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Understanding inequities in hypertension management and related outcomes in the Veterans Health Administration

Summer 2023

Project Background

Our goal is to reduce hypertension-related morbidity and mortality racial/ethnic disparities in the Veterans Health Administration (VHA) by optimizing antihypertensive medication management in primary care teams. Achieving and maintaining the most recent intensive blood pressure control guidelines, such as those released by the American College of Cardiology/American Heart Association in 2017, may avert half a million cardiovascular disease events over 10 years in the US population. The goal of this project is to contrast patient-, provider-, and facility-level factors associated with intensive antihypertensive medication management (initiation, adherence, and intensification) and blood pressure control by race/ethnicity by leveraging the VHA national electronic health record. The findings from this project will help us to leverage the VHA Office of Health Equity Primary Care Equity Dashboard, launched in 2021, an audit feedback tool, to support the eventual development of a team-based playbook designed to mitigate hypertension disparities and support implementation of evidence-based care among racial/ethnic minority Veterans.

This project is funded by the Research Experiences to Advance the Careers of HBCU Undergraduates at the University of Utah (REACH U2) program, which is co-directed by Dr. Kola Okuyemi of University of Utah and Dr. Ray Samuel of North Carolina A&T. Applicants must be North Carolina Agricultural & Technical State University students.

Student Role

The student will have the opportunity to select from multiple research questions falling within the broader scope of the project. Some of the knowledge gaps we seek to address include the following: 1) unknown adoption of the new intensive BP EBPs by race/ethnicity; 2) few real-world VA studies of virtual and non-VA community care for hypertension; 3) limited understanding of provider/team or healthcare facility factors related to intensive antihypertensive medication management by race/ethnicity in VHA. My team has the data and statistical support personnel to support the research. The student will partner with the team to lead and/or contribute to the refinement of the research question, analysis plan, and will be mentored through the dissemination of research products, which could include an abstract submission, poster/oral presentation, manuscript or report development, and publication.

Student Learning Outcomes and Benefits

The student will gain an understanding of the research opportunities and health equity research priorities of the largest integrated healthcare systems in the US. They will gain hands-on experience contributing to team science, developing collaboration and communication skills, learn project management strategies, and will gain an understanding of the multiple roles of individuals who contribute to team science. The student will be encouraged to attend regular team meetings and will be given the opportunity to present internally and externally on research activities. The student will learn how co-lead a research project, including how to review the relevant literature to the research, identify knowledge and practice gaps, develop a hypothesis, and plan a research study. They will learn some of the challenges and opportunities of working with ‘big and real-world data’. The student will learn some of the methods used in epidemiology, health services, and implementation science research, as they are interested.

April Mohanty

Research Assistant Professor
Internal Medicine

My philosophy is to meet the mentee’s needs and their definition of a successful experience. I aim to be wholistic in my approach to support their advancement and not just the research products. Once the mentee and I agree on the research question they want to address, we will prepare a timeline, planned deliverables and activities, discuss resources needed, and formulate an agreed upon list of mentor/mentee expectations. I will meet with the mentee 1 on 1 at least weekly to ensure they are receiving support they need to be successful, that milestones are being met, and we will also discuss any adaptations needed to milestones and expectations. I will be highly accessible to the mentee while also aiming to empower them to being creative and self-led.