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Hypertension Improvement Project (HIP): study protocol and implementation challenges.
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 articleSubject
HumansHypertension
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/10161/22839Published Version (Please cite this version)
10.1186/1745-6215-10-13Publication 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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Show full item recordScholars@Duke
Bryan Courtney Batch
Associate Professor of Medicine
Type 2 Diabetes, Obesity/Overweight, Behavior change, Non-pharmacologic intervention,
Health disparities
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
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 chair
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
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 Multiple Principal Investigators 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<br
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.
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. She is also the Director
of Duke’s CTSA-sponsored internal career development award program (KL2) and the Associate
Director of Duke’s REACH Equity Disparities Research Center, in which she also leads
the Investigator Development Core.
Dr. Svetkey has over 30 years of experience in the investigation of hypertens
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
Alphabetical list of authors with Scholars@Duke profiles.

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