Ignite Creation Date:
2025-12-24 @ 2:50 PM
Ignite Modification Date:
2026-02-28 @ 9:03 PM
Study NCT ID:
NCT03818659
Status:
COMPLETED
Last Update Posted:
2025-03-03
First Post:
2019-01-22
Is NOT Gene Therapy:
True
Has Adverse Events:
True
Brief Title:
Improving BP Control in Diverse Populations Using BP MAP
Sponsor:
Organization:
Raw JSON
{'hasResults': True, 'derivedSection': {'miscInfoModule': {'versionHolder': '2025-12-24'}, 'conditionBrowseModule': {'meshes': [{'id': 'D006973', 'term': 'Hypertension'}], 'ancestors': [{'id': 'D014652', 'term': 'Vascular Diseases'}, {'id': 'D002318', 'term': 'Cardiovascular Diseases'}]}}, 'resultsSection': {'moreInfoModule': {'pointOfContact': {'email': 'mark.pletcher@ucsf.edu', 'phone': '415-514-8008', 'title': 'Dr. Mark Pletcher', 'organization': 'University of California, San Francisco'}, 'certainAgreement': {'piSponsorEmployee': True}}, 'adverseEventsModule': {'timeFrame': 'Not applicable: adverse events were not collected.', 'description': 'Adverse events were not collected.', 'eventGroups': [{'id': 'EG000', 'title': 'Full Support', 'description': 'Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.\n\nFull Support M.A.P. BP Improvement Program: Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.', 'otherNumAtRisk': 0, 'deathsNumAtRisk': 0, 'otherNumAffected': 0, 'seriousNumAtRisk': 0, 'deathsNumAffected': 0, 'seriousNumAffected': 0}, {'id': 'EG001', 'title': 'Self-Guided', 'description': 'Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.\n\nSelf-Guided M.A.P. BP Improvement Program: Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.', 'otherNumAtRisk': 0, 'deathsNumAtRisk': 0, 'otherNumAffected': 0, 'seriousNumAtRisk': 0, 'deathsNumAffected': 0, 'seriousNumAffected': 0}, {'id': 'EG002', 'title': 'Usual Care', 'description': 'The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating "Usual Care" institutions in PCORnet.', 'otherNumAtRisk': 0, 'deathsNumAtRisk': 0, 'otherNumAffected': 0, 'seriousNumAtRisk': 0, 'deathsNumAffected': 0, 'seriousNumAffected': 0}], 'frequencyThreshold': '0'}, 'outcomeMeasuresModule': {'outcomeMeasures': [{'type': 'PRIMARY', 'title': 'Change in Blood Pressure Control, % of Patients', 'denoms': [{'units': 'Participants', 'counts': [{'value': '11821', 'groupId': 'OG000'}, {'value': '14454', 'groupId': 'OG001'}, {'value': '1212560', 'groupId': 'OG002'}]}, {'units': 'Number of Clinics', 'counts': [{'value': '12', 'groupId': 'OG000'}, {'value': '12', 'groupId': 'OG001'}, {'value': '18', 'groupId': 'OG002'}]}], 'groups': [{'id': 'OG000', 'title': 'Full Support', 'description': 'Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.\n\nFull Support M.A.P. BP Improvement Program: Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.'}, {'id': 'OG001', 'title': 'Self-Guided', 'description': 'Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.\n\nSelf-Guided M.A.P. BP Improvement Program: Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.'}, {'id': 'OG002', 'title': 'Usual Care', 'description': 'The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating "Usual Care" institutions in PCORnet.'}], 'classes': [{'categories': [{'measurements': [{'value': '2.8', 'groupId': 'OG000', 'lowerLimit': '-0.9', 'upperLimit': '6.5'}, {'value': '1.6', 'groupId': 'OG001', 'lowerLimit': '-0.8', 'upperLimit': '4.0'}, {'value': '-0.4', 'groupId': 'OG002', 'lowerLimit': '-1.0', 'upperLimit': '0.2'}]}]}], 'paramType': 'MEAN', 'timeFrame': 'baseline and 6 months', 'description': 'The primary outcome will be clinic-level change in the proportion of patients with controlled BP from baseline to 6 months after the start of the intervention. BP control will be defined according to NQF 0018 as the percent of eligible patients (defined below) with SBP \\<140 mmHg and DBP \\< 90 mmHg, based on measurements obtained at the most recent ambulatory clinical encounter at baseline (using the lowest measures of SBP and DBP at that encounter) and similarly at the 6-month time point after initiation of the intervention.', 'unitOfMeasure': 'percentage of patients', 'dispersionType': '95% Confidence Interval', 'reportingStatus': 'POSTED', 'typeUnitsAnalyzed': 'Number of Clinics', 'denomUnitsSelected': 'Number of Clinics', 'populationDescription': 'The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the numerator and denominator for each metric.'}, {'type': 'SECONDARY', 'title': 'Change in Improvement in Blood Pressure, % of Patients', 'denoms': [{'units': 'Participants', 'counts': [{'value': '11821', 'groupId': 'OG000'}, {'value': '14454', 'groupId': 'OG001'}, {'value': '1212560', 'groupId': 'OG002'}]}, {'units': 'Number of Clinics', 'counts': [{'value': '12', 'groupId': 'OG000'}, {'value': '12', 'groupId': 'OG001'}, {'value': '18', 'groupId': 'OG002'}]}], 'groups': [{'id': 'OG000', 'title': 'Full Support', 'description': 'Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.\n\nFull Support M.A.P. BP Improvement Program: Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.'}, {'id': 'OG001', 'title': 'Self-Guided', 'description': 'Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.\n\nSelf-Guided M.A.P. BP Improvement Program: Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.'}, {'id': 'OG002', 'title': 'Usual Care', 'description': 'The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating "Usual Care" institutions in PCORnet.'}], 'classes': [{'categories': [{'measurements': [{'value': '-3.4', 'groupId': 'OG000', 'lowerLimit': '-10.3', 'upperLimit': '3.5'}, {'value': '-5.4', 'groupId': 'OG001', 'lowerLimit': '-8.2', 'upperLimit': '-2.5'}, {'value': '-3.1', 'groupId': 'OG002', 'lowerLimit': '-4.1', 'upperLimit': '-2.1'}]}]}], 'paramType': 'MEAN', 'timeFrame': 'baseline and 12 months', 'description': 'This overall measure of BP improvement implements CMS065v4\\[ref\\], which defines BP improvement as either a reduction of 10 mmHg in SBP or achievement of SBP that is "adequately controlled" (SBP \\< 140 mmHg) in months 12 of the measurement period, among hypertensive patients not previously controlled.', 'unitOfMeasure': 'percentage of patients', 'dispersionType': '95% Confidence Interval', 'reportingStatus': 'POSTED', 'typeUnitsAnalyzed': 'Number of Clinics', 'denomUnitsSelected': 'Number of Clinics', 'populationDescription': 'The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the numerator and denominator for each metric.'