# Assessing the use practice facilitation to optimize scale up of CDS for hypertension management

> **NIH AHRQ R18** · FUND FOR PUBLIC HEALTH IN NEW YORK, INC. · 2022 · $375,828

## Abstract

Project Summary/Abstract
Hypertension (HTN) is the most prevalent modifiable risk factor for cardiovascular disease among U.S. adults.
Despite a long history of established guidelines to support clinical management, only half of U.S. adults
diagnosed with HTN have poorly controlled blood pressure (BP)4 and medication adherence to proven
effective treatment remains suboptimal. Clinical decision support (CDS) has the potential to overcome barriers
to delivering guideline-recommended care and improve HTN management. However, optimal strategies for
scaling CDS have not been well established, particularly in small independent primary care practices which
often lack the resources to effectively change practice routines in order to effectively utilize CDS. Further, CDS
is used in relatively few components of the medication management process, despite indications that CDS
alerts are likely to impact patient care. Practice facilitation is a well-demonstrated implementation strategy to
support process changes and has the potential to facilitate CDS implementation. Our objective is to rigorously
evaluate whether practice facilitation provided in concert with a hypertension-focused CDS that incorporates
medication adherence results is an effective strategy for scaling and implementing CDS. We will initially update
and incorporate an evidence-based hypertension-focused CDS shown to be effective in Federally Qualified
Health Centers (FQHCs) into an existing commercial electronic health record (EHR) system used by a large
network of independent primary care practices. This CDS will employ several features shown to be effective in
the FQHCs, including passive alerts, order sets, documentation templates, standardized medication adherence
questionnaires, and clinical reminders. Additionally, the CDS will incorporate a new feature, a medication
adherence alert based on prescription claims data. We will then randomize 40 small independent primary care
practices in New York City to receive either practice facilitation in addition to the CDS or the CDS alone. The
PF intervention will include an initial training in the CDS and review of current guidelines along with follow-up
in-person and remote meetings for coaching and supporting integration into the workflow. After an eighteen-
month intervention period, we will examine the differences in blood pressure control achieved by practices in
the CDS plus practice facilitation group versus practices that received the CDS alone. We will also assess the
implementation process for scaling the CDS using the RE-AIM framework. The results of this study will inform
future efforts to implement and scale CDS into small primary care practices, where much of care delivery
occurs in the U.S.

## Key facts

- **NIH application ID:** 10489374
- **Project number:** 5R18HS027120-03
- **Recipient organization:** FUND FOR PUBLIC HEALTH IN NEW YORK, INC.
- **Principal Investigator:** Saul B. Blecker
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2022
- **Award amount:** $375,828
- **Award type:** 5
- **Project period:** 2020-09-30 → 2024-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10489374

## Citation

> US National Institutes of Health, RePORTER application 10489374, Assessing the use practice facilitation to optimize scale up of CDS for hypertension management (5R18HS027120-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10489374. Licensed CC0.

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