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Implementation of a self-management program: VA HTN-IMPROVE Study

Jackson GL, Maciejewski ML, Kaufman A, Powers BJ, Oddone EZ, Smith VA, Olsen MK, Rakley SM, Almirall D, Bosworth HB, Weiner BJ, Lee SD, Damush TM, Anderson DR, Kravetz JD, Roumie CL, Bowen ME. Implementation of a self-management program: VA HTN-IMPROVE Study. Poster session presented at: National Institutes of Health Conference on the Science of Dissemination and Implementation: Methods and Measurement; 2010 Mar 15; Bethesda, MD.

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Abstract:

The Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) seeks to link VA research and operations with the goal of translating promising health services interventions into practice. Our objective is to describe the process of using the six-step QUERI framework to expand an efficacious disease management intervention into the realm of implementation. Over the past decade, investigators at the Durham, NC VA Health Services Research and Development (HSRandD) Center of Excellence have conducted a series of studies following the QUERI steps to identify and now implement improvements in hypertension management, including: (1) describing the burden of hypertension and related patterns of care; (2) developing a conceptual model for hypertension management; and (3) conducting a series of clinical trials to test approaches to improving hypertension management. We demonstrated the efficacy of a nurse-delivered tailored behavioral and educational intervention (V-STITCH; HSRandD IIR-20-034), showing that the intervention improves patients' BP control by 13% at 24-months compared to usual care. We are climbing the QUERI implementation steps by: (1) working under the auspices of the Stroke QUERI to conduct a study implementing a nurse-delivered self-management support among front line clinical providers within 3 VA Medical Centers across multiple regions in the US, Hypertension Telemedicine Nurse Implementation Project for Veterans (HTN-IMPROVE) and (2) expanding the intervention beyond hypertension to other chronic illnesses with the goal of improving overall primary care. The poster will highlight opportunities and challenges that have been encountered in the areas of: (1) starting and conducting a research program aimed at developing real-world interventions; (2) moving from results of clinical trials to implementation; (3) developing partnerships to implement changes in care outside of research; and (4) expanding beyond specific disease to multiple chronic illnesses. HTN-IMPROVE is funded by the VA HSRandD Service (RRP-09-198).





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