Evaluation of a Quality Improvement Project for Pediatric Blood Pressure Screening in Community Clinics Guided by Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework

OBJECTIVES: Pediatric hypertension (HTN) requires accurate, timely diagnosis, and management to prevent long-term adverse cardiac events. Our health system's adherence to the American Academy of Pediatrics best practice guidelines (AAP 2017) was noted to be suboptimal, including gaps in blood pressure (BP) screening, repeat BP measurements after an elevated BP, and documentation. A quality improvement (QI) project was conducted to improve adherence to the guideline among children aged 3-18 years at systemwide pediatric primary care clinics from June 2024 through December 2024. DESIGN: The QI project was evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Education on accurate BP measurement and AAP guidelines were delivered in primary care clinics within one Southeast health system. Data were extracted from electronic health records 4 times: preintervention, midpoint, postintervention, and 6-month follow-up. RESULTS: Reach: Participating clinics cared for 9781 children, representing 25.27% of the system's population. Effectiveness: Repeat BP measurement after an elevated BP significantly improved from 5.58% preintervention to 11.22% at follow-up, peaking at 17.29% postintervention (P < 0.01). Overall BP screening rates remained stable over time but significantly improved in clinics providing care for both adults and children. The proportion of elevated BP among boys significantly decreased from preintervention to postintervention, whereas no significant changes were observed among girls. Adoption: Approximately three-quarters (73.33%) of invited clinics participated in the QI project. Implementation: Staff education on accurate BP measurements was the most used implementation strategy across participating clinics (100%). Maintenance: BP screening rates remained stable, and repeated BP measurements were partially sustained at 6-month follow-up. CONCLUSIONS: This QI project improved adherence to AAP guidelines by increasing accurate BP measurement, primarily through staff education. Further research should explore strategies to improve long-term adherence to pediatric HTN guidelines and address BP measurement challenges in children under the age of 5.