title: The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol (01295).
abstract: 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.
authors.affiliation: Center for Health Services Research in Primary Care, Durham VAMC, Durham NC, USA. hayden.bosworth@duke.edu.
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.forename: Daniel
authors.initials: D
authors.lastname: Almirall
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Weiner
authors.forename: Mathew
authors.initials: M
authors.lastname: Maciejewski
authors.forename: Miriam A
authors.initials: MA
authors.lastname: Kaufman
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Powers
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.forename: Shoou-Yih D
authors.initials: SY
authors.lastname: Lee
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Damush
authors.forename: Valerie
authors.initials: V
authors.lastname: Smith
authors.forename: Maren K
authors.initials: MK
authors.lastname: Olsen
authors.forename: Daren
authors.initials: D
authors.lastname: Anderson
authors.forename: Christianne L
authors.initials: CL
authors.lastname: Roumie
authors.forename: Susan
authors.initials: S
authors.lastname: Rakley
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Del Monte
authors.forename: Michael E
authors.initials: ME
authors.lastname: Bowen
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Kravetz
authors.forename: George L
authors.initials: GL
authors.lastname: Jackson