The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol (01295).
BACKGROUND
Despite the impact of hypertension and widely accepted target values for blood pressure (BP), interventions to improve BP control have had limited success.


OBJECTIVE
We describe the design of a 'translational' study that examines the implementation, impact, sustainability, and cost of an evidence-based nurse-delivered tailored behavioral self-management intervention to improve BP control as it moves from a research context to healthcare delivery. The study addresses four specific aims: assess the implementation of an evidence-based behavioral self-management intervention to improve BP levels; evaluate the clinical impact of the intervention as it is implemented; assess organizational factors associated with the sustainability of the intervention; and assess the cost of implementing and sustaining the intervention.


METHODS
The project involves three geographically diverse VA intervention facilities and nine control sites. We first conduct an evaluation of barriers and facilitators for implementing the intervention at intervention sites. We examine the impact of the intervention by comparing 12-month pre/post changes in BP control between patients in intervention sites versus patients in the matched control sites. Next, we examine the sustainability of the intervention and organizational factors facilitating or hindering the sustained implementation. Finally, we examine the costs of intervention implementation. Key outcomes are acceptability and costs of the program, as well as changes in BP. Outcomes will be assessed using mixed methods (e.g., qualitative analyses--pattern matching; quantitative methods--linear mixed models).


CONCLUSIONS
The study results will provide information about the challenges and costs to implement and sustain the intervention, and what clinical impact can be expected.
Bosworth
Hayden B
HB
Center for Health Services Research in Primary Care, Durham VAMC, Durham NC, USA. hayden.bosworth@duke.edu.
Almirall
Daniel
D
Weiner
Bryan J
BJ
Maciejewski
Mathew
M
Kaufman
Miriam A
MA
Powers
Benjamin J
BJ
Oddone
Eugene Z
EZ
Lee
Shoou-Yih D
SY
Damush
Teresa M
TM
Smith
Valerie
V
Olsen
Maren K
MK
Anderson
Daren
D
Roumie
Christianne L
CL
Rakley
Susan
S
Del Monte
Pamela S
PS
Bowen
Michael E
ME
Kravetz
Jeffrey D
JD
Jackson
George L
GL