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Hypertension Improvement Project (HIP): study protocol and implementation challenges.

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Date
2009-02-26
Authors
Dolor, Rowena J
Yancy, William S
Owen, William F
Matchar, David B
Samsa, Gregory P
Pollak, Kathryn I
Lin, Pao-Hwa
Ard, Jamy D
Prempeh, Maxwell
McGuire, Heather L
Batch, Bryan C
Fan, William
Svetkey, Laura P
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(13 total)
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Abstract
<h4>Background</h4>Hypertension affects 29% of the adult U.S. population and is a leading cause of heart disease, stroke, and kidney failure. Despite numerous effective treatments, only 53% of people with hypertension are at goal blood pressure. The chronic care model suggests that blood pressure control can be achieved by improving how patients and physicians address patient self-care.<h4>Methods and design</h4>This paper describes the protocol of a nested 2 x 2 randomized controlled trial to test the separate and combined effects on systolic blood pressure of a behavioral intervention for patients and a quality improvement-type intervention for physicians. Primary care practices were randomly assigned to the physician intervention or to the physician control condition. Physician randomization occurred at the clinic level. The physician intervention included training and performance monitoring. The training comprised 2 internet-based modules detailing both the JNC-7 hypertension guidelines and lifestyle modifications for hypertension. Performance data were collected for 18 months, and feedback was provided to physicians every 3 months. Patient participants in both intervention and control clinics were individually randomized to the patient intervention or to usual care. The patient intervention consisted of a 6-month behavioral intervention conducted by trained interventionists in 20 group sessions, followed by 12 monthly phone contacts by community health advisors. Follow-up measurements were performed at 6 and 18 months. The primary outcome was the mean change in systolic blood pressure at 6 months. Secondary outcomes were diastolic blood pressure and the proportion of patients with adequate blood pressure control at 6 and 18 months.<h4>Discussion</h4>Overall, 8 practices (4 per treatment group), 32 physicians (4 per practice; 16 per treatment group), and 574 patients (289 control and 285 intervention) were enrolled. Baseline characteristics of patients and providers and the challenges faced during study implementation are presented. The HIP interventions may improve blood pressure control and lower cardiovascular disease risk in a primary care practice setting by addressing key components of the chronic care model. The study design allows an assessment of the effectiveness and cost of physician and patient interventions separately, so that health care organizations can make informed decisions about implementation of 1 or both interventions in the context of local resources.<h4>Trial registration</h4>ClinicalTrials.gov identifier NCT00201136.
Type
Journal article
Subject
Humans
Hypertension
Chronic Disease
Antihypertensive Agents
Treatment Outcome
Clinical Protocols
Combined Modality Therapy
Exercise
Diet
Attitude of Health Personnel
Health Knowledge, Attitudes, Practice
Patient Compliance
Risk Reduction Behavior
Blood Pressure
Research Design
Time Factors
Clinical Competence
Cost-Benefit Analysis
Guideline Adherence
Patient Education as Topic
Practice Guidelines as Topic
Practice Patterns, Physicians'
Permalink
https://hdl.handle.net/10161/22839
Published Version (Please cite this version)
10.1186/1745-6215-10-13
Publication Info
Dolor, Rowena J; Yancy, William S; Owen, William F; Matchar, David B; Samsa, Gregory P; Pollak, Kathryn I; ... Svetkey, Laura P (2009). Hypertension Improvement Project (HIP): study protocol and implementation challenges. Trials, 10(1). pp. 13. 10.1186/1745-6215-10-13. Retrieved from https://hdl.handle.net/10161/22839.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Batch

Bryan Courtney Batch

Associate Professor of Medicine
Type 2 Diabetes, Obesity/Overweight, Behavior change, Non-pharmacologic intervention, Health disparities
Dolor

Rowena Joy Dolor

Professor of Medicine
Rowena J. Dolor, MD, MHS did her medical training and internal medicine residency at Duke University Medical Center. She completed the Ambulatory Care/Health Services Research fellowship at the Durham VA Medical Center in 1996 and obtained her Masters in Health Sciences degree in Biometry (renamed MHS in Clinical Research) from the Duke University School of Medicine in 1998. Dr. Dolor was a staff physician in the Ambulatory Care Service at the Durham VA Medical Center and Research Associate at t
Lin

Pao-Hwa Lin

Associate Professor in Medicine
My research interest lies generally in the area of dietary patterns and chronic diseases including hypertension using controlled feeding study and lifestyle intervention designs. Two major controlled feeding clinical trials that I was involved in include the Dietary Approaches to Stop Hypertension (DASH) Study and the Dietary Approaches to Stop Hypertension-Sodium (DASH-Sodium) Study. In addition to being an active member for the diet committee for DASH, I also function as the
Matchar

David Bruce Matchar

Professor of Medicine
My research relates to clinical practice improvement - from the development of clinical policies to their implementation in real world clinical settings. Most recently my major content focus has been cerebrovascular disease. Other major clinical areas in which I work include the range of disabling neurological conditions, cardiovascular disease, and cancer prevention. Notable features of my work are: (1) reliance on analytic strategies such as meta-analysis, simulation, decision analy
Pollak

Kathryn IIonka Pollak

Professor in Population Health Sciences
Dr. Pollak is a social psychologist who designs and tests behavioral interventions to promote smoking cessation, reduce health disparities, and improve clinician-patient communication. She also is one of the heads of the Palliative Care Research Cooperative that supports multi-site palliative care trials. Finally, Dr. Pollak serves as a Communication Coach where she teaches clinicians effective communication techniques.Area of expertise: Health Behavior
Samsa

Gregory P. Samsa

Professor of Biostatistics & Bioinformatics
Greg Samsa is an applied statistician whose primary interests are in study design, instrument development, information synthesis, practice improvement, effective communication of statistical results, and teaching. He is a believer in the power of statistical thinking, as broadly defined.
Svetkey

Laura Pat Svetkey

Professor of Medicine
Laura P. Svetkey, MD MHS is Professor of Medicine/Nephrology, Vice Chair for Faculty Development and Diversity in the Department of Medicine, and School of Medicine Faculty Ombudsperson. She is also the Director of Duke’s CTSA-sponsored internal career development award program (KL2) and the Investigator Development Core of Duke’s REACH Equity Disparities Research Center. Dr. Svetkey has over 30 years of experience in the investigation of hypertension, obe
Yancy

William Samuel Yancy Jr.

Professor of Medicine
Impact of obesity on health, health care delivery, quality of life. Diet and other weight loss interventions Preventive medicine
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