@article{52a9ea55ad1f48c7bc0c7282cfc6224f,
title = "A bundled quality improvement program to standardize clinical blood pressure measurement in primary care",
abstract = "We evaluated use of a program to improve blood pressure measurement at 6 primary care clinics over a 6-month period. The program consisted of automated devices, clinical training, and support for systems change. Unannounced audits and electronic medical records provided evaluation data. Clinics used devices in 81.0% of encounters and used them as intended in 71.6% of encounters, but implementation fidelity varied. Intervention site systolic and diastolic blood pressure with terminal digit “0” decreased from 32.1% and 33.7% to 11.1% and 11.3%, respectively. Improvement occurred uniformly, regardless of sites{\textquoteright} adherence to the measurement protocol. Providers rechecked blood pressure measurements less often post-intervention (from 23.5% to 8.1% of visits overall). Providers at sites with high protocol adherence were less likely to recheck measurements than those at low adherence sites. Comparison sites exhibited no change in terminal digit preference or repeat measurements. This study demonstrates that clinics can apply a pragmatic intervention to improve blood pressure measurement. Additional refinement may improve implementation fidelity.",
keywords = "blood pressure measurement, chronic disease, hypertension, implementation science, primary care, quality improvement",
author = "Boonyasai, {Romsai T.} and Carson, {Kathryn A.} and Marsteller, {Jill A.} and Dietz, {Katherine B.} and Noronha, {Gary J.} and Hsu, {Yea Jen} and Flynn, {Sarah J.} and Charleston, {Jeanne M.} and Prokopowicz, {Greg P.} and Miller, {Edgar R.} and Cooper, {Lisa A.}",
note = "Funding Information: Funding information National Heart, Lung, and Blood Institute, Grant/Award Numbers: P50HL0105187 and K24HL083113). NHLBI had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation or approval of the manuscript; or decision to submit the manuscript for publication. The authors thank all of the workgroup members, trainees, research staff and administrative staff at the Johns Hopkins Center for Health Equity (formerly the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities), as well as all of the participating providers, staff members, organizational leaders and patients at participating Johns Hopkins Community Physicians sites for making the completion of this study possible. The authors also wish to acknowledge Crystal Salcido for her assistance with data collection, the members of the Johns Hopkins Center for Health Equity Community Advisory Board for guidance throughout the project; and Mary Twomley for her project management during early stages of the project. At the time this study was conducted, Dr. Noronha was Office Medical Director for Wyman Park Internal Medicine and Director of Research at Johns Hopkins Community Physicians. Publisher Copyright: {\textcopyright}2017 Wiley Periodicals, Inc.",
year = "2018",
month = feb,
day = "1",
doi = "10.1111/jch.13166",
language = "English (US)",
volume = "20",
pages = "324--333",
journal = "Journal of Clinical Hypertension",
issn = "1524-6175",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "2",
}