# Implementing Remote Patient Monitoring to Improve Hypertension Control in a Primary Care Network

> **NIH NIH R01** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2022 · $716,022

## Abstract

SUMMARY
Based on evidence from multiple systematic reviews, hypertension guidelines strongly recommend that
hypertensive patients measure their blood pressure (BP) at home as an approach to improving BP control so
long as this self-measured BP monitoring (SMBP) is conducted with clinical support (i.e., Supported SMBP).
Pragmatic trials demonstrate that Supported SMBP increases opportunities for medication titrations, increases
BP medication regimen intensity and adherence, and ultimately, improves BP control. Yet, few health systems
are systematically implementing Supported SMBP, and less than 20% of hypertensive patients routinely
measure their BP at home, resulting in a gap in the translation of evidence-based recommendations into
practice. This gap is driven by lack of knowledge regarding how best to implement Supported SMBP to
maximize uptake by patients and providers at an acceptable health system cost.
In partnership with leaders at New York-Presbyterian (NYP), we developed a nurse-supported SMBP
intervention in which
a centralized team of nurses is responsible for engaging patients in SMBP, monitoring
SMBP data, and providing feedback on HTN control to patients and providers
. We next followed a theory-
driven process (the Behavior Change Wheel) to select an implementation strategy aimed at increasing uptake
of Supported SMBP. We identified telemonitoring as a key implementation strategy. We then pilot tested this
intervention and implementation strategy at one clinic and found moderate uptake and promising trends in BP
control, but there was still a need to improve the implementation strategy. Few if any studies have assessed
the systematic implementation of Supported SMBP in primary care, particularly in low-income settings.
We now propose to apply human-centered design to refine our implementation strategy, and then implement
and evaluate the Supported SMBP intervention across a primary care network (12 clinics) that provides care to
socioeconomically diverse patients (27,600 HTN patients, 35% with uncontrolled BP). We will evaluate the
program by conducting a parallel-group cluster randomized trial in which clinics will be randomly assigned
to early (intervention) versus delayed (wait-list control) implementation of the telemonitoring-enabled, nurse-
supported SMBP intervention. The primary clinical effectiveness outcome will be pre-to-post implementation
change in the clinic mean of patients' last systolic BP during a 12-month calendar period. The impact of the
implementation strategy will be assessed by measuring uptake of Supported SMBP by patients and providers
and by interviewing patients and providers to assess key implementation outcomes (acceptability, fidelity). To
inform dissemination, the cost-effectiveness of the intervention from a health system and total healthcare cost
perspective will also be assessed. If successful, our project will provide a roadmap for widely implementing
SMBP, and will accelerate a change in the par...

## Key facts

- **NIH application ID:** 10428468
- **Project number:** 5R01HL152699-02
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Ian Matthew Kronish
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $716,022
- **Award type:** 5
- **Project period:** 2021-06-15 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10428468

## Citation

> US National Institutes of Health, RePORTER application 10428468, Implementing Remote Patient Monitoring to Improve Hypertension Control in a Primary Care Network (5R01HL152699-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10428468. Licensed CC0.

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