Open Access Open Badges Study protocol

The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol (01295)

Hayden B Bosworth123*, Daniel Almirall14, Bryan J Weiner5, Mathew Maciejewski12, Miriam A Kaufman1, Benjamin J Powers12, Eugene Z Oddone12, Shoou-Yih D Lee5, Teresa M Damush6, Valerie Smith1, Maren K Olsen14, Daren Anderson7, Christianne L Roumie8, Susan Rakley1, Pamela S Del Monte1, Michael E Bowen9, Jeffrey D Kravetz7 and George L Jackson12

Author Affiliations

1 Center for Health Services Research in Primary Care, Durham VAMC, Durham NC. USA

2 Department of Medicine, Division of General Internal Medicine, Duke University, Durham NC. USA

3 Department of Psychiatry and Behavioral Sciences & Center for Aging and Human Development, Duke University, Durham NC. USA

4 Department of Biostatistics and Bioinformatics, Duke University, Durham NC. USA

5 Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC. USA

6 VA Stroke QUERI Center, VA HSRD Center of Excellence on Implementing Evidence-Based Practice, Roudebush VAMC; IU Center for Aging, Regenstrief Institute, Indianapolis, IN. USA

7 Department of Medicine, VA Connecticut Healthcare System, West Haven, CT; Yale University School of Medicine New Haven, CT. USA

8 VA Tennessee Valley Geriatric Research Education Clinical Center (GRECC), HSR&D Targeted Research Enhancement Program for Patient Healthcare Behavior, and Clinical Research Center of Excellence (CRCoE), and the Department of Medicine, Vanderbilt University, Nashville, TN. USA

9 VA Tennessee Valley Healthcare System, National Quality Scholars Fellowship Program, VA Tennessee Valley Geriatric Research Education Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Health Services Research (HSR), and the Department of Medicine, Vanderbilt University, Nashville, TN. USA

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Implementation Science 2010, 5:54  doi:10.1186/1748-5908-5-54

Published: 16 July 2010



Despite the impact of hypertension and widely accepted target values for blood pressure (BP), interventions to improve BP control have had limited success.


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.


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).


The study results will provide information about the challenges and costs to implement and sustain the intervention, and what clinical impact can be expected.