A bundled quality improvement program to standardize clinical blood pressure measurement in primary care

Boonyasai, Romsai T.; Carson, Kathryn A.; Marsteller, Jill A.; Dietz, Katherine B.; Noronha, Gary J.; Hsu, Yea‐Jen; Flynn, Sarah J.; Charleston, Jeanne M.; Prokopowicz, Greg P.; Miller, Edgar R.; Cooper, Lisa A.

doi:10.1111/jch.13166

Cited by 34Blood Pressure and Hypertension StudiesPrimary Care and Health OutcomesClinical practice guidelines implementation

A bundled quality improvement program to standardize clinical blood pressure measurement in primary care

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Boonyasai, Romsai T., Carson, Kathryn A., Marsteller, Jill A., Dietz, Katherine B., Noronha, Gary J., Hsu, Yea‐Jen, Flynn, Sarah J., Charleston, Jeanne M. +3 more·2018·The Journal of Clinical Hypertension

DOI 10.1111/jch.13166PMC PMC5820207

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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’ 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.

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Studies have shown that addressing the barriers to standardized blood pressure measurement can dramatically improve the quality of clinic blood pressure measurements.
“However, studies have also shown that addressing these barriers can dramatically improve the quality of clinic BP measurements.32–36”
From International Consensus on Standardized Clinic Blood Pressure Measurement – A Call to Action (2023) · cites this paper as [32]

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Measuring Blood Pressure in Primary Care for Accurate Diagnosis and Decision Making: Implementing Evidence-based Protocols Across a Health System
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Abstract P052: The Effect of Re-designing Workflow and Introducing Automated Blood Pressure Devices in Community-based Primary Care Clinics
Boonyasai, R. T., Prokopowicz, G. P., Charleston, J. B., Carson, K. A., Noronha, G. J., Miller, E. R., & Cooper, L. A. (2012) · Circulation · doi:10.1161/circ.125.suppl_10.ap052
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Protocol to improve hypertension management in a VA outpatient clinic
Gozdecki, L., Kramer, H., Thomas, M., Gardezi, K., Tarlov, E., Hughes, A. M., Stroupe, K. T., & O’Halloran, M. (2022) · Journal of Human Hypertension · doi:10.1038/s41371-021-00650-0 · Cited by 9 · see citing works
Standardisation of Blood Pressure Measurement Among Patients Attending an Urban Primary Health Centre: A Quality Improvement Initiative
Nongkynrih, B., Kaur, R., Muthukumarasamy, T., Patil, N., Chandra, A., & Das, A. S. (2024) · Cureus · doi:10.7759/cureus.73811 · Cited by 1 · see citing works
Appropriate Blood Pressure Measurement for Initial Diagnosis of Hypertension: A Best Practice Implementation Project
Sheen, S.-Y., Chen, P.-H., Chen, S., Chang, C.-F., Chiu, P.-T., Lin, L.-T., & Sheu, M.-J. (2023) · International Journal of Studies in Nursing · doi:10.20849/ijsn.v8i2.1363

Authors: Boonyasai, R. T., Carson, K. A., Marsteller, J. A., Dietz, K. B., Noronha, G. J., Hsu, Y., Flynn, S. J., Charleston, J. M., Prokopowicz, G. P., Miller, E. R., & Cooper, L. A.
Affiliations: Johns Hopkins University (US)
University of Rochester Medicine (US)
Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
Corresponding author: Boonyasai, Romsai T.
ORCID: Boonyasai, Romsai T.
Carson, Kathryn A.
Marsteller, Jill A.
Hsu, Yea‐Jen
Flynn, Sarah J.
Cooper, Lisa A.
Venue: The Journal of Clinical Hypertension
Publisher: Wiley
Published: 2017-12-21
Volume: 20
Issue: 2
Pages: 324-333
ISSN: 1524-6175 (ISSN-L)
1751-7176
DOI: 10.1111/jch.13166
PMC: PMC5820207
OpenAlex: W2776822492
Cited by: 34
References: 44
Citations by year: 2026: 2 · 2025: 3 · 2024: 3 · 2023: 2 · 2022: 4 · 2021: 4 · 2020: 5 · 2019: 7 · 2018: 3 · 2017: 1
FWCI: 3.38
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Journal of Clinical Hypertension (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
Funders: National Heart, Lung, and Blood Institute (P50HL0105187, K24HL083113)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords: blood pressure measurement, measurement standardization, primary care, automated blood pressure devices, terminal digit preference, implementation fidelity, protocol adherence, hypertension screening
MeSH terms: Adult, Aged, Blood Pressure, Blood Pressure Determination, Female, Humans, Hypertension, Male, Middle Aged, Patient Education as Topic, Primary Health Care, Sphygmomanometers, Guideline Adherence, Quality Improvement

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A bundled quality improvement program to standardize clinical blood pressure measurement in primary care

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