}, {'type': 'SECONDARY', 'title': 'Change in Confirmatory Repeated Blood Pressure Measurement, % of Visits', 'denoms': [{'units': 'Participants', 'counts': [{'value': '11821', 'groupId': 'OG000'}, {'value': '14454', 'groupId': 'OG001'}, {'value': '1212560', 'groupId': 'OG002'}]}, {'units': 'Number of Clinics', 'counts': [{'value': '12', 'groupId': 'OG000'}, {'value': '12', 'groupId': 'OG001'}, {'value': '18', 'groupId': 'OG002'}]}], 'groups': [{'id': 'OG000', 'title': 'Full Support', 'description': 'Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.\n\nFull Support M.A.P. BP Improvement Program: Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.'}, {'id': 'OG001', 'title': 'Self-Guided', 'description': 'Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.\n\nSelf-Guided M.A.P. BP Improvement Program: Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.'}, {'id': 'OG002', 'title': 'Usual Care', 'description': 'The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating "Usual Care" institutions in PCORnet.'}], 'classes': [{'categories': [{'measurements': [{'value': '19.8', 'groupId': 'OG000', 'lowerLimit': '6.9', 'upperLimit': '32.7'}, {'value': '11.6', 'groupId': 'OG001', 'lowerLimit': '2.1', 'upperLimit': '21.1'}, {'value': '0.1', 'groupId': 'OG002', 'lowerLimit': '-0.0', 'upperLimit': '0.2'}]}]}], 'paramType': 'MEAN', 'timeFrame': 'baseline and 6 months', 'description': 'This process measure is designed to capture the practice of repeating a blood pressure measurement in the same visit when the first measurement done in clinic is high (SBP≥140 mmHg or DBP≥90 mmHg).', 'unitOfMeasure': 'percentage of visits', 'dispersionType': '95% Confidence Interval', 'reportingStatus': 'POSTED', 'typeUnitsAnalyzed': 'Number of Clinics', 'denomUnitsSelected': 'Number of Clinics', 'populationDescription': 'The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the numerator and denominator for each metric.'}, {'type': 'SECONDARY', 'title': 'Change in Medication Intensification, % of Visits', 'denoms': [{'units': 'Participants', 'counts': [{'value': '11821', 'groupId': 'OG000'}, {'value': '14454', 'groupId': 'OG001'}, {'value': '1212560', 'groupId': 'OG002'}]}, {'units': 'Number of Clinics', 'counts': [{'value': '12', 'groupId': 'OG000'}, {'value': '12', 'groupId': 'OG001'}, {'value': '18', 'groupId': 'OG002'}]}], 'groups': [{'id': 'OG000', 'title': 'Full Support', 'description': 'Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.\n\nFull Support M.A.P. BP Improvement Program: Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.'}, {'id': 'OG001', 'title': 'Self-Guided', 'description': 'Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.\n\nSelf-Guided M.A.P. BP Improvement Program: Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.'}, {'id': 'OG002', 'title': 'Usual Care', 'description': 'The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating "Usual Care" institutions in PCORnet.'}], 'classes': [{'categories': [{'measurements': [{'value': '-1.6', 'groupId': 'OG000', 'lowerLimit': '-6.1', 'upperLimit': '3.0'}, {'value': '-3.4', 'groupId': 'OG001', 'lowerLimit': '-8.2', 'upperLimit': '1.2'}, {'value': '-0.1', 'groupId': 'OG002', 'lowerLimit': '-0.3', 'upperLimit': '0.1'}]}]}], 'paramType': 'MEAN', 'timeFrame': 'baseline and 6 months', 'description': 'This process measure captures the proportion of visits where BP is uncontrolled where a medication is ordered that is of a different class of medication than had previously been used. Note that this explicitly does not give credit for ordering a simple refill or medication dose increase, or use of a different medication in the same class.', 'unitOfMeasure': 'percentage of visits', 'dispersionType': '95% Confidence Interval', 'reportingStatus': 'POSTED', 'typeUnitsAnalyzed': 'Number of Clinics', 'denomUnitsSelected': 'Number of Clinics', 'populationDescription': 'The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the numerator and denominator for each metric.'}, {'type': 'SECONDARY', 'title': 'Change in Average Systolic Blood Pressure (SBP) Reduction After a Medication Intensification Visit, mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '11821', 'groupId': 'OG000'}, {'value': '14454', 'groupId': 'OG001'}, {'value': '1212560', 'groupId': 'OG002'}]}, {'units': 'Number of Clinics', 'counts': [{'value': '12', 'groupId': 'OG000'}, {'value': '12', 'groupId': 'OG001'}, {'value': '18', 'groupId': 'OG002'}]}], 'groups': [{'id': 'OG000', 'title': 'Full Support', 'description': 'Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.\n\nFull Support M.A.P. BP Improvement Program: Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.'}, {'id': 'OG001', 'title': 'Self-Guided', 'description': 'Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.\n\nSelf-Guided M.A.P. BP Improvement Program: Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.'}, {'id': 'OG002', 'title': 'Usual Care', 'description': 'The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating "Usual Care" institutions in PCORnet.'}], 'classes': [{'categories': [{'measurements': [{'value': '2.3', 'groupId': 'OG000', 'lowerLimit': '0.9', 'upperLimit': '3.7'}, {'value': '-1.6', 'groupId': 'OG001', 'lowerLimit': '-5.6', 'upperLimit': '2.4'}, {'value': '-1.1', 'groupId': 'OG002', 'lowerLimit': '-1.5', 'upperLimit': '-0.8'}]}]}], 'paramType': 'MEAN', 'timeFrame': 'baseline and 6 months', 'description': 'This continuous metric describes the change in SBP (+/- standard deviation) observed between a visit with a medication intensification to the subsequent visit occurring at least 10 days later.', 'unitOfMeasure': 'mmHg', 'dispersionType': '95% Confidence Interval', 'reportingStatus': 'POSTED', 'typeUnitsAnalyzed': 'Number of Clinics', 'denomUnitsSelected': 'Number of Clinics', 'populationDescription': 'The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the average reduction in patients with a recent medication intensification.'}, {'type': 'SECONDARY', 'title': 'Change in Repeat Visit in 4 Weeks After a Visit With Elevated BP, % of Visits', 'denoms': [{'units': 'Participants', 'counts': [{'value': '11821', 'groupId': 'OG000'}, {'value': '14454', 'groupId': 'OG001'}, {'value': '1212560', 'groupId': 'OG002'}]}, {'units': 'Number of Clinics', 'counts': [{'value': '12', 'groupId': 'OG000'}, {'value': '12', 'groupId': 'OG001'}, {'value': '18', 'groupId': 'OG002'}]}], 'groups': [{'id': 'OG000', 'title': 'Full Support', 'description': 'Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.