Robert M. Califf, MD

Rob Califf was shocked when he discovered he had hypertension. It had been a few years since he’d paid much attention to his blood pressure -- then, in 2010, his doctor told him it was too high.

Considering Califf’s life and work, his high blood pressure is not surprising. He is an executive at a large corporation, he eats out frequently, he travels all over the world, he’s in his late 50s, and he doesn’t care for exercise.

But here’s the twist -- Rob Califf, MD, is Duke’s vice chancellor for clinical research, he’s a practicing cardiologist, he directs the Duke Translational Medicine Institute, and he’s one of the world’s foremost researchers in cardiovascular medicine.

Check It, Change It

Califf had already begun treatment for hypertension when he decided to enroll in a Duke-led, community-based quality improvement initiative designed to help residents of Durham County control their blood pressure. He was the first person to enroll in Check It, Change It, a grassroots effort that is an offshoot of Durham Health Innovations (DHI), a public-private-academic partnership that Califf helped found.

Check It, Change It is a unique model of integrated care for hypertension. The genesis of the project was when Califf and Duke won an award from the National Institutes of Health to investigate how medical researchers can translate findings more quickly from an academic setting into the community to improve population-based health.

With the award in hand and the knowledge that 30 percent of Durham County residents suffer from hypertension, DHI began to formulate an intervention strategy. Meanwhile, the American Heart Association (AHA) heard about the effort and contributed substantial funding.

The program began enrollment in December 2010 after hiring three physician assistants and seven community health coaches to serve as patient liaisons. These Check It, Change It staffers promoted the program heavily in busy community venues such as churches, mosques, barbershops, schools, libraries, and community centers.

“We wanted to drive blood pressure care outside of traditional health care settings into the community where people work, live, and play,” says Bimal Shah, MD, a Duke cardiologist who is co-principal investigator for Check It, Change It with fellow Duke cardiologist Kevin Thomas, MD, and Sharon Elliott-Bynum, PhD, executive director of community health nonprofit CAARE Inc.

Through eight participating clinics, program staff enrolled 2,045 Durham County residents. With the Check It, Change It team, participants designed a plan to reduce their blood pressure (BP), including diet and exercise modifications, hypertension educational counseling, and/or medication. Physician assistants monitored progress and followed up to make sure participants stayed on track.

Patients checked their own BP at least once a week, either at home or at blood pressure monitoring stations located in 17 convenient locations throughout the community.

The self-check stations automatically entered blood pressure measurements into the AHA’s Heart 360 Web portal, a tool that promotes data sharing with primary care providers and Check It, Change It staff. (Those monitoring at home entered their data on Heart 360 themselves.) The goal was a reduction in BP after six months of program participation.

Califf’s results have been good. He has lost 10 pounds, with a goal of losing five to 10 more; his blood pressure is controlled by one medication; and he works out at least 30 minutes a day on an elliptical machine.

His regular monitoring has allowed him to adjust the dosage of his medicine right away when he notices spikes in his BP. But it has been the human contact of Check It, Change It that he has found the most helpful.

“We know that people are busy and lead stressful, complex lives,” Califf says, noting that program staff helped him stay diligent. “They’ll get on the phone and give you a call if you haven’t entered your data, or your data doesn’t look good. Active follow-up and reminders are the most important thing.”

The intervention phase of Check It, Change It ended in February, and preliminary results are positive. If final results indicate success, organizers plan to extend the community-based model to other chronic health issues such as obesity, diabetes, and high cholesterol. They also hope that other communities will adopt the model.