The Hopkins/Michigan DECIPHeR Alliance study, Achieving Cardiovascular Health Equity in Community Mental Health: Optimizing Implementation Strategies, is led by Dr. Gail Daumit and Dr. Amy Kilbourne. The Hopkins/Michigan DECIPHeR study focuses on cardiovascular disease (CVD) risk factors in adults with serious mental illness (SMI). People with SMI make up 5% of the U.S. population yet experience one of the largest CVD-related mortality disparities of any group; with rates 2 times higher and dying 10-20 years earlier from CVD than the overall U.S. population.

The IDEAL Goals intervention is a cardiovascular disease risk reduction program adapted from two evidence-based interventions tailored for persons with SMI that focused on psychoeducation, care management, and collaborative care (IDEAL and Life Goals). IDEAL Goals incorporates components of self-management of CVD risk behaviors and is aligned with national policy goals related to the implementation of behavioral health homes that provide healthcare services taking into consideration the intersection of physical and mental health.

The implementation strategies used to promote uptake of IDEAL Goals include: 1) Replicating Effective Programs (REP) which consists of training in IDEAL Goals’ evidence-based practices, packaged intervention material, and technical support; 2) Coaching to mitigate provider barriers to uptake; and 3) Facilitation to address organizational barriers to implementation and sustainment.

We will test the effects of these implementation strategies on delivery of the IDEAL Goals intervention using a cluster-randomized Type 3 hybrid implementation-effectiveness trial using a non-restricted sequential, multiple assignment randomized trial (SMART) design.

Primary Aim:

To determine the effect of the most intensive sequence of strategies (Coaching followed by Facilitation) versus REP alone on number of IDEAL Goals sessions patients receive after 18 months since phase 1 randomization.

Principal Investigators:

Gail L. Daumit, MD, MHS

Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Amy M. Kilbourne, PhD, MPH

Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.

VA Quality Enhancement Research Initiative (QUERI), Office of Research and Development, U.S. Department of Veterans Affairs

Grant number: UH3HL154280

The New York DECIPHeR Alliance study, Actions to Decrease Disparities In Risk and Engage In Shared Support For Blood Pressure Control (ADDRESS-BP) In Blacks, is led by Dr. Gbenga Ogedegbe, Dr. Antoinette Schoenthaler, and Dr. Nadia Islam. The NYU DECIPHeR Team will focus on uncontrolled hypertension (<130/80 mmHg) in New York City, NY. Hypertension accounts for the greatest portion of racial disparities in mortality between Black and White Americans. Black Americans have the highest rate of hypertension in the United States, (42% prevalence compared to 27% in Whites) and greater rates of fatal stroke (1.8X) and CVD mortality (1.5X).

The NYU DECIPHeR team’s evidence-based intervention is called Practice support and Community Engagement (PACE), which harnesses practice facilitation and community health workers to implement three evidence-based interventions into routine care within New York primary care practices, including: 1) Nurse case management; 2) Remote blood pressure monitoring; and 3) Social determinants of health support. Thestudy’s implementation strategy is Practice facilitation And social deTerminants of health support utilizing CHWs (PATCH), a tailored practice facilitation and community health worker strategy.

Primary implementation aim:

To determine if PATCH, a tailored practice facilitation and community health worker implementation strategy, results in a higher level of adoption of PACE (remote blood pressure monitoring + nurse case management + social determinants of health support) than ‘training as usual.’

Principal Investigators:

Gbenga Ogedegbe, MD, MPH, FACP

Institute for Excellence in Health Equity and Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.

Antoinette Schoenthaler, EdD

Institute for Excellence in Health Equity and Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.

Nadia Islam, PhD

Department of Population Health, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, NY, USA.

Grant number: UH3HL151310

The Northwestern DECIPHeR Alliance study, Community Intervention to Reduce CardiovascuLar Disease in Chicago (CIRCL-Chicago)-Northwestern University, is led by Dr. Abel Kho, Dr. Justin Smith, and Dr. Paris Davis. The Northwestern DECIPHeR study focuses on hypertension control in South Side Chicago, Illinois. Hypertension affects 1 in every 3 adults in the U.S. and contributes to 410,000 deaths annually. Hypertension and its associated complications disproportionately affect minority populations living in urban areas.

The Northwestern DECIPHeR team will adapt the Kaiser Permanente evidence-based intervention for community-centered testing in South Side Chicago churches. The tailored approach includes registry/audit, simplified treatments, and precise Blood Pressure measurement based on the Kaiser bundle. Implementation in community health centers will be randomized with or without practice facilitation for effective adoption of evidence-based interventions.

Employing the Exploration, Preparation, Implementation, and Sustainment (EPIS) process model, the Northwestern DECIPHeR study ensures meticulous evaluation through a comprehensive multimethod approach, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation framework.

Primary implementation aim:

To compare the reach of a community-adapted Kaiser Bundle in adults with hypertension in community health centers randomized to implementation with versus without practice facilitation over a two-year period.

Principal Investigators:

Abel N Kho, MD

Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

Justin D Smith

PhD Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA.