\n\nFull Support M.A.P. BP Improvement Program: Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.'}, {'id': 'OG001', 'title': 'Self-Guided', 'description': 'Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.\n\nSelf-Guided M.A.P. BP Improvement Program: Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.'}, {'id': 'OG002', 'title': 'Usual Care', 'description': 'The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating "Usual Care" institutions in PCORnet.'}], 'classes': [{'categories': [{'measurements': [{'value': '-0.8', 'groupId': 'OG000', 'lowerLimit': '-3.2', 'upperLimit': '1.7'}, {'value': '-2.0', 'groupId': 'OG001', 'lowerLimit': '-4.3', 'upperLimit': '0.2'}, {'value': '-0.6', 'groupId': 'OG002', 'lowerLimit': '-1.0', 'upperLimit': '-0.2'}]}]}], 'paramType': 'MEAN', 'timeFrame': 'baseline and 6 months', 'description': 'This process measure captures the proportion of persons who had uncontrolled HTN who made a subsequent visit within the following 4 weeks.', 'unitOfMeasure': 'percentage of visits', 'dispersionType': '95% Confidence Interval', 'reportingStatus': 'POSTED', 'typeUnitsAnalyzed': 'Number of Clinics', 'denomUnitsSelected': 'Number of Clinics', 'populationDescription': 'The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the numerator and denominator for each metric.'}, {'type': 'SECONDARY', 'title': 'Change in Use of Fixed Dose Combination Product Among Patients Taking 2 or More Classes of Medications, % of Patients', 'denoms': [{'units': 'Participants', 'counts': [{'value': '11821', 'groupId': 'OG000'}, {'value': '14454', 'groupId': 'OG001'}, {'value': '1212560', 'groupId': 'OG002'}]}, {'units': 'Number of Clinics', 'counts': [{'value': '12', 'groupId': 'OG000'}, {'value': '12', 'groupId': 'OG001'}, {'value': '18', 'groupId': 'OG002'}]}], 'groups': [{'id': 'OG000', 'title': 'Full Support', 'description': 'Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.\n\nFull Support M.A.P. BP Improvement Program: Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.'}, {'id': 'OG001', 'title': 'Self-Guided', 'description': 'Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.\n\nSelf-Guided M.A.P. BP Improvement Program: Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.'}, {'id': 'OG002', 'title': 'Usual Care', 'description': 'The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating "Usual Care" institutions in PCORnet.'}], 'classes': [{'categories': [{'measurements': [{'value': '1.6', 'groupId': 'OG000', 'lowerLimit': '-1.4', 'upperLimit': '4.7'}, {'value': '-0.1', 'groupId': 'OG001', 'lowerLimit': '-1.8', 'upperLimit': '1.7'}, {'value': '-0.7', 'groupId': 'OG002', 'lowerLimit': '-0.8', 'upperLimit': '-0.6'}]}]}], 'paramType': 'MEAN', 'timeFrame': 'baseline and 6 months', 'description': 'Use of fixed dose combination medications helps with adherence, promotes rational combinations of medications, and increases likelihood of achieving BP control. This metric, which is limited to patients taking more than one medication class, describes the prevalence of fixed dose combination pill use.', 'unitOfMeasure': 'percentage of patients', 'dispersionType': '95% Confidence Interval', 'reportingStatus': 'POSTED', 'typeUnitsAnalyzed': 'Number of Clinics', 'denomUnitsSelected': 'Number of Clinics', 'populationDescription': 'The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the numerator and denominator for each metric.'}, {'type': 'SECONDARY', 'title': 'Change in Use of a CCB or Thiazide or Thiazide-like Diuretic Among African-American Patients on at Least One Medication, % of Patients', 'denoms': [{'units': 'Participants', 'counts': [{'value': '11821', 'groupId': 'OG000'}, {'value': '14454', 'groupId': 'OG001'}, {'value': '1212560', 'groupId': 'OG002'}]}, {'units': 'Number of Clinics', 'counts': [{'value': '12', 'groupId': 'OG000'}, {'value': '12', 'groupId': 'OG001'}, {'value': '18', 'groupId': 'OG002'}]}], 'groups': [{'id': 'OG000', 'title': 'Full Support', 'description': 'Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.\n\nFull Support M.A.P. BP Improvement Program: Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.'}, {'id': 'OG001', 'title': 'Self-Guided', 'description': 'Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.\n\nSelf-Guided M.A.P. BP Improvement Program: Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.'}, {'id': 'OG002', 'title': 'Usual Care', 'description': 'The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating "Usual Care" institutions in PCORnet.'}], 'classes': [{'categories': [{'measurements': [{'value': '-0.9', 'groupId': 'OG000', 'lowerLimit': '-1.8', 'upperLimit': '0.1'}, {'value': '-0.1', 'groupId': 'OG001', 'lowerLimit': '-1.5', 'upperLimit': '1.2'}, {'value': '0.0', 'groupId': 'OG002', 'lowerLimit': '-0.3', 'upperLimit': '0.3'}]}]}], 'paramType': 'MEAN', 'timeFrame': 'baseline and 6 months', 'description': 'Use of calcium channel blockers (CCB) OR a thiazide or thiazide-like diuretic medication classes is recommended to treat black or African American patients as first line monotherapy due to increased efficacy. This metric, which is limited to African-American patients with a diagnosis of hypertension taking at least one medication class, describes the prevalence of those receiving the recommended drug class.', 'unitOfMeasure': 'percentage of patients', 'dispersionType': '95% Confidence Interval', 'reportingStatus': 'POSTED', 'typeUnitsAnalyzed': 'Number of Clinics', 'denomUnitsSelected': 'Number of Clinics', 'populationDescription': 'The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the numerator and denominator for each metric.'}, {'type': 'SECONDARY', 'title': 'Change in Terminal Digit = Zero, % of Measurements', 'denoms': [{'units': 'Participants', 'counts': [{'value': '11821', 'groupId': 'OG000'}, {'value': '14454', 'groupId': 'OG001'}, {'value': '1212560', 'groupId': 'OG002'}]}, {'units': 'Number of Clinics', 'counts': [{'value': '12', 'groupId': 'OG000'}, {'value': '12', 'groupId': 'OG001'}, {'value': '18', 'groupId': 'OG002'}]}], 'groups': [{'id': 'OG000', 'title': 'Full Support', 'description': 'Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.\n\nFull Support M.A.P. BP Improvement Program: Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.'}, {'id': 'OG001', 'title': 'Self-Guided', 'description': 'Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.\n\nSelf-Guided M.A.P. BP Improvement Program: Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.'