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Community Outreach and Cardiovascular Health (COACH) Trial: A Randomized, Controlled Trial of Nurse Practitioner/Community Health Worker Cardiovascular Disease Risk Reduction in Urban Community Health Centers
Open accessAbstract
BACKGROUND: Despite well-publicized guidelines on the appropriate management of cardiovascular disease and type 2 diabetes, the implementation of risk-reducing practices remains poor. This report describes the results of a randomized, controlled clinical trial evaluating the effectiveness of a comprehensive program of cardiovascular disease risk reduction delivered by nurse practitioner /community health worker (NP/CHW) teams versus enhanced usual care (EUC) to improve lipids, blood pressure, glycated hemoglobin (HbA1c), and patient perceptions of the quality of their chronic illness care in patients in urban community health centers. METHODS AND RESULTS: A total of 525 patients with documented cardiovascular disease, type 2 diabetes, hypercholesterolemia, or hypertension and levels of LDL cholesterol, blood pressure, or HbA1c that exceeded goals established by national guidelines were randomly assigned to NP/CHW (n=261) or EUC (n=264) groups. The NP/CHW intervention included aggressive pharmacological management and tailored educational and behavioral counseling for lifestyle modification and problem solving to address barriers to adherence and control. Compared with EUC, patients in the NP/CHW group had significantly greater 12-month improvement in total cholesterol (difference, 19.7 mg/dL), LDL cholesterol (difference,15.9 mg/dL), triglycerides (difference, 16.3 mg/dL), systolic blood pressure (difference, 6.2 mm Hg), diastolic blood pressure (difference, 3.1 mm Hg), HbA1c (difference, 0.5%), and perceptions of the quality of their chronic illness care (difference, 1.2 points). CONCLUSIONS: An intervention delivered by an NP/CHW team using individualized treatment regimens based on treat-to-target algorithms can be an effective approach to improve risk factor status and perceptions of chronic illness care in high-risk patients.
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“A randomized controlled trial in 2 community health centers enrolled 525 patients with uncontrolled ASCVD, T2D, hypertension, or hyperlipidemia; results showed that pairing nurse practitioners and community health workers demonstrated significant reductions in blood pressure, cholesterol, and HbA 1c over 1 year of follow-up compared with usual care (86).”
From The CardioMetabolic Health Alliance (2015) · cites this paper as [86]
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Metadata
- Authors
- Allen, J. K., Dennison-Himmelfarb, C. R., Szanton, S. L., Bone, L., Hill, M. N., Levine, D. M., West, M., Barlow, A., Lewis-Boyer, L., Donnelly-Strozzo, M., Curtis, C., & Anderson, K.
- Affiliations
- Johns Hopkins University (US)
- From Johns Hopkins University School of Nursing (J.K.A., C.R.D.H., S.L.S., M.N.H., D.M.L., A.B., L.L.-B., C.C., M.D.-S., K.A.), Johns Hopkins University School of Medicine (J.K.A., C.R.D.H., M.N.H., D.M.L.), Johns Hopkins University School of Public Health (J.K.A., L.B., M.N.H., D.M.L.), Baltimore, MD; and Baltimore Medical Systems (M.W.), Baltimore, MD.
- Venue
- Circulation Cardiovascular Quality and Outcomes
- Published
- 2011-11
- Volume
- 4
- Issue
- 6
- Pages
- 595-602
- ISSN
- 1941-7705 (ISSN-L)
- 1941-7713
- PMC
- PMC3218795
- OpenAlex
- W2123602096
- Cited by
- 187
- References
- 51
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 23 · 2023: 14 · 2022: 10 · 2021: 11 · 2020: 11 · 2019: 10 · 2018: 7 · 2017: 17 · 2016: 15 · 2015: 14 · 2014: 21 · 2013: 7 · 2012: 12
- FWCI
- 13.19
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation Cardiovascular Quality and Outcomes (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (R01HL082638)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24HD042854)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- cardiovascular disease risk reduction, type 2 diabetes, nurse practitioners, community health workers, hypercholesterolemia, hypertension, lipid control, blood pressure control, HbA1c, lifestyle modification, medication adherence, community health centers, urban health centers
- MeSH terms
- Blood Pressure, Cardiovascular Diseases, Community Health Services, Counseling, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Nurse Practitioners, Patient Education as Topic, Risk, Urban Population, Program Evaluation, Practice Guidelines as Topic, Risk Reduction Behavior, Lipid Metabolism, Precision Medicine
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