Final Research Report
View this project's final research report.
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Helping Patients Better Control High Blood Pressure
Principal Investigator Karen Margolis speaks about this study, which is comparing two methods of monitoring high blood pressure to determine whether telehealth offers an edge over more traditional clinic-based care.
More Telehealth Research Needed
Principal Investigator Karen Margolis says more research is needed to determine whether telehealth offers an advantage to patients as it becomes more widely available.
Results of This Project
Related Journal Citations
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers questioned how well the interventions in the study could be tested given the low rate of attendance for blood pressure checks at the six-week mark. The reviewers also felt that the high nonadherence to the intervention protocols was an important finding in this study and had large implications for implementing the interventions in real-world settings. The researchers pointed out that the low rate of attendance referred to blood pressure checks with the specific healthcare professional (HCP) listed in the intervention protocol, and this specificity led to the impression of low adherence to the interventions. In fact, a much higher percentage of patients completed the required follow-up if the researchers looked at patients receiving the care from other available HCPs. In response, the researchers added this information in their results and limitations sections, indicating that preferentially directing patients to specific follow-up choices limited adherence to the study protocol.
- The reviewers asked whether the researchers applied multiple imputation techniques to account for the large amount of missing data for the primary outcome, systolic blood pressure, at the six-month follow-up. The researchers explained that the primary outcome was change in systolic blood pressure over 12 months, and almost all of the study participants had at least one more blood pressure reading during that time period. Change in outcomes in the first six months was the secondary outcome, and the researchers applied statistical methods to account for the missing data.
- The reviewers expressed concern about the study conclusions because two graphs relaying the study results seemed to indicate that both systolic and diastolic blood pressure decreased before the start of the interventions. The researchers revised the two graphs to increase the precision of the blood pressure measurements taken, which showed that the sharp drop in blood pressure took place in the 1-15 days after the study start. The researchers attributed this early drop to the alert system incorporated into the electronic health record. This alert meant that clinicians were more likely to identify high blood pressure as a concern at the first study visit and therefore begin treating the condition before the study interventions started. The researchers added this information to their descriptions of clinic referral and follow-up care procedures. The researchers further justified the strength of their results by noting that if the effect was actually due to regression to the mean, the change in blood pressure would be several times smaller.
Conflict of Interest Disclosures
- Has Results