}, {'id': 'OG002', 'title': 'Usual Care', 'description': 'The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating "Usual Care" institutions in PCORnet.'}], 'classes': [{'categories': [{'measurements': [{'value': '0.8', 'groupId': 'OG000', 'lowerLimit': '-1.5', 'upperLimit': '3.1'}, {'value': '0.9', 'groupId': 'OG001', 'lowerLimit': '-1.1', 'upperLimit': '2.8'}, {'value': '-0.6', 'groupId': 'OG002', 'lowerLimit': '-1.0', 'upperLimit': '-0.3'}]}]}], 'paramType': 'MEAN', 'timeFrame': 'baseline and 6 months', 'description': 'Inappropriate rounding of blood pressure measurements (usually to zero) leads to measurement error and worse treatment decisions. This continuous metric is calculated for a clinic as the percent of measurements at that clinic (for hypertensive patients) where the terminal digit of the measurement is zero. A percent greater than 10% (if an automated BP monitor is used) or greater than 20% (if a manual BP monitor is used with recommended rounding to even digits) indicates evidence of inappropriate rounding. Unlike most of our metrics, lower is better, down to an ideal value of 10-20%, which would be expected if no rounding were occurring.\n\nFor this study we calculated the change in this continuous metric for each clinic from baseline to 6 months, and then described the mean change across clinics by group. As with our other outcomes, the unit of analysis in the study is a clinic.', 'unitOfMeasure': 'percentage of measurements', 'dispersionType': '95% Confidence Interval', 'reportingStatus': 'POSTED', 'typeUnitsAnalyzed': 'Number of Clinics', 'denomUnitsSelected': 'Number of Clinics', 'populationDescription': 'The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the numerator and denominator for each metric.'}, {'type': 'SECONDARY', 'title': 'Change in Blood Pressure Controlled to 2017 Guideline Goal, % of Patients', 'denoms': [{'units': 'Participants', 'counts': [{'value': '11821', 'groupId': 'OG000'}, {'value': '14454', 'groupId': 'OG001'}, {'value': '1212560', 'groupId': 'OG002'}]}, {'units': 'Number of clinic', 'counts': [{'value': '12', 'groupId': 'OG000'}, {'value': '12', 'groupId': 'OG001'}, {'value': '18', 'groupId': 'OG002'}]}], 'groups': [{'id': 'OG000', 'title': 'Full Support', 'description': 'Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.\n\nFull Support M.A.P. BP Improvement Program: Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.'}, {'id': 'OG001', 'title': 'Self-Guided', 'description': 'Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.\n\nSelf-Guided M.A.P. BP Improvement Program: Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.'}, {'id': 'OG002', 'title': 'Usual Care', 'description': 'The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating "Usual Care" institutions in PCORnet.'}], 'classes': [{'categories': [{'measurements': [{'value': '-1.5', 'groupId': 'OG000', 'lowerLimit': '-2.6', 'upperLimit': '-0.3'}, {'value': '-1.1', 'groupId': 'OG001', 'lowerLimit': '-2.2', 'upperLimit': '0.1'}, {'value': '-0.5', 'groupId': 'OG002', 'lowerLimit': '-0.7', 'upperLimit': '-0.2'}]}]}], 'paramType': 'MEAN', 'timeFrame': 'baseline and 6 months', 'description': 'This alternative overall measure of BP control is identical to Metric 1, except that attainment of BP Control is defined by SBP \\< 130 mmHg and DBP \\< 80 mmHg, as per the goal stated in the 2017 ACC/AHA Hypertension Guideline\\[ref\\]. Note that while the treatment threshold varies in the Guideline, depending on cardiovascular risk, the goal applies to all patients.', 'unitOfMeasure': 'percentage of patients', 'dispersionType': '95% Confidence Interval', 'reportingStatus': 'POSTED', 'typeUnitsAnalyzed': 'Number of clinic', 'denomUnitsSelected': 'Number of clinic', 'populationDescription': 'The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the numerator and denominator for each metric.'}]}, 'participantFlowModule': {'groups': [{'id': 'FG000', 'title': 'Full Support', 'description': 'Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.\n\nFull Support M.A.P. BP Improvement Program: Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.'}, {'id': 'FG001', 'title': 'Self-Guided', 'description': 'Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.\n\nSelf-Guided M.A.P. BP Improvement Program: Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.'}, {'id': 'FG002', 'title': 'Usual Care', 'description': 'The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating "Usual Care" institutions in PCORnet.'}], 'periods': [{'title': 'Overall Study', 'milestones': [{'type': 'STARTED', 'achievements': [{'comment': 'We had 10445 participants at baseline. Since we cannot report a greater number of participants that Completed the Period than the number of participants that Started the Period, we are reporting the Completed number.', 'groupId': 'FG000', 'numUnits': '12', 'numSubjects': '11821'}, {'comment': 'We had 13163 participants at baseline. Since we cannot report a greater number of participants that Completed the Period than the number of participants that Started the Period, we are reporting the Completed number.', 'groupId': 'FG001', 'numUnits': '12', 'numSubjects': '14454'}, {'comment': 'We had 1177804 participants at baseline. Since we cannot report a greater number of participants that Completed the Period than the number of participants that Started the Period, we are reporting the Completed number.', 'groupId': 'FG002', 'numUnits': '18', 'numSubjects': '1212560'}]}, {'type': 'COMPLETED', 'achievements': [{'groupId': 'FG000', 'numUnits': '12', 'numSubjects': '11821'}, {'groupId': 'FG001', 'numUnits': '12', 'numSubjects': '14454'}, {'groupId': 'FG002', 'numUnits': '18', 'numSubjects': '1212560'}]}, {'type': 'NOT COMPLETED', 'achievements': [{'groupId': 'FG000', 'numUnits': '0', 'numSubjects': '0'}, {'groupId': 'FG001', 'numUnits': '0', 'numSubjects': '0'}, {'groupId': 'FG002', 'numUnits': '0', 'numSubjects': '0'}]}]}], 'typeUnitsAnalyzed': 'Number of clinic', 'recruitmentDetails': 'The unit of randomization was the participating clinical unit.', 'preAssignmentDetails': '24 clinic leaders agreed to participate in a BP control quality improvement program and 24 clinics were randomized and assigned to one of the intervention arms. We included 18 PCORnet clinics in our Blood Pressure Control Laboratory Surveillance Program (BP Track) for our control arms.\n\nNo individuals were consented. This study was exempt from IRB review as a quality improvement program not human subjects research.'