Led by Antoinette M. Schoenthaler, EdD, and the Connected2Care Project team at NYU Langone’s Institute for Excellence in Health Equity, ALTA is an evidence-based, structured program designed to improve medication adherence and blood pressure control in primary care using a team-based, technology-facilitated model.

About ALTA

Growing evidence shows that multilevel systems–based interventions—those in which the patient, healthcare providers, and clinical systems are all recognized and targeted—can produce significant improvements in patients’ medication adherence and clinical outcomes. However, although evidence-based practice is considered the gold standard in healthcare, it can take up to 17 years to translate into an actual healthcare practice. Many practices are unsure how to proceed with designing and implementing such programs. ALTA addresses this gap by integrating high-quality, system-level interventions into existing primary care workflows to enhance hypertension care.

ALTA employs a multilevel systems–based approach, recognizing and targeting the patient, healthcare providers, and clinical systems to improve medication adherence and clinical outcomes. Through practice facilitation, ALTA assists practices in redesigning hypertension workflows using quality improvement methods. These are some of the program’s key aims:

• collaborating with primary care practices to determine how practice facilitation can support ALTA implementation
• assessing the integration of ALTA into routine care
• evaluating the impact of ALTA on medication adherence and blood pressure control among patients with uncontrolled hypertension

ALTA Framework

ALTA’s team-based, technology-facilitated model consists of five key drivers that enhance standard hypertension care:

• identifying patients with uncontrolled hypertension who are nonadherent to their medications
• referring patients for home blood pressure monitoring (HBPM) and adherence health coaching by clinical staff (such as nurses)
• coaching patients using patient-centered communication to address nonadherence and develop action plans
• documenting home blood pressure readings, adherence levels, and action plans in the electronic health record (EHR)
• monitoring patients’ progress toward achieving blood pressure and adherence goals

ALTA has been implemented in six NYU Langone-affiliated primary care practices. In these locations we will evaluate its impact on blood pressure control among 700 patients with uncontrolled hypertension who are nonadherent to their antihypertensive medications at 12 months post-implementation.

Phased Approach to Implementing ALTA as Standard of Care

To support practices in implementing and sustaining ALTA’s five key drivers—identify, refer, coach, document, and monitor—we conducted a three-month environmental scan to assess each practice’s capacity for adoption. During this period, staff participated in web-based surveys and interviews, allowing us to develop tailored facilitation strategies to optimize implementation. These strategies included on-site coaching, expert consultation, data tracking and feedback, electronic health record (EHR) support, and shared learning collaboratives.

ALTA Training Toolkit for Participating Practices

To guide practices through successful implementation, our team developed a comprehensive training toolkit, adapted from the Agency for Healthcare Research and Quality and informed by our prior work in primary care settings. This 10-module toolkit provides resources for creating EHR-based hypertension registries, referring patients to health coaches, supporting health coaches in delivering patient-centered counseling for hypertension control, documenting coaching sessions, and monitoring patient progress. Practices interested in accessing these materials can request them by emailing  Connected2Care@NYULangone.org.

ALTA Evaluation (“ALTA 1.5”)

We are currently enrolling patients in the participating FHCs to be a part of the evaluation for ALTA, specifically examining changes in trust and commitment between patients and providers at baseline and 12 months. Patients who participated in ALTA are encouraged to enroll. Patients who were eligible but did not participate in ALTA’s health coaching are encouraged to enroll to participate in the evaluation as usual care participants, to help us compare changes in trust and commitment with their provider over time as well. Both groups receive a total of $50 for completion of all the surveys, to be paid in portions at baseline, 6, and 12 months.

Contact Us

If you are interested in learning more or you feel that your practice is a potential ALTA partner, please contact Jocelyn Cruz, MPH, program manager, at Jocelyn.Acosta@NYULangone.org or 646-501-3474.