A hypertension control quality improvement pilot program: Experiences and blood pressure outcomes from physician practices

Abstract

Improving Health Outcomes: Blood Pressure (IHO: BP) was a Quality Improvement (QI) pilot program developed by the American Medical Association (AMA) and Johns Hopkins Medicine aimed at helping physicians and their care teams better manage patients with uncontrolled hypertension. The pilot study was conducted at 10 ambulatory practice sites between October 2013 and November 2014 in which the initiative was to devise a framework and intervention strategies for improving hypertension control. The program included evidence-based tools and materials to support the Measure Accurately, Act Rapidly, and Partner with Patients (M.A.P.) framework, interactive components with coaching support and peer-to-peer learning opportunities, and a measurement system supported by health technology, all intended to aid blood pressure management. This paper captures the learnings from the engagement, experiences, and satisfaction of care teams from the IHO: BP pilot that were used to adjust, reassess, and refine components of the QI program. Overall, participation in the IHO: BP pilot was associated with an increase in BP control rates from a mean of 69% to 75% (p < .05) for 3 of the 10 practices. Mean systolic and diastolic blood pressure was reduced in 8 of 10 practices by a mean of 12.5 mmHg/6.5 mmHg (p < .05). Furthermore, evaluation of participant experiences indicated that 75% of the respondents were satisfied or very satisfied with the initiative. The results from this study include components of the pilot that participants indicated were most helpful and were used to generate useful information for hypertension QI efforts that were later scaled and spread to subsequent initiatives.

Protocol to improve hypertension management in a VA outpatient clinic

“…Most studies shown reductions in average SBP with use of AOBP compared to manual BP measurements [5,10,11], and this reduction has been largely attributed to mitigation of white coat effect. Our finding of higher BP with standardized BP measurement protocol vs. manual BP measurement has been reported by one other published study which found lower estimates of BP control in four out of ten clinics after implementation of a quality improvement program for hypertension which included AOBP [12]. Lower rates of BP control in these four clinics were attributed to attenuation of digit preference in that study [12,13].…”

Improving Hypertension Control in Primary Care With the Measure Accurately, Act Rapidly, and Partner With Patients Protocol

“…Thus, 6 months of practice facilitation combined with ongoing monthly reports (Figure S1) including patient-level data appears sufficient to sustain meaningful improvement in hypertension control. With successful completion of the MAP framework and 2 pilot studies, 12 – 14 the 3 components of the MAP protocol and logic model (Figure S2) were adapted to support Target: BP, a national hypertension quality improvement initiative of the American Heart Association and American Medical Association. 3…”

“…The development and stream-lining of MAP have been described. 12 – 14 Approximately 20 hours of practice facilitation was provided to each clinical site during the first 6 months of MAP by a single trained individual. Goals of facilitation were to provide education, support, and logistical problem-solving necessary to incorporate MAP into the unique patient flow operations of each clinical site.…”

“…Measure accurately, Act rapidly, and Partner with patients (MAP) is a 6-month quality improvement program, 12 – 14 which includes practice facilitation, to increase hypertension control. MAP was designed and adapted for ambulatory, out-patient clinical settings without additional personnel typical of team-based care interventions.…”

The potential role of dashboard use and navigation in reducing medical errors of an electronic health record system: a mixed-method simulation handoff study

“…One common way to use EHR dashboards is as an "information hub", providing a glimpse of the patient's condition as well as offering tools to explore specific aspects of the patient's health and medical history in more detail. Studies have shown improvements in decision-making and patient outcomes with the increased use of EHR dashboards (Bakos, Zimmermann, & Moriconi, 2012;Etamesor, Ottih, Salihu, & Okpani, 2018;Franklin et al, 2017;Khan et al, 2018). Moreover, navigation patterns in EHRs may differ between cued and non-cued events.…”