Impact of a Telehealth Navigator Intervention on Hypertension Control Among Black Patients Served by Federally Qualified Health Centers

BACKGROUND: Hypertension-a leading cardiovascular disease risk factor-disproportionately impacts Black individuals in part due to inequities in access to quality, coordinated health care. OBJECTIVE: To evaluate the effectiveness of a federally qualified health center (FQHC) telehealth navigator intervention that provided enhanced care coordination and remote patient monitoring (RPM) to Black patients with hypertension at one northeast FQHC. DESIGN: Leveraging a staggered difference-in-differences approach and FQHC electronic health record data, this observational study used doubly robust ordinary least squares regression models to compare outcomes before versus after a patient enrolled in the intervention compared to similar patients who were not-yet or never enrolled. Models adjusted for demographic variables, unmet health-related social needs, and clinical diagnoses, and applied inverse propensity weights. Patient-month was the unit of analysis. PARTICIPANTS: The study cohort included Black individuals who received care from a Massachusetts-based FQHC network, aged ≥ 18 years, with a baseline hypertension diagnosis, and with blood pressure measurement data across multiple study period intervals. MAIN MEASURES: Exposure was enrollment in the FQHC telehealth navigator intervention. The primary outcome was controlled blood pressure (< 140/90); total primary care visits were examined as a secondary outcome. KEY RESULTS: Prior to applying propensity weights, the intervention group (n = 5175 person-months; mean age of 60 years) was 44.3% female; the comparison group (n = 328,950 person-months; mean age of 57 years) was 61% female. The intervention was associated with a 31.4 percentage point (95% CI 13.2, 49.1; p = 0.001) increase in probability of having controlled blood pressure. There were no changes in primary care engagement overall, but event study analyses showed significant increases in visits in the first 2 months of the intervention. CONCLUSIONS: Findings suggest that expanding telehealth navigator programs in primary care may improve hypertension control. This may be supported through expanded reimbursement of RPM and care delivery models that incorporate telehealth navigator roles.