Paris Davis

PHD, MBA Total Resource CDO and Pastors4PCOR, Triedstone Full Gospel Baptist Church, Chicago, IL, USA

Grant number: UH3HL154297

The Tulane DECIPHeR Alliance study ― Church-based Health Intervention to Eliminate Racial Inequalities in Cardiovascular Health (CHERISH), is led by Dr. Jiang He, Dr. Keith Ferdinand, and Dr. Katherine Mills. The CHERISH study uses a church-based community health worker-led multifaceted intervention to address racial inequities in cardiovascular disease risk factors in Black communities in New Orleans, Louisiana.

The UCLA DECIPHeR Alliance study, Multi-ethnic Multi-level Strategies, and Behavioral Economics to Eliminate Hypertension Disparities in Los Angeles County, is led by Dr. Arleen Brown and Dr. Alejandra Casillas. The study will focus on the racial and ethnic gaps in evidence-based treatment that contribute to hypertension disparities in the Los Angeles County Department of Health Services (LAC DHS). Of the 43% of LAC DHS patients with hypertension, 60% are uncontrolled. Racial and ethnic differences in hypertension rates and blood pressure control in the LAC DHS result from a multitude of factors such as diet, exercise, obesity, poverty, social support, hypertension measurement access, hypertension medication education, use, and adherence, hypertension community awareness and education, and variable health and socioeconomic resource access.

During the study’s planning phase (UG3), barriers to and preferences for interventions and implementation strategies were identified at the patient, provider, clinic, health system, and community levels to tailor hypertension interventions with the goal of improving blood pressure control among racially and ethnically diverse safety net health system patients with uncontrolled HTN. This three-year phase included the formation of routine meetings with the study Steering Committee and five race- and ethnic-specific community action boards (CABs), a LAC DHS health system intervention and implementation planning group, a study meta-analysis team, a behavioral science subcommittee, and Technical Assistance meetings with NIH statisticians.

The intervention partners with LAC DHS to randomize clinics to one of three strategies: 1) provider-focused strategies, 2) patient-focused strategies, and 3) usual care strategies. Provider-focused strategies center on increasing provider knowledge of evidence-based blood pressure management, increasing cultural awareness of barriers to and facilitators of control, increasing access to medications, and integrating gained knowledge into practice. Patient-focused strategies include using culturally tailored materials and reminders to improve patient understanding of hypertension, how to manage the condition, and the available resources; increasing access to home blood pressure monitors; and social needs screening with linkage to community resources.

The UCLA DECIPHeR Team employs the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to guide the implementation process. The team will use the RE-AIM framework to test the effectiveness of their implementation strategies.

Primary implementation aim:

To test the effectiveness of the implementation strategies (usual care, patient-focused strategies, and provider-focused strategies) on change in adoption of culturally tailored evidence-based practices (at the end of Year 1).

Principal Investigators:

Arleen F. Brown, MD, PhD

Division of General Internal Medicine and Health Services Research at UCLA, Los Angeles, CA, USA.

Olive View-UCLA Medical Center, Sylmar, CA, USA.

Alejandra Casillas, MD, MSHS

Division of General Internal Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, CA, USA

Grant number: UH3HL154302

The Colorado DECIPHeR Alliance study, Reducing Asthma Attacks in Disadvantaged School Children with Asthma, is led by Dr. Stanley Szefler, Dr. Lisa Cicutto, and Dr. Amy Huebschmann. The study will focus on improving asthma disparities for children ages 5-12 in low-income communities in Colorado. Asthma is a leading cause of children's hospitalizations, missed school days, and caregivers' missed workdays which has a significant impact on low-income families.

The Colorado DECIPHeR team will employ the Better Asthma Control for Kids (BACK) program in schools. BACK, facilitated by school nurses and asthma navigators, aims to reduce asthma exacerbations and missed school days, while also addressing social determinants of health which their pilot identified as major drivers of asthma disparities. School nurses will be randomized to implement BACK-Standard or BACK-Enhanced, which includes BACK-Standard package plus Enhanced strategy to develop interrelationships with students, family, and communities.

The team is using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to engage stakeholders and guide implementation. The Colorado DECIPHeR team used the Pragmatic Implementation and Sustainability Model (PRISM) to assess contextual determinants of successful implementation and will use the RE-AIM framework as an evaluation tool. The Colorado DECIPHeR team completed a three-year planning phase in August 2023 and has now started the 4-year clinical trial phase to determine whether they can replicate their successful school-centered asthma program, developed in a large urban setting in the Denver Metropolitan Area, to selected regions outside the Denver area in mid-size and rural areas.

Primary implementation aim:

To compare the reach of the Better Asthma Control for Kids (BACK) intervention when offered to children with uncontrolled asthma by asthma navigators supporting school nurses randomized to deliver the BACK-standard vs. the BACK-enhanced implementation package in diverse schools in Colorado.

Principal Investigators:

Stanley J Szefler, MD

Department of Pediatrics, Breathing Institute, Children's Hospital Colorado, University of Colorado, School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.

