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Improving Hypertension Control

Keywords: Hypertension

Overview

A program to enhance hypertension management at an urban, academic primary care clinic

Innovator

Julie Tishler MD

Kristin Huang MD

Editor

Selena Li

Location

Tufts Medical Center, Boston, MA

Organizational Context

  • Academic medical practice in downtown Boston that employs 40 Physicians (~28 FTE), 6 NPs (~4.5 clinical FTE), 2 PAs, 3 social workers, 72 residents, 8 FTE RNs, and 60 support staff. 
  • Sees 38,000 patients in 6500 visits per month. Practice gets 14,000 incoming calls a month
  • 9400 patients served by Tufts Medical Center have hypertension. The practice's goal was to have patients under 60 or with diabetes or CKD achieve a BP of < 140/90. A BP goal of < 150/90 was set for patients 60+.

Patient Population

  • Serves a diverse patient population, with ~10% of its population African American, 10% Asian, and 9% Hispanic. 
  • 25% of its patients are on Medicaid, and 32% are on Medicare

Project Leadership

  • The effort was led by two MDs, one NP, and one EMR administrator

Funding

  • $2000 grant from the New England Quality Care Alliance

Project Tools & Components

  • The team set up an EMR-derived registry to identify patients with hypertension.
    • The registry includes patients’ comorbidities, last two BPs, last and next appointment dates, and number of prescribed HTN medications.
  • English and Chinese patient education materials were developed. 
    • The handout uses pictures and is at a 6th grade reading level.
  • The EMR was refined to visually alert (using red text next to the field for BP) providers to patients with high BPs and to alert medical assistants to print educational materials for appropriate patients. 

Tech Involved

Epic

Team Members

  • Physicians
  • MAs

Daily Workflow Steps

  • Quarterly, registry-derived reports are sent to providers about their patients with uncontrolled hypertension.
  • Quarterly, automated outreach phone calls are made to patients with uncontrolled hypertension without an upcoming appointment to remind them to call for an appointment. 
  • At a typical visit, the EMR prompts medical assistants to print a patient educational handout if patients’ initial BP is high.
  • The handout is given to the provider, thus serving as a reminder to address the patient’s high BP
  • After rechecking the BP, the provider decides whether the patient should receive the handout 
  • Practice-wide emails are sent on a regular basis that include the percentage of each provider’s hypertension patients at a goal blood pressure and the percentage of time providers recheck patients’ BP if the triage BP is high.

Budget

$2000

Status

The intervention is currently ongoing.

Key Outcome

Percent of patients with adequate blood pressure control.

Outcome Analysis

  • At baseline in August 2016, 72% of patients were at their BP goal. After implementation of the intervention (October 2017), 75% of patients had achieved their BP goal as of October 2017. The percentage of time that providers rechecked an initially high BP rose from 43% to 57%.
  • As of January 2018, 75% of patients are at their BP goal and the percentage of time providers recheck an initially high BP has increased further to 64%. 
  • 54% of initially high BPs were found to enter the goal range (< 140/90) upon provider recheck.Add paragraph text here.

Benefits

  • Improved achievement of BP control and enhanced processes for identifying and managing patients with uncontrolled hypertension

Unique Challenges

  • There are challenges in maintaining follow-up. For example, handouts are only printed out 76% of the time.
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