A Multi-Intervention Approach to Blood Pressure Control: A Description of How a Large University Based Primary Care Clinic Tackled Hypertension

Abstract

Uncontrolled hypertension remains a leading modifiable risk factor for cardiovascular disease. Numerous quality improvement initiatives have aimed to address health care challenges associated with uncontrolled hypertension, many of which have been organized around the American Medical Association Measure Accurately, Act Rapidly, and Partner with Patients (AMA MAP) hypertension quality improvement framework. This paper describes a multifaceted hypertension quality improvement program initiated within a large university-based internal medicine clinic. Key interventions targeted at “Measure Accurately” included staff retraining on blood pressure (BP) measurement, implementation of BP recheck protocols, and a structured home BP monitor validation process. To combat clinical inertia and “Act Rapidly,” the clinic introduced a visual BP alert system, promoted clinical pharmacist comanagement, and distributed monthly provider performance reports. Lastly, to “Partner with Patients,” patient engagement was enhanced via targeted outreach, a care team approach focused on holistic patient care, and increased patient education. One year after implementation, the clinic’s hypertension control rate had increased from 66% to 72% (P = 0.047), while control rates across other system clinics remained unchanged. During this time, 343 patients had staff visits for BP checks, 287 patients had validated home BP monitors documented in their electronic health record, 302 patients engaged with a clinical pharmacist for hypertension comanagement, and 575 received individualized outreach from the care manager to increase engagement. This multifaceted quality improvement program improved patient care and increased hypertension control rates. These interventions have demonstrated sustainability and have been adopted by other primary care clinics in this system.