Abstract 093: Can Hypertension Control be Improved Within a Short Time Frame? - Results From Implementing the Measure Accurately, Act Rapidly and Partner With Patients (MAP) Program

Abstract

Objective: Evaluate a multifaceted quality improvement program with evidenced-based interventions for Measuring blood pressure (BP, mm Hg) accurately, Acting rapidly to manage uncontrolled BP, and Partnering with patients to promote BP self-management (MAP) in primary care. Methods: Study design : Quasi-experimental, pre-post intervention, design. BP control and BPs of uncontrolled patients were compared at baseline, February 2015[A1] to May 2016, at the last visit of the next 6 months.. Measure accurately included training staff in BP measurement. If attended BP was ≥140/90, unattended, automated office (AO) BP was obtained. Act rapidly included intensification of BP meds when unattended AOBP was ≥140/90 assessed by percent of visits with uncontrolled BP and no treatment change (therapeutic inertia). Partner with patients including BP self-monitoring and using low-priced generic BP meds assessed indirectly by the fall in systolic BP (SBP) per therapeutic intensification. Population Studied: Hypertensive patients (21,035) from 16 practices who had a visit during the baseline period and either no visit (4,691) or at least one visit (16,344) during the program. Results: BP control rose from 65.6% (13,790 of 21,035) to 74.8% (12,234 of 16,344) (p<.001); 12 of 16 practices had significant increases in BP control. In uncontrolled patients at baseline, mean SBP/DBP fell from 149/85 to 139/80 (p<.001/p<.001). Measure accurately lowered SBP 12.8 mm Hg (p<.001) in uncontrolled patients with better technique in attended BP reducing SBP ≥6.5 mm Hg per practice; while unattended AOBP lowered SBP 8.6 mm Hg (p<.001). Therapeutic inertia was unchanged (50.2% vs. 48.4%; p=.10); the mean fall in SBP per therapeutic change increased from 5.4 to 14.0 mm Hg (p<.001). Conclusions: MAP was associated with significant improvement in hypertension control in primary care during a six-month period. The decrease in SBP and improved control were largely explained by Measure accurately and Partner with patients as therapeutic inertia (Act rapidly) did not change. Evidence-based strategies in MAP provide opportunities for primary care practices to quickly improve hypertension control toward the national goals of 80%, and importantly to reduce cardiovascular risk.