This project at an academic medical center utilized a quality improvement program focused on medication intensification and serial measurement to improve hypertension management.
- Academic Medical Center
- Community health system
- Integrated healthcare system/network
- Even though health systems nationwide already provide high-quality hypertension care, there is still a need for higher levels of blood pressure control.
- Hypertension caused or contributed to about half a million deaths in the United States in 2017 (CDC, 2020).
- About 76% of adults in the United States do not have their hypertension under control (CDC, 2020).
- There was the need for higher levels of blood pressure control at the Cleveland Clinic, a large integrated academic health system.
Patient Population Served and Payor Information
- Median patient age was 64.1 years.
- 52% of patients were female and 77% of patients were male.
- Elizabeth R. Pfoh, PhD spearheaded the project by creating the QI program, which includes two key components: blood pressure rechecks and medication intensification.
- Dr. Pfoh also provided leadership for the project during the implementation phase.
Research + Planning
- The implementation of this quality improvement program began June 2016.
- The program includes two components: medication intensification and repeated measurement of blood pressure.
- Primary care providers were trained to implement the quality improvement program when hypertensive patients showed up for their primary care visit.
- MDs and NPs were trained to implement the quality improvement (QI) program by intensifying the medications prescribed and repeating blood pressure measurements when they saw patients with a diagnosis of hypertension at their primary care visit.
- Electronic medical record
Team Members Involved
- A patient with a diagnosis of hypertension walks in for their primary care appointment.
- The primary care provider takes a blood pressure measurement or intensifies the medication regimen that the patient is prescribed during the appointment.
- At every subsequent appointment, the primary care provider repeats blood pressure measurement and intensifies the patient’s medication regimen.
- Blood pressure control measures from 2016 are compared to those for each patient between 2016 and 2015.
- Labor costs associated with additional time spent by clinical staff members taking blood pressure measurements at every appointment.
- Labor costs associated with additional time spent by clinical staff members implementing medication intensification.
- Mean systolic blood pressure measurement: The mean systolic blood pressure at last visit increased from 130.1mmHg in 2015 to 129.2mmHg in 2016.
- Percentage of patients with controlled blood pressure reading: 79% of hypertensive patients had a controlled blood pressure measurement at their last visit in 2016 compared to 72% in 2015.
- More patients having controlled blood pressure measurements between visits.
- Pfoh, E.R., Martinez, K., Vahaaria, N., Rothberg, M.B. (2019 June). Impact of a system-wide quality improvement initiative on blood pressure control. Poster session at the Academy Health Annual Research Meeting. Washington, D.C., United States.
- Facts about hypertension. (2020, February 25). Retrieved from https://www.cdc.gov/bloodpressure/facts.htm
- Elizabeth R. Pfoh, PhD
- Kathryn Martinez, PhD
- Nirav Vakharia, MD
- Michael B. Rothberg, MD, MPH
- Rebecca Tsai, BA
Cleveland, OhioTalk to the Innovators