}, 'baselineCharacteristicsModule': {'denoms': [{'units': 'Participants', 'counts': [{'value': '11821', 'groupId': 'BG000'}, {'value': '14454', 'groupId': 'BG001'}, {'value': '1212560', 'groupId': 'BG002'}, {'value': '1238835', 'groupId': 'BG003'}]}, {'units': 'Number of Clinics', 'counts': [{'value': '12', 'groupId': 'BG000'}, {'value': '12', 'groupId': 'BG001'}, {'value': '18', 'groupId': 'BG002'}, {'value': '42', 'groupId': 'BG003'}]}], 'groups': [{'id': 'BG000', 'title': 'Full Support', 'description': 'Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.\n\nFull Support M.A.P. BP Improvement Program: Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.'}, {'id': 'BG001', 'title': 'Self-Guided', 'description': 'Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.\n\nSelf-Guided M.A.P. BP Improvement Program: Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.'}, {'id': 'BG002', 'title': 'Usual Care', 'description': 'The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating "Usual Care" institutions in PCORnet.'}, {'id': 'BG003', 'title': 'Total', 'description': 'Total of all reporting groups'}], 'measures': [{'title': 'Age, Continuous', 'classes': [{'categories': [{'measurements': [{'value': '57.1', 'spread': '2.49', 'groupId': 'BG000'}, {'value': '57.1', 'spread': '2.61', 'groupId': 'BG001'}, {'value': '63.47', 'spread': '1.76', 'groupId': 'BG002'}, {'value': '63.46', 'spread': '1.78', 'groupId': 'BG003'}]}]}], 'paramType': 'MEAN', 'unitOfMeasure': 'Age in years', 'dispersionType': 'STANDARD_DEVIATION', 'denomUnitsSelected': 'Number of Clinics'}, {'title': 'Age, Customized', 'classes': [{'title': '18-44 years', 'categories': [{'measurements': [{'value': '16.0', 'spread': '4.91', 'groupId': 'BG000'}, {'value': '16.1', 'spread': '5.33', 'groupId': 'BG001'}, {'value': '9.3', 'spread': '2.21', 'groupId': 'BG002'}, {'value': '13.8', 'spread': '5.42', 'groupId': 'BG003'}]}]}, {'title': '45-64 years', 'categories': [{'measurements': [{'value': '56.5', 'spread': '4.50', 'groupId': 'BG000'}, {'value': '56.5', 'spread': '6.07', 'groupId': 'BG001'}, {'value': '38.1', 'spread': '4.58', 'groupId': 'BG002'}, {'value': '50.4', 'spread': '10.06', 'groupId': 'BG003'}]}]}, {'title': '65+ years', 'categories': [{'measurements': [{'value': '27.5', 'spread': '8.03', 'groupId': 'BG000'}, {'value': '27.4', 'spread': '8.38', 'groupId': 'BG001'}, {'value': '52.6', 'spread': '6.14', 'groupId': 'BG002'}, {'value': '35.8', 'spread': '14.09', 'groupId': 'BG003'}]}]}], 'paramType': 'MEAN', 'unitOfMeasure': 'percentage of participants', 'dispersionType': 'STANDARD_DEVIATION', 'denomUnitsSelected': 'Number of Clinics'}, {'title': 'Sex/Gender, Customized', 'classes': [{'title': 'Female, %', 'categories': [{'measurements': [{'value': '57.2', 'spread': '5.80', 'groupId': 'BG000'}, {'value': '60.7', 'spread': '5.75', 'groupId': 'BG001'}, {'value': '51.4', 'spread': '3.08', 'groupId': 'BG002'}, {'value': '56.4', 'spread': '6.35', 'groupId': 'BG003'}]}]}, {'title': 'Male, %', 'categories': [{'measurements': [{'value': '42.8', 'spread': '5.80', 'groupId': 'BG000'}, {'value': '39.3', 'spread': '5.75', 'groupId': 'BG001'}, {'value': '48.6', 'spread': '3.08', 'groupId': 'BG002'}, {'value': '43.6', 'spread': '6.35', 'groupId': 'BG003'}]}]}], 'paramType': 'MEAN', 'unitOfMeasure': 'percentage of participants', 'dispersionType': 'STANDARD_DEVIATION', 'denomUnitsSelected': 'Number of Clinics'}, {'title': 'Race/Ethnicity, Customized', 'classes': [{'title': 'White, %', 'categories': [{'measurements': [{'value': '50.3', 'spread': '33.8', 'groupId': 'BG000'}, {'value': '29.8', 'spread': '27.01', 'groupId': 'BG001'}, {'value': '79.2', 'spread': '15.56', 'groupId': 'BG002'}, {'value': '53.1', 'spread': '33.40', 'groupId': 'BG003'}]}]}, {'title': 'LatinX, %', 'categories': [{'measurements': [{'value': '10.3', 'spread': '5.9', 'groupId': 'BG000'}, {'value': '26.3', 'spread': '28.3', 'groupId': 'BG001'}, {'value': '3.1', 'spread': '2.01', 'groupId': 'BG002'}, {'value': '13.2', 'spread': '19.36', 'groupId': 'BG003'}]}]}, {'title': 'Black, %', 'categories': [{'measurements': [{'value': '34.9', 'spread': '33.8', 'groupId': 'BG000'}, {'value': '36.8', 'spread': '34.6', 'groupId': 'BG001'}, {'value': '13.4', 'spread': '15.3', 'groupId': 'BG002'}, {'value': '28.4', 'spread': '31.12', 'groupId': 'BG003'}]}]}, {'title': 'Asian, %', 'categories': [{'measurements': [{'value': '1.6', 'spread': '2.34', 'groupId': 'BG000'}, {'value': '3.8', 'spread': '5.69', 'groupId': 'BG001'}, {'value': '1.7', 'spread': '0.67', 'groupId': 'BG002'}, {'value': '2.3', 'spread': '3.72', 'groupId': 'BG003'}]}]}, {'title': 'Other, %', 'categories': [{'measurements': [{'value': '3.0', 'spread': '2.29', 'groupId': 'BG000'}, {'value': '3.2', 'spread': '2.69', 'groupId': 'BG001'}, {'value': '2.5', 'spread': '0.95', 'groupId': 'BG002'}, {'value': '2.9', 'spread': '2.14', 'groupId': 'BG003'}]}]}], 'paramType': 'MEAN', 'unitOfMeasure': 'percentage of participants', 'dispersionType': 'STANDARD_DEVIATION', 'denomUnitsSelected': 'Number of Clinics'}, {'title': 'Median total number of patients with hypertension', 'classes': [{'categories': [{'measurements': [{'value': '517', 'groupId': 'BG000', 'lowerLimit': '299', 'upperLimit': '1049'}, {'value': '1040', 'groupId': 'BG001', 'lowerLimit': '630', 'upperLimit': '1623'}, {'value': '53266', 'groupId': 'BG002', 'lowerLimit': '26200', 'upperLimit': '74379'}, {'value': '2003', 'groupId': 'BG003', 'lowerLimit': '596', 'upperLimit': '46407'}]}]}], 'paramType': 'MEDIAN', 'unitOfMeasure': 'number of participants', 'dispersionType': 'INTER_QUARTILE_RANGE', 'denomUnitsSelected': 'Number of Clinics'}, {'title': 'Diabetes, %', 'classes': [{'categories': [{'measurements': [{'value': '29.9', 'spread': '3.43', 'groupId': 'BG000'}, {'value': '33.8', 'spread': '9.89', 'groupId': 'BG001'}, {'value': '26.7', 'spread': '2.74', 'groupId': 'BG002'}, {'value': '26.7', 'spread': '2.78', 'groupId': 'BG003'}]}]}], 'paramType': 'MEAN', 'unitOfMeasure': 'percentage of participants', 'dispersionType': 'STANDARD_DEVIATION', 'denomUnitsSelected': 'Number of Clinics'}, {'title': 'Heart Failure, %', 'classes': [{'categories': [{'measurements': [{'value': '2.9', 'spread': '1.51', 'groupId': 'BG000'}, {'value': '2.6', 'spread': '1.36', 'groupId': 'BG001'}, {'value': '6.8', 'spread': '1.30', 'groupId': 'BG002'}, {'value': '6.8', 'spread': '1.31', 'groupId': 'BG003'}]}]}], 