Abstract WMP52: Shake, Rattle & Roll Trial - Effects on Blood Pressure Control and Therapy
Bibliographic record
Abstract
Background: In Kaiser Permanente Northern California (KPNC), a setting where all members have similar access to healthcare and a very high overall rate of HTN control, blacks still had poorer BP control than whites. It has been suggested that greater difficulty in controlling BP and lifestyle differences may account for this difference. The “Shake, Rattle and Roll” (SRR) trial is named for: 1) “shake” the salt habit; 2) “rattle” the intensity of current BP management; and 3) adapt and “roll” out the interventions to other communities. Methods: SRR is a pragmatic clustered randomized controlled trial. All PCPs at Kaiser Oakland and their panels of black patients were randomized, stratified by panel size, to one of 3 arms: 1) usual care (UC); or 2) enhanced monitoring (EM) of current KPNC BP management protocol; or 3) culturally tailored diet and lifestyle (LS) coaching focused on the DASH eating plan. Black patients from KPNC HTN registry with an identifying high BP reading ≥ 140/90 qualified to be recruited into SRR. The intervention period lasted 12 months. We assessed rates of BP control using the latest follow-up BP measurements between enrollment and 15 months post-enrollment. Data on demographics and anti-hypertensives were collected from participants’ EMRs. Results: We cluster randomized 107 PCPs to one of 3 arms. There were 1185 enrolled in UC, and 318 in EM and 259 in LS. Median ages ranged from 63-65 years [Table]. Among those enrolled, BP control rates were higher in EM and LS than in UC (53% in UC, 69% in EM, and 71% in LS, p<0.001). However, a significant proportion of UC did not have a follow-up BP measurement during the trial period. There were also significant differences in anti-hypertensive usage across the 3 arms [Table]. Conclusions: Preliminarily, among those enrolled in SRR, EM and LS arms had better BP control than UC and there were differences in the types of anti-hypertensive therapy used. Further analyses of all aspects of BP management in SRR are under way.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.024 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".