Measure Accurately, Act Rapidly, and Partner With Patients (MAP) improves hypertension control in medically underserved patients: Care Coordination Institute and American Medical Association Hypertension Control Project Pilot Study results

Abstract

Measure Accurately, Act Rapidly, and Partner With Patients (MAP) is an evidence‐based protocol implemented to improve hypertension control in a clinic for underserved patients (49.9% Medicaid and 50.2% black). Patients with hypertension seen during the year before intervention and with at least one visit during the 6‐month intervention (N = 714) were included. If initial attended blood pressure (BP; standard aneroid manometer) was ≥140/≥90 mm Hg, unattended automated office BP was measured in triplicate and averaged (Measure Accurately) using an Omron HEM‐907XL. When automated office BP was ≥140/≥90 mm Hg, Act Rapidly included intensification of antihypertensive medications, assessed by therapeutic inertia. Partner With Patients included BP self‐monitoring, reducing pill burden, and minimizing medication costs, which was assessed by systolic BP change per therapeutic intensification. Between baseline and the last study visit, BP control to <140/<90 mm Hg increased from 61.2% to 89.9% (P < .0001). MAP rapidly and significantly improved hypertension control in medically underserved patients, largely as a result of measuring BP accurately and partnering with patients.

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

“…[28] More recently, the AMA has collaborated with the Care Coordination Institute. [29] and the American Heart Association in Target: BP. [26] The changes in the primary outcomes measured dur-ing the IHO: BP pilot may not reflect the potential impact of the program, but these efforts continue to offer valuable insights to the IHO: BP project team on how best to engage physicians and care teams across the nation in the effort to improve blood pressure control and reduce the risks of heart attack and strokes.…”

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

“…Our MAP study in 16 Family Medicine clinics confirmed a clinically and statistically significant improvement in BP as reported in our pilot study. 13 Hypertension control increased from 64.4% to 74.3% ( P <0.0001) in 16 787 hypertensive adults in only 6 months (Figure). Absolute hypertension control rates improved 9.9% although the increase was smaller than the absolute increase of 28.6% in our single site pilot.…”

“…Absolute hypertension control rates improved 9.9% although the increase was smaller than the absolute increase of 28.6% in our single site pilot. 13 Implementing the project across multiple sites yielded significant but less dramatic changes than the pilot study.…”

“…Our pilot study showed robust improvement in hypertension control after 6 months of MAP in a single, resource-limited healthcare setting serving disproportionately minority patients with Medicaid health insurance. 13 Objectives for the current study included determining whether (1) MAP was effective in a larger number of diverse Family Medicine practice sites, and (2) improvement in hypertension control at 6 months with practice facilitation persisted at 12 months, 6 months after practice facilitation ended.…”

Mitigating Implicit Bias in Patient-Clinician Communication in Clinical Encounters: Early Insights from the COmmuNity-engaged SimULation Training (CONSULT) Trial

“…We focused on implicit bias given the evidence of its impact on interpersonal communication 7 and patient outcomes, 2,5 particularly in hypertension where it contributes to a complex interaction of suboptimal clinical decision making and unsatisfactory patient experience of care. 18 (Figure 1)…”