'paramType': 'MEAN', 'unitOfMeasure': 'percentage of participants', 'dispersionType': 'STANDARD_DEVIATION', 'denomUnitsSelected': 'Number of Clinics'}, {'title': 'Depression, %', 'classes': [{'categories': [{'measurements': [{'value': '17.0', 'spread': '9.47', 'groupId': 'BG000'}, {'value': '18.2', 'spread': '16.4', 'groupId': 'BG001'}, {'value': '14.5', 'spread': '5.80', 'groupId': 'BG002'}, {'value': '14.5', 'spread': '5.83', 'groupId': 'BG003'}]}]}], 'paramType': 'MEAN', 'unitOfMeasure': 'percentage of participants', 'dispersionType': 'STANDARD_DEVIATION', 'denomUnitsSelected': 'Number of Clinics'}, {'title': 'COPD (%)', 'classes': [{'categories': [{'measurements': [{'value': '6.6', 'spread': '4.18', 'groupId': 'BG000'}, {'value': '4.4', 'spread': '2.43', 'groupId': 'BG001'}, {'value': '5.7', 'spread': '1.51', 'groupId': 'BG002'}, {'value': '5.7', 'spread': '1.51', 'groupId': 'BG003'}]}]}], 'paramType': 'MEAN', 'unitOfMeasure': 'percentage of participants', 'dispersionType': 'STANDARD_DEVIATION', 'denomUnitsSelected': 'Number of Clinics'}], 'typeUnitsAnalyzed': 'Number of Clinics', 'populationDescription': 'The unit of measure in this study is a clinic.'}}, 'documentSection': {'largeDocumentModule': {'largeDocs': [{'date': '2020-06-12', 'size': 430525, 'label': 'Study Protocol, Statistical Analysis Plan, and Informed Consent Form', 'hasIcf': True, 'hasSap': True, 'filename': 'Prot_SAP_ICF_000.pdf', 'typeAbbrev': 'Prot_SAP_ICF', 'uploadDate': '2023-02-03T05:02', 'hasProtocol': True}]}}, 'protocolSection': {'designModule': {'phases': ['NA'], 'studyType': 'INTERVENTIONAL', 'designInfo': {'allocation': 'RANDOMIZED', 'maskingInfo': {'masking': 'NONE'}, 'primaryPurpose': 'TREATMENT', 'interventionModel': 'PARALLEL'}, 'enrollmentInfo': {'type': 'ACTUAL', 'count': 1238835}}, 'statusModule': {'overallStatus': 'COMPLETED', 'startDateStruct': {'date': '2019-07-01', 'type': 'ACTUAL'}, 'expandedAccessInfo': {'hasExpandedAccess': False}, 'statusVerifiedDate': '2025-02', 'completionDateStruct': {'date': '2021-06-30', 'type': 'ACTUAL'}, 'lastUpdateSubmitDate': '2025-02-28', 'studyFirstSubmitDate': '2019-01-22', 'resultsFirstSubmitDate': '2023-02-07', 'studyFirstSubmitQcDate': '2019-01-24', 'lastUpdatePostDateStruct': {'date': '2025-03-03', 'type': 'ACTUAL'}, 'resultsFirstSubmitQcDate': '2025-02-28', 'studyFirstPostDateStruct': {'date': '2019-01-28', 'type': 'ACTUAL'}, 'resultsFirstPostDateStruct': {'date': '2025-03-03', 'type': 'ACTUAL'}, 'primaryCompletionDateStruct': {'date': '2021-02-28', 'type': 'ACTUAL'}}, 'outcomesModule': {'primaryOutcomes': [{'measure': 'Change in Blood Pressure Control, % of Patients', 'timeFrame': 'baseline and 6 months', 'description': 'The primary outcome will be clinic-level change in the proportion of patients with controlled BP from baseline to 6 months after the start of the intervention. BP control will be defined according to NQF 0018 as the percent of eligible patients (defined below) with SBP \\<140 mmHg and DBP \\< 90 mmHg, based on measurements obtained at the most recent ambulatory clinical encounter at baseline (using the lowest measures of SBP and DBP at that encounter) and similarly at the 6-month time point after initiation of the intervention.'}], 'secondaryOutcomes': [{'measure': 'Change in Improvement in Blood Pressure, % of Patients', 'timeFrame': 'baseline and 12 months', 'description': 'This overall measure of BP improvement implements CMS065v4\\[ref\\], which defines BP improvement as either a reduction of 10 mmHg in SBP or achievement of SBP that is "adequately controlled" (SBP \\< 140 mmHg) in months 12 of the measurement period, among hypertensive patients not previously controlled.'}, {'measure': 'Change in Confirmatory Repeated Blood Pressure Measurement, % of Visits', 'timeFrame': 'baseline and 6 months', 'description': 'This process measure is designed to capture the practice of repeating a blood pressure measurement in the same visit when the first measurement done in clinic is high (SBP≥140 mmHg or DBP≥90 mmHg).'}, {'measure': 'Change in Medication Intensification, % of Visits', 'timeFrame': 'baseline and 6 months', 'description': 'This process measure captures the proportion of visits where BP is uncontrolled where a medication is ordered that is of a different class of medication than had previously been used. Note that this explicitly does not give credit for ordering a simple refill or medication dose increase, or use of a different medication in the same class.'}, {'measure': 'Change in Average Systolic Blood Pressure (SBP) Reduction After a Medication Intensification Visit, mmHg', 'timeFrame': 'baseline and 6 months', 'description': 'This continuous metric describes the change in SBP (+/- standard deviation) observed between a visit with a medication intensification to the subsequent visit occurring at least 10 days later.'}, {'measure': 'Change in Repeat Visit in 4 Weeks After a Visit With Elevated BP, % of Visits', 'timeFrame': 'baseline and 6 months', 'description': 'This process measure captures the proportion of persons who had uncontrolled HTN who made a subsequent visit within the following 4 weeks.'}, {'measure': 'Change in Use of Fixed Dose Combination Product Among Patients Taking 2 or More Classes of Medications, % of Patients', 'timeFrame': 'baseline and 6 months', 'description': 'Use of fixed dose combination medications helps with adherence, promotes rational combinations of medications, and increases likelihood of achieving BP control. This metric, which is limited to patients taking more than one medication class, describes the prevalence of fixed dose combination pill use.'}, {'measure': 'Change in Use of a CCB or Thiazide or Thiazide-like Diuretic Among African-American Patients on at Least One Medication, % of Patients', 'timeFrame': 'baseline and 6 months', 'description': 'Use of calcium channel blockers (CCB) OR a thiazide or thiazide-like diuretic medication classes is recommended to treat black or African American patients as first line monotherapy due to increased efficacy. This metric, which is limited to African-American patients with a diagnosis of hypertension taking at least one medication class, describes the prevalence of those receiving the recommended drug class.'