Led by Antoinette M. Schoenthaler, EdD, and her Connected2Care Project team at NYU Langone’s Center for Healthful Behavior Change, ALTA provides an evidence-based, structured process for addressing medication non-adherence and improving blood pressure control in primary care.
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, while 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 also uncertain about how to proceed with designing and implementing such programs.
Our program, Advancing Long-Term Improvements in Hypertension Outcomes Through a Team-Based Care Approach (ALTA), provides a strategy for integrating high-quality, effective system-level interventions into the existing care process in primary care settings for improving hypertension care.
ALTA evaluates the effectiveness of using a quality improvement method called practice facilitation to implement a five-step, team-based care intervention for improved medication adherence and blood pressure control in primary care. Practice facilitators are specially trained individuals who work with practices to help them develop the skills they need to adapt and implement evidence-based approaches, such as ALTA, by redesigning hypertension workflows to support team-based care.
Our project aims are as follows:
- to work together with practices to determine if an evidence-based quality improvement strategy (practice facilitation) can help primary care practices implement ALTA, a five-step, team-based care model of hypertension care into routine care
- to assess the process of implementing ALTA into routine care at practices
- to evaluate the impact of ALTA on medication adherence and improvement in blood pressure control for patients with uncontrolled hypertension
ALTA is a team-based approach to hypertension care. It consists of five key drivers that enhance the standard hypertension care process:
- Identify patients with uncontrolled hypertension who are non-adherent to their medications.
- Refer the identified patients for health coaching by clinical staff (e.g., a nurse).
- Coach using patient-centered communication skills to address non-adherence and create an action plan.
- Document patients’ blood pressure, adherence level, and action plan.
- Monitor patients’ progress over time toward their blood pressure and adherence goals.
We are partnering with primary care practices to determine whether an evidence-based quality improvement strategy—practice facilitation—can help practices integrate the five key drivers into the clinic workflow.
We are engaging clinical and nonclinical staff and administrative leadership at 10 participating practices affiliated with NYU Langone. Within these practices, our trial will enroll 700 patients who have uncontrolled hypertension and are non-adherent to their antihypertensive medications.
Phased Approach to Implementing ALTA as Standard of Care
Our project team will work directly with practice staff who would be responsible for delivering health coaching for improving medication adherence and hypertension management.
To help a practice sustain the five key elements of ALTA—identify, refer, coach, document, and monitor—we will first spend three months understanding a practice’s ability to implement ALTA and refining strategies to help it succeed, including on-site coaching, expert consultation, data tracking and feedback, electronic health record (EHR) support, and shared learning collaboratives.
Phase two will last 12 months, and staff will participate in brief web-based surveys and interviews before and after implementing ALTA. We will also measure changes in participating patients’ blood pressure control and medication adherence at 12 months.
ALTA Training Toolkit for Participating Practices
Our team has developed a robust training toolkit to help participating practices implement the program from start to finish. Components of the toolkit are adapted from the Agency for Healthcare Research and Quality and based on our previous work in primary care practices. The nine-module toolkit includes resources to create EHR hypertension registries, refer patients to a health coach using the EHR, help health coaches deliver patient-centered counseling for hypertension control, create documentation of coaching sessions, monitor patients, and more.
ALTA participants may request training materials by emailing email@example.com.
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 firstname.lastname@example.org or 646-501-3474.