in a variety of health care environments. She has authored over 150 peer-reviewed publications. 

Dr. Zullig completed her BS in Health Promotion, her MPH in Public Health Administration, and her PhD in Health Policy.

Areas of expertise: Implementation Science, Health Measurement, Health Policy, Health Behavior, Telehealth, and Health Services Research


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