ArticleAnnals of family medicine
Improving Smoking and Blood Pressure Outcomes: The Interplay Between Operational Changes and Local Context.
Article in Annals of family medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02560428 (Evaluating System Change to Advance Learning and Take Evidence to Scale), which is not on this map. Cited by 21 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Evaluating System Change to Advance Learning and Take Evidence to Scale (ESCALATES)
Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Federal Investment in Primary Care Transformation: A Systematic Review and Qualitative Analysis.JAMA health forum · 2025Pooled it
- A Cluster Randomized Trial of Primary Care Practice Redesign to Integrate Behavioral Health for Those Who Need It Most: Patients With Multiple Chronic Conditions.Annals of family medicineTrial
- Community organization capacity and barriers to mental health promotion efforts: a configurational analysis.BMC public health · 2026Article
- How segregation, low birth weight, unemployment, and violence link to low life expectancy in Chicago.Health affairs scholar · 2026Article
- Adaptation of a cardiovascular quality improvement initiative for worksite health centers: application of the ADAPT-ITT framework.Implementation science communications · 2026Article
- Article
- Difference-Making Factors Linked to Higher Reach of Specialist Palliative Care Among People With Heart Failure Across a National Sample of VA Medical Centers.The American journal of hospice & palliative care · 2025Article
- Feasibility and perceptions of a benzodiazepine deprescribing quality improvement initiative for primary care providers in Japan.BMC primary care · 2024Article
- The role of organizational capacity in intervention efficacy in a church-based cancer education program: A configurational analysis.Global implementation research and applications · 2023Article
- The VA National Teleneurology Program (NTNP): Implementing Teleneurology to Improve Equitable Access to Outpatient Neurology Care.Journal of general internal medicine · 2023Article
- Estimating the Cardiovascular Disease Risk Reduction of a Quality Improvement Initiative in Primary Care: Findings from EvidenceNOW.Journal of the American Board of Family Medicine : JABFM · 2023Article
- The VA National TeleNeurology Program implementation: a mixed-methods evaluation guided by RE-AIM framework.Frontiers in health services · 2023Article
- Determinants of inter-organizational implementation success: A mixed-methods evaluation of Veteran Directed Care.Healthcare (Amsterdam, Netherlands) · 2022Article
- Organizational Factors Associated with Guideline Concordance of Chronic Disease Care and Management Practices.Journal of the American Board of Family Medicine : JABFM · 2022Article
- Protocol for evaluating external facilitation as a strategy to nationally implement a novel stigma reduction training tool for healthcare providers.Implementation science communications · 2022Article
- Observational
- How education and racial segregation intersect in neighborhoods with persistently low COVID-19 vaccination rates in Philadelphia.BMC public health · 2022Article
- Evaluation of organizational capacity in the implementation of a church-based cancer education program.Global implementation research and applications · 2022Article
- Facility-level conditions leading to higher reach: a configurational analysis of national VA weight management programming.BMC health services research · 2021Article
- Clinic Factors Associated With Mailed Fecal Immunochemical Test (FIT) Completion: The Difference-Making Role of Support Staff.Annals of family medicineArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
Abstract
purposeWe undertook a study to identify conditions and operational changes linked to improvements in smoking and blood pressure (BP) outcomes in primary care.
methodsWe purposively sampled and interviewed practice staff (eg, office managers, clinicians) from a subset of 104 practices participating in EvidenceNOW-a multisite cardiovascular disease prevention initiative. We calculated Clinical Quality Measure improvements, with targets of 10-point or greater absolute improvements in the proportion of patients with smoking screening and, if relevant, counseling and in the proportion of hypertensive patients with adequately controlled BP. We analyzed interview data to identify operational changes, transforming these into numeric data. We used Configurational Comparative Methods to assess the joint effects of multiple factors on outcomes.
resultsIn clinician-owned practices, implementing a workflow to routinely screen, counsel, and connect patients to smoking cessation resources, or implementing a documentation change or a referral to a resource alone led to an improvement of at least 10 points in the smoking outcome with a moderate level of facilitation support. These patterns did not manifest in health- or hospital system-owned practices or in Federally Qualified Health Centers, however. The BP outcome improved by at least 10 points among solo practices after medical assistants were trained to take an accurate BP. Among larger, clinician-owned practices, BP outcomes improved when practices implemented a second BP measurement when the first was elevated, and when staff learned where to document this information in the electronic health record. With 50 hours or more of facilitation, BP outcomes improved among larger and health- and hospital system-owned practices that implemented these operational changes.
conclusionsThere was no magic bullet for improving smoking or BP outcomes. Multiple combinations of operational changes led to improvements, but only in specific contexts of practice size and ownership, or dose of external facilitation.
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