DECIPHeR

The DECIPHeR (Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk) Alliance

The UCLA DECIPHeR Alliance study, Multi-ethnic Multi-level Strategies and Behavioral Economics to Eliminate Hypertension Disparities in LA County, is led by the CTSI's Community Engagement and Research Program leaders, Dr. Arleen Brown and Dr. Alejandra Casillas. The study focuses on the racial/ethnic gaps in evidence-based treatment that contribute to hypertension disparities in the Los Angeles County Department of Health Services (LAC DHS). 43% of LAC DHS patients have hypertension, of which 60% are uncontrolled. The study focuses on racial/ethnic populations within LAC DHS with high rates of hypertension, including Latinos (42%), African Americans (48%), Chinese (31%), Filipino (62%), and Koreans (34%).

The UCLA DECIPHeR Team is using the Exploration, Preparation, Implementation, Sustainment (EPIS) implementation framework. They are engaging variety of stakeholders including community-based organizations, LAC DHS and other governmental agencies, health care providers, community health workers, and study participants. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE- AIM) evaluation framework will be used to evaluate the implementation strategies.

The UCLA DECIPHeR specific aims are:

Aim 1 (UG3 phase): Assess multilevel (patient, clinician, health system leadership, and community) barriers to, facilitators of, and preferences for a menu of culturally tailored evidence-based practices (EBPs) and implementation strategies with established efficacy for hypertension control.

Aim 2 (UG3 phase): Select and systematically apply behavioral economics to the design of our patient-, clinician-, and community-directed implementation strategies to maximize acceptability, uptake, and effectiveness.

Aim 3 (UH3 phase): Test the effectiveness of our implementation strategies in a stepped-wedge cluster randomized trial design using RE-AIM to guide assessment of uncontrolled hypertension, disparities in comparison to non-minority LAC populations, and evidence-based practices.

DECIPHeR | Centers (decipheralliance.org) is a national consortium comprised of seven research centers with funding from the National Heart, Lung, and Blood Institute to identify implementation strategies to effectively deliver evidence-based interventions and engage diverse multidisciplinary stakeholders in communities with high burdens of heart and/or lung disease.

In partnership with the Los Angeles County Department of Health Services (LAC DHS) and the RAND Corporation, the UCLA DECIPHeR Project aims to develop and implement culturally-tailored, evidence-based, multi-level interventions to improve blood pressure (BP) control and reduce BP-related health disparities among patients in LAC DHS. The study will operate within LAC DHS outpatient and hospital-based clinics and will include Latino, Black, Korean, Chinese and Filipino American patients with uncontrolled hypertension. The evidence-based interventions have been tailored in collaboration with Los Angeles County patient, community, and health system stakeholders, and includes cultural tailoring based on the needs of different racial, ethnic, and socioeconomic groups.