}, {'measure': 'Change in Terminal Digit = Zero, % of Measurements', 'timeFrame': 'baseline and 6 months', 'description': 'Inappropriate rounding of blood pressure measurements (usually to zero) leads to measurement error and worse treatment decisions. This continuous metric is calculated for a clinic as the percent of measurements at that clinic (for hypertensive patients) where the terminal digit of the measurement is zero. A percent greater than 10% (if an automated BP monitor is used) or greater than 20% (if a manual BP monitor is used with recommended rounding to even digits) indicates evidence of inappropriate rounding. Unlike most of our metrics, lower is better, down to an ideal value of 10-20%, which would be expected if no rounding were occurring.\n\nFor this study we calculated the change in this continuous metric for each clinic from baseline to 6 months, and then described the mean change across clinics by group. As with our other outcomes, the unit of analysis in the study is a clinic.'}, {'measure': 'Change in Blood Pressure Controlled to 2017 Guideline Goal, % of Patients', 'timeFrame': 'baseline and 6 months', 'description': 'This alternative overall measure of BP control is identical to Metric 1, except that attainment of BP Control is defined by SBP \\< 130 mmHg and DBP \\< 80 mmHg, as per the goal stated in the 2017 ACC/AHA Hypertension Guideline\\[ref\\]. Note that while the treatment threshold varies in the Guideline, depending on cardiovascular risk, the goal applies to all patients.'}]}, 'oversightModule': {'oversightHasDmc': False, 'isFdaRegulatedDrug': False, 'isFdaRegulatedDevice': False}, 'conditionsModule': {'conditions': ['Hypertension']}, 'referencesModule': {'references': [{'pmid': '36695297', 'type': 'DERIVED', 'citation': "Fontil V, Modrow MF, Cooper-DeHoff RM, Wozniak G, Rakotz M, Todd J, Azar K, Murakami L, Sanders M, Chamberlain AM, O'Brien E, Lee A, Carton T, Pletcher MJ. Improvement in Blood Pressure Control in Safety Net Clinics Receiving 2 Versions of a Scalable Quality Improvement Intervention: BP MAP A Pragmatic Cluster Randomized Trial. J Am Heart Assoc. 2023 Feb 7;12(3):e024975. doi: 10.1161/JAHA.121.024975. Epub 2023 Jan 25."}]}, 'descriptionModule': {'briefSummary': 'BP-MAP is a cluster randomized controlled trial (RCT) designed to compare the effectiveness of BP lowering from a clinic-based quality improvement program with Full Support (dedicated practice facilitation) vs. a Self-Guided version of the program. The American Medical Association (AMA) developed the framework for the interventions.', 'detailedDescription': 'BP-MAP is a cluster randomized controlled trial (RCT) designed to compare the effectiveness of BP lowering from a clinic-based quality improvement program with Full Support (dedicated practice facilitation) vs. a Self-Guided version of the program. The American Medical Association (AMA) developed the framework for the interventions. The trial will be conducted within the National Patient-Centered Clinical Research Network (PCORnet) that enables distributed querying of electronic health record data in a common data model. The primary outcome will be change in clinic-level blood pressure (BP) control at 6 months. Secondary outcomes will include other blood pressure (BP) control metrics, other time points (12 and 18 months), and process measures such as BP measurement accuracy, medication intensification, and average systolic blood pressure (SBP) reduction after a medication intensification, and repeat visit within 4 weeks after a visit with elevated BP. The investigators hypothesize clinics randomized to the Full Support version will achieve a larger increase from baseline in the proportion of their hypertensive patients with controlled BP at 6 months as compared to clinics randomized to the Self-Guided version, and also as compared with usual care. The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating "Usual Care" institutions in PCORnet. This study was submitted to the IRB at UCSF, determined to be quality improvement and exempt from further review.'}, 'eligibilityModule': {'sex': 'ALL', 'stdAges': ['ADULT', 'OLDER_ADULT'], 'maximumAge': '85 Years', 'minimumAge': '18 Years', 'healthyVolunteers': False, 'eligibilityCriteria': 'ACTIVE CLINICS\n\nFor inclusion as an Active Clinic in this study, clinics may participate must be able to identify:\n\n* A Site Champion who works at the clinic and who is willing to take primary responsibility for implementing the M.A.P. intervention\n* A Physician Champion who works at the clinic and who is willing to advocate actively for the M.A.P. intervention\n* A Practice Change Facilitator willing to attend a 1-day training and help guide implementation of the M.A.P intervention for Full Support sites, with the support of AMA staff (may be the Site Champion or Physician Champion, or a person with regional responsibilities who can support multiple sites)\n\nSites will be excluded if they:\n\n* Have implemented any high blood pressure quality improvement component from the M.A.P. BP improvement program as part of Target: BP or from the AMA or Target: BP websites\n* Are currently involved in an ongoing clinical trial or grant funded project related to high blood pressure or hypertension\n\nUSUAL CARE CLINICS:\n\nUsual Care Clinics will include PCORnet Datamarts participating in BP TRACK, a concurrently-running BP Control Registry within PCORnet that will provide quarterly datamart-level estimates of BP control and other aggregate metrics relevant to BP control. All participating datamarts will be included, with the following exceptions:\n\n* Datamarts with any Active Clinics participating in BP MAP will be excluded\n* Datamarts that obscure dates via date-shifting will be excluded, as this will not allow for control of concurrent secular trends\n\nPATIENTS\n\nWithin clinics (Active or Usual Care), patients will be eligible (and identified from the electronic health record) if they meet National Quality Forum BP Control Metric (NQF 0018) criteria:\n\n* Age 18-85 on the date of analysis\n* At least one outpatient encounter with a diagnosis of hypertension during the first six months of the measurement year (ending on the date of analysis)\n* No diagnosis or evidence of end-stage renal disease on or prior to the end of the measurement year\n* No pregnancy during the measurement year\n* No admission to an inpatient setting during the measurement year'}, 'identificationModule': {'nctId': 'NCT03818659', 'acronym': 'BP MAP', 'briefTitle': 'Improving BP Control in Diverse Populations Using BP MAP', 'organization': {'class': 'OTHER', 'fullName': 'University of California, San Francisco'}, 'officialTitle': 'Improving Blood Pressure Control in Diverse Populations by Measuring Accurately, Acting Rapidly, and Partnering With Patients', 'orgStudyIdInfo': {'id': '18-25890'}}, 'armsInterventionsModule': {'armGroups': [{'type': 'ACTIVE_COMPARATOR', 'label': 'Self-Guided', 'description': 'Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.', 'interventionNames': ['Other: Self-Guided M.A.P. BP Improvement Program']}, {'type': 'EXPERIMENTAL', 'label': 'Full Support', 'description': 'Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.', 'interventionNames': ['Other: Full Support M.A.P. BP Improvement Program']}, {'type': 'NO_INTERVENTION', 'label': 'Usual Care', 'description': 'The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating "Usual Care" institutions in PCORnet.'