Championing Hypertension Remote Monitoring for Equity and Dissemination (CHARMED): A multi-site factorial randomized...

Area of Science:

• Implementation science
• Digital health
• Hypertension management

Background:

• Evidence-based strategies like remote patient monitoring (RPM) and digital health tools can improve hypertension outcomes.
• Large-scale studies are needed to disseminate these practices into routine clinical care, particularly in safety-net settings serving marginalized populations.

Purpose of the Study:

• To conduct a hybrid type 1 implementation trial evaluating the dissemination of RPM for hypertension management in safety-net clinics.
• To assess the impact of different levels of support (training vs. training plus facilitation) and patient-facing interventions (basic reminders vs. tailored feedback) on hypertension control.

Main Methods:

• A 2x2 factorial hybrid type 1 implementation trial involving 25 safety-net clinics and 2500 patients with uncontrolled hypertension.
• Randomization of clinics to receive baseline training or training plus practice facilitation.
• Randomization of patients to receive either basic text message reminders or tailored text message feedback alongside cellular-enabled blood pressure monitors.

Main Results:

• The primary outcome is the change in systolic blood pressure during routine office visits.
• Secondary outcomes include changes in home blood pressure and patient-reported measures of clinical care and medication adherence.
• Primary implementation outcomes focus on patient and clinic-level adoption of the intervention.

Conclusions:

• This trial will provide crucial evidence on implementing patient- and clinic-facing strategies for hypertension management.
• Findings will advance implementation science by demonstrating how to integrate digital health tools into routine care within safety-net settings.