Lisa Cicutto, PhD, RN

Community Outreach and Research, National Jewish Health, Denver, CO, USA.

Amy Huebschmann MD, MSCS

Division of General Internal Medicine, University of Colorado Center for Women’s Health Research, University of Colorado, School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.

Grant number: UH3HL151297

The University of Illinois Chicago (UIC) DECIPHeR Alliance study, Mi Quit CARE (Mile Square Quit Community-Access-Referral-Expansion), is led by Dr. Phoenix Matthews and Dr. Geri Donenberg. The UIC DECIPHeR study will focus on tobacco cessation in low-income populations in Chicago, Illinois. Nationally,14.1% of adults continue to smoke. Low-income populations are disproportionately burdened by tobacco use and carry a greater burden of smoking-related pulmonary health morbidity. Federally Qualified Health Care Centers (FQHCs) represent an important yet under-utilized model for reducing smoking-related health inequalities. Nationally, 25.8% of all patients receiving care at FHQCs are current smokers.

The UIC DECIPHeR Team will create Mi Quit CARE by combining three evidence-based interventions - (1) an electronically delivered brief smoking cessation intervention (Ask, Advise, Refer, AAR), (2) proactive linkage of smokers to the Illinois Tobacco Quit Line (ITQL), and (3) patient navigation to reduce barriers to care. They will be using the Practical, Robust Implementation and Sustainability Model (PRISM) implementation framework. They are engaging a variety of stakeholders, including community agencies, health systems, government agencies, large non-profit organizations and institutional partners. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation framework will be used to evaluate the implementation strategies.

The UIC DECIPHeR specific aims are:

Aim 1 (UG3 phase): Examine the burden of tobacco use and its influence on pulmonary health disparities (lung cancer, COPD, and asthma) in the patient population and the economically disadvantaged and racially segregated catchment areas of Mile Square Health Centers (MSHC).

Aim 2 (UG3 phase): Evaluate knowledge, attitudes, barriers, and facilitators to smoking cessation, engagement with the tobacco quit line, linkage to the tobacco quit line via a patient health portal, and receipt of patient navigation to facilitate access to the tobacco quit line among MSHC patients and health care providers.

Aim 3 (UG3 phase): Evaluate the use of community engagement strategies to increase uptake of the UI Health Patient Portal among low-income patients receiving care at MSHC.

Aim 4 (UG3 phase): Test the acceptability, feasibility, and capacity of MSHC to deliver Mi Quit CARE, an evidence-based and multi-level intervention to increase engagement with the quit line via the UI Health Portal.

Aim 1 (UH3 phase): Determine the effectiveness of Mi Quit CARE compared to standard of care in increasing patient engagement with the Illinois Tobacco Quit Line and subsequent smoking cessation outcomes.

Aim 2 (UH3 phase): Evaluate the scalability of Mi Quit CARE to multiple sites within the MSHC clinic network and by translating the intervention to Spanish.

Aim 3 (UG3 phase): Examine the cost effectiveness of Mi Quit CARE on smoking cessation outcomes compared to standard of care among a high risk FQHC population.

Demonstrating the feasibility, effectiveness, and cost-effectiveness of electronically delivered smoking cessation interventions via patient portals in FQHC settings has the potential for wide-spread dissemination and significant public health impact on patient populations with demonstrated high rates of smoking.

Principal Investigators:

Phoenix Matthews, PhD
College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.

Geri Donenberg, PhD
Professor of Medicine and Psychology, Healthy Youths Program, Center for Dissemination and Implementation Science, University of Illinois at Chicago, Chicago, IL, USA

The DECIPHeR Research Coordinating Center (RCC) is led by Dr. June Stevens at the Gillings School of Public Health at the University of North Carolina in Chapel Hill. The RCC supports the work of the Implementation Research Centers in the conduct of outstanding research that will test implementation strategies with the ultimate goal of reducing or eliminating cardiovascular and/or pulmonary health disparities.

The DECIPHeR RCC specific aims are:

Aim 1: Provide organization and management

Aim 2: Supply cross-study research coordination and support data analysis

Aim 3: Facilitate research skills development and capacity building

Aim 4: Promote dissemination and initiate partnerships

To accomplish those aims the RCC manages in-person and virtual steering committee meetings and workshops and establishes a cross-study organization that promotes collaboration and communication among investigators. They arrange meetings of cross-study data safety and monitoring board (DSMB) and provide reports to them as requested. The RCC supports the creation of a consolidated database of common variables and assists in data transfer and cleaning as well as providing statistical and data analysis expertise. They also conduct regular site visits. The RCC promotes skills development in implementation science by providing webinars and workshops on timely topics. Dissemination is supported by tracking and archiving of scientific products, creation, and posting of public use data, and by inclusion of community partners in webinars and workshops.

Principal Investigator:

Kimberly Truesdale, PhD, MSPH

Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA

June Stevens, MS PhD

Departments of Nutrition and Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA

Grant number: U24 HL151308