{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T20:08:41Z","timestamp":1788120521919,"version":"build-2803163510"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Mobile health (mHealth) strategies initiated in safety-net Emergency Departments may be one approach to address the US hypertension epidemic, but the optimal mHealth components or dose are unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Reach Out is an mHealth, health theory-based, 2\u00d72\u00d72 factorial trial among hypertensive patients evaluated in a safety-net Emergency Department in Flint, Michigan. Reach Out consisted of 3 mHealth components, each with 2 doses: (1) healthy behavior text messaging (yes versus no), (2) prompted self-measured blood pressure (BP) monitoring and feedback (weekly versus daily), and (3) facilitated primary care provider appointment scheduling and transportation (yes versus no). The primary outcome was a change in systolic BP from baseline to 12 months. In a complete case analysis, we fit a linear regression model and accounted for age, sex, race, and prior BP medications to explore the association between systolic BP and each mHealth component.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Among 488 randomized participants, 211 (43%) completed follow-up. Mean age was 45.5 years, 61% were women, 54% were Black people, 22% did not have a primary care doctor, 21% lacked transportation, and 51% were not taking antihypertensive medications. Overall, systolic BP declined after 6 months (\u22129.2 mm\u2009Hg [95% CI, \u221212.2 to \u22126.3]) and 12 months (\u22126.6 mm\u2009Hg, \u22129.3 to \u22123.8), without a difference across the 8 treatment arms. The higher dose of mHealth components were not associated with a greater change in systolic BP; healthy behavior text messages (point estimate, mmHG=\u22120.5 [95% CI, \u22126.0 to 5];\n              <jats:italic>P<\/jats:italic>\n              =0.86), daily self-measured BP monitoring (point estimate, mmHG=1.9 [95% CI, \u22123.7 to 7.5];\n              <jats:italic>P<\/jats:italic>\n              =0.50), and facilitated primary care provider scheduling and transportation (point estimate, mmHG=0 [95% CI, \u22125.5 to 5.6];\n              <jats:italic>P<\/jats:italic>\n              =0.99).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Among participants with elevated BP recruited from an urban safety-net Emergency Department, BP declined over the 12-month intervention period. There was no difference in change in systolic BP among the 3 mHealth components. Reach Out demonstrated the feasibility of reaching medically underserved people with high BP cared for at a safety-net Emergency Departments, yet the efficacy of the Reach Out mHealth intervention components requires further study.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Registration:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT03422718.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.122.009606","type":"journal-article","created":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T17:53:55Z","timestamp":1684259635000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Reach Out Emergency Department: A Randomized Factorial Trial to Determine the Optimal Mobile Health Components to Reduce Blood Pressure"],"prefix":"10.1161","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct03422718","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Lesli E.","family":"Skolarus","sequence":"first","affiliation":[{"name":"Davee Department of Neurology, Northwestern University, Feinberg School of Medicine Chicago, IL (L.E.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mackenzie","family":"Dinh","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (M.D., R.O., D.E.T., C.W., Z.F., A.F., S.M., W.J.M.), University of Michigan, Ann Arbor."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1717-4483","authenticated-orcid":true,"given":"Kelley M.","family":"Kidwell","sequence":"additional","affiliation":[{"name":"Department of Statistics, University of Michigan School of Public Health, Ann Arbor (K.M.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun Chieh","family":"Lin","sequence":"additional","affiliation":[{"name":"Health Services Research Program (C.C.L.), University of Michigan, Ann Arbor."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorraine R.","family":"Buis","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Policy and Innovation (L.R.B.), University of Michigan, Ann Arbor."},{"name":"Department of Family Medicine (L.R.B.), University of Michigan, Ann Arbor."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9815-3421","authenticated-orcid":true,"given":"Devin L.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Neurology (D.L.B., W.J.M.), University of Michigan, Ann Arbor."},{"name":"Stroke Program (D.L.B., W.J.M.), University of Michigan, Ann Arbor."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rockefeller","family":"Oteng","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (M.D., R.O., D.E.T., C.W., Z.F., A.F., S.M., W.J.M.), University of Michigan, Ann Arbor."},{"name":"Department of Emergency Medicine, Hurley Medical Center, Flint, MI (R.O., D.B., M.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Giacalone","sequence":"additional","affiliation":[{"name":"Hamilton Community Health Network, Flint, MI (M.G., K.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2379-6553","authenticated-orcid":true,"given":"Kimberly","family":"Warden","sequence":"additional","affiliation":[{"name":"Hamilton Community Health Network, Flint, MI (M.G., K.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah E.","family":"Trimble","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (M.D., R.O., D.E.T., C.W., Z.F., A.F., S.M., W.J.M.), University of Michigan, Ann Arbor."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Candace","family":"Whitfield","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (M.D., R.O., D.E.T., C.W., Z.F., A.F., S.M., W.J.M.), University of Michigan, Ann Arbor."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahera","family":"Farhan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (M.D., R.O., D.E.T., C.W., Z.F., A.F., S.M., W.J.M.), University of Michigan, Ann Arbor."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4480-0910","authenticated-orcid":true,"given":"Adam","family":"Flood","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (M.D., R.O., D.E.T., C.W., Z.F., 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