}], 'interventions': [{'name': 'Self-Guided M.A.P. BP Improvement Program', 'type': 'OTHER', 'description': 'Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.', 'armGroupLabels': ['Self-Guided']}, {'name': 'Full Support M.A.P. BP Improvement Program', 'type': 'OTHER', 'description': 'Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.', 'armGroupLabels': ['Full Support']}]}, 'contactsLocationsModule': {'locations': [{'zip': '95531', 'city': 'Crescent City', 'state': 'California', 'country': 'United States', 'facility': 'Open Door Del Norte CHC', 'geoPoint': {'lat': 41.75595, 'lon': -124.20175}}, {'zip': '95501', 'city': 'Eureka', 'state': 'California', 'country': 'United States', 'facility': 'Open Door Eureka Community Health & Wellness Center', 'geoPoint': {'lat': 40.80207, 'lon': -124.16367}}, {'zip': '90026', 'city': 'Los Angeles', 'state': 'California', 'country': 'United States', 'facility': 'QueensCare Echo Park Clinic', 'geoPoint': {'lat': 34.05223, 'lon': -118.24368}}, {'zip': '93906', 'city': 'Salinas', 'state': 'California', 'country': 'United States', 'facility': 'Monterey County Health Department Laurel Family Practice', 'geoPoint': {'lat': 36.67774, 'lon': -121.6555}}, {'zip': '70037', 'city': 'Belle Chasse', 'state': 'Louisiana', 'country': 'United States', 'facility': 'Belle Chasse Community Health Center', 'geoPoint': {'lat': 29.85493, 'lon': -89.99063}}, {'zip': '70118', 'city': 'Carrollton', 'state': 'Louisiana', 'country': 'United States', 'facility': 'Daughters of Charity Carrollton', 'geoPoint': {'lat': 29.94727, 'lon': -90.12969}}, {'zip': '70043', 'city': 'Chalmette', 'state': 'Louisiana', 'country': 'United States', 'facility': 'St. Bernard Community Health Center', 'geoPoint': {'lat': 29.94296, 'lon': -89.96537}}, {'zip': '70056', 'city': 'Gretna', 'state': 'Louisiana', 'country': 'United States', 'facility': 'Daughters of Charity Gretna', 'geoPoint': {'lat': 29.91465, 'lon': -90.05396}}, {'zip': '70065', 'city': 'Kenner', 'state': 'Louisiana', 'country': 'United States', 'facility': 'Daughters of Charity Kenner', 'geoPoint': {'lat': 29.99409, 'lon': -90.24174}}, {'zip': '70065', 'city': 'Kenner', 'state': 'Louisiana', 'country': 'United States', 'facility': 'Kenner Community Health Center', 'geoPoint': {'lat': 29.99409, 'lon': -90.24174}}, {'zip': '70070', 'city': 'Luling', 'state': 'Louisiana', 'country': 'United States', 'facility': 'St Charles Community Health Center- Paul Maillard', 'geoPoint': {'lat': 29.93215, 'lon': -90.36647}}, {'zip': '70070', 'city': 'Luling', 'state': 'Louisiana', 'country': 'United States', 'facility': 'St. Charles Community Health Center', 'geoPoint': {'lat': 29.93215, 'lon': -90.36647}}, {'zip': '70001', 'city': 'Metairie', 'state': 'Louisiana', 'country': 'United States', 'facility': 'Daughters of Charity Metairie', 'geoPoint': {'lat': 29.98409, 'lon': -90.15285}}, {'zip': '700117', 'city': 'New Orleans', 'state': 'Louisiana', 'country': 'United States', 'facility': 'Daughters of Charity St. Cecilia', 'geoPoint': {'lat': 29.95465, 'lon': -90.07507}}, {'zip': '700126', 'city': 'New Orleans', 'state': 'Louisiana', 'country': 'United States', 'facility': 'Daughters of Charity Higgins', 'geoPoint': {'lat': 29.95465, 'lon': -90.07507}}, {'zip': '700127', 'city': 'New Orleans', 'state': 'Louisiana', 'country': 'United States', 'facility': 'Daughters of Charity New Orleans East', 'geoPoint': {'lat': 29.95465, 'lon': -90.07507}}, {'zip': '70112', 'city': 'New Orleans', 'state': 'Louisiana', 'country': 'United States', 'facility': 'Access Health Louisiana Primary Care at the Pythian', 'geoPoint': {'lat': 29.95465, 'lon': -90.07507}}, {'zip': '70122', 'city': 'New Orleans', 'state': 'Louisiana', 'country': 'United States', 'facility': 'Daughters of Charity Gentilly', 'geoPoint': {'lat': 29.95465, 'lon': -90.07507}}, {'zip': '97459', 'city': 'North Bend', 'state': 'Oregon', 'country': 'United States', 'facility': 'Waterfall CHC', 'geoPoint': {'lat': 43.4065, 'lon': -124.22428}}, {'zip': '97141', 'city': 'Tillamook', 'state': 'Oregon', 'country': 'United States', 'facility': 'Tillamook CHC', 'geoPoint': {'lat': 45.4564, 'lon': -123.84553}}, {'zip': '98007', 'city': 'Bellevue', 'state': 'Washington', 'country': 'United States', 'facility': 'Public Health: Seattle & King County Eastgate Public Health Center', 'geoPoint': {'lat': 47.61038, 'lon': -122.20068}}, {'zip': '98166', 'city': 'Burien', 'state': 'Washington', 'country': 'United States', 'facility': 'Public Health: Seattle & King County Primary Care at Navos', 'geoPoint': {'lat': 47.47038, 'lon': -122.34679}}, {'zip': '98632', 'city': 'Longview', 'state': 'Washington', 'country': 'United States', 'facility': 'Cowlitz County Health Department Cowlitz County: North Beach Clinic', 'geoPoint': {'lat': 46.13817, 'lon': -122.93817}}, {'zip': '98121', 'city': 'Seattle', 'state': 'Washington', 'country': 'United States', 'facility': 'Public Health: Seattle & King County Downtown Public Health Center', 'geoPoint': {'lat': 47.60621, 'lon': -122.33207}}], 'overallOfficials': [{'name': 'Mark Pletcher, MD, MPH', 'role': 'PRINCIPAL_INVESTIGATOR', 'affiliation': 'University of California, San Francisco'}]}, 'ipdSharingStatementModule': {'ipdSharing': 'NO'}, 'sponsorCollaboratorsModule': {'leadSponsor': {'name': 'University of California, San Francisco', 'class': 'OTHER'}, 'collaborators': [{'name': 'OCHIN, Inc.', 'class': 'OTHER'}, {'name': 'Louisiana Public Health Institute', 'class': 'OTHER'}, {'name': 'American Medical Association', 'class': 'OTHER'}, {'name': 'American Heart Association', 'class': 'OTHER'}], 'responsibleParty': {'type': 'SPONSOR'}}}}