Evaluating the Impact of an Equity Focused Dashboard and Clinical Support on Disparities in Primary Care Ambulatory Quality Outcome Measures: a Quality Improvement Research Project

A clinical program will be implemented to utilize the equity dashboard in routine clinical practice augmented by clinical support to address current disparities in hypertension control among MGH primary care patients who are Black, Indigenous and People of Color (BIPOC) as well as patients with limited English proficiency (LEP). The clinical support will be provided by population health coordinators (PHCs) and/or community health workers (CHWs).

To evaluate the program, the investigators propose a stepped wedge design that will randomize the primary care providers to the provision of the equity dashboard and additional clinical support at different intervals. The primary reason to randomize the primary care providers is because the PHCs and CHWs have limited capacity to contact and assist the patients in our primary care practices with poorly controlled hypertension and can only engage a limited number of patients at a time.

The stepped wedge cluster-randomized study design will randomize providers in all 15 MGH primary care practices to receiving the intervention (i.e. equity dashboard with additional clinical support) in twelve groups. Each step will be a one-month period. Providers randomized to Group 1 will receive the equity dashboard data as well as additional clinical support starting in Step 1 while providers randomized to Group 12 will receive the same intervention at the beginning of Step 12 but receive usual care in Steps 0-11. We will match Providers in the opposite steps (e.g. Group 1 vs. Group 12, Group 2 vs. Group 11, etc.) by practice, baseline hypertension control rate, and the number of patients in their panel who are eligible for the intervention to ensure balance between data collected from the intervention periods and control periods. The stepped wedge design will allow for an open cohort (i.e. new patients of the providers allocated to the intervention can enter in subsequent steps) and a repeated measures data analysis with the same patients experiencing both control and intervention conditions.