Implementation of streamlined, standardized blood pressure measurement protocols in primary care - PROJECT ABSTRACT Accurate blood pressure (BP) measurements are essential for diagnosing and treating hypertension. In clinical practice, however, BP is often not measured following a guideline-recommended protocol. This can result in inaccurate measurements, which can lead to under- or over-treatment, and clinical uncertainty about the patient’s BP, which can lead to therapeutic inertia (i.e., lack of treatment initiation or intensification), a major contributor to uncontrolled BP in the US. To obtain accurate BP measurements, clinical practice guidelines recommend a standardized series of steps, including allowing the patient to rest for >5 minutes, properly positioning the patient, using validated equipment and an appropriate-sized cuff, and performing multiple BP measurements with a 1–2-minute interval between readings. The guideline-recommended protocol takes nearly 10 minutes to complete, making it difficult to implement in clinical practice. Therefore, clinics need ways to measure BP that are both accurate and efficient to inform treatment decisions and improve BP control. Recent studies have rigorously demonstrated it is possible to reduce the rest period from 5 to 3 or even 0 minutes and the interval between measurements from 60 to 30 seconds without compromising accuracy. Further, for patients with BP below the threshold for hypertension, it may only be necessary to measure BP one time. If streamlined, standardized BP measurement protocols incorporating these elements can be implemented in primary care, this could improve hypertension treatment decisions and BP control. The objective of this proposal is to determine whether streamlined, standardized BP measurement protocols can be implemented in primary care. The project builds on the Alabama Cardiovascular Cooperative’s Heart Health Improvement Project (HHIP), a quality improvement project using a practice facilitation implementation strategy in 47 primary care practices. However, the BP measurement protocol used in the HHIP can be optimized. In a subset of 6 HHIP practices, we will adapt the HHIP practice facilitation strategy to support clinics to implement streamlined, standardized BP measurement protocols. We will evaluate the efficiency of the BP measurement procedure at baseline and after 6 months of practice facilitation. We will use mixed methods to assess factors influencing implementation of and fidelity to the streamlined, standardized protocol. To accelerate my trajectory towards becoming an independent investigator and leader in the implementation of evidence-based interventions to prevent and manage hypertension, I have developed a training plan with my mentors to increase my expertise in 1) conducting research in primary care, 2) implementation science, 3) mixed methods research, and 4) leadership skills needed to be a PI. This proposal aligns with NHLBI’s strategic objective to optimize clinical and implementation research to improve health and reduce disease and its December 2024 workshop on clinic BP assessment. Completing the research and training aims will position me to submit an R01 to test whether implementing these BP measurement protocols improves BP control.
