Two scalable versions of the BP MAP quality improvement program (Full Support and Self-Guided) implemented in 24 safety net clinics led to modest improvements in blood pressure control that were not statistically significant (difference-in-differences +1.2%, p=0.59).
RCT (n=23,608)
Open-label
Cluster randomization
Yes
Do scalable versions of a quality improvement program (Full Support or Self-Guided) improve clinic-level blood pressure control in safety net clinics compared to usual care?
Implementation of a scalable quality improvement intervention for blood pressure control in safety net clinics led to modest, non-statistically significant improvements in BP control at 6 months.
Mean Difference: 1.2 (95% CI -3.2–5.6)
Absolute Event Rate: 59.1% vs 63.1%
p-value: p=0.59
Background Uncontrolled blood pressure (BP) remains a leading cause of death in the United States. The American Medical Association developed a quality improvement program to improve BP control, but it is unclear how to efficiently implement this program at scale across multiple health systems. Methods and Results We conducted BP MAP (Blood Pressure Measure Accurately, Act Rapidly, and Partner With Patients), a comparative effectiveness trial with clinic‐level randomization to compare 2 scalable versions of the quality improvement program: Full Support (with support from quality improvement expert) and Self‐Guided (using only online materials). Outcomes were clinic‐level BP control (<140/90 mm Hg) and other BP‐related process metrics calculated using electronic health record data. Difference‐in‐differences were used to compare changes in outcomes from baseline to 6 months, between intervention arms, and to a nonrandomized Usual Care arm composed of 18 health systems. A total of 24 safety‐net clinics in 9 different health systems underwent randomization and then simultaneous implementation. BP control increased from 56.7% to 59.1% in the Full Support arm, and 62.0% to 63.1% in the Self‐Guided arm, whereas BP control dropped slightly from 61.3% to 60.9% in the Usual Care arm. The between‐group differences‐in‐differences were not statistically significant (Full Support versus Self‐Guided=+1.2% 95% CI, −3.2% to 5.6%, P =0.59; Full Support versus Usual Care=+3.2% −0.5% to 6.9%, P =0.09; Self‐Guided versus Usual Care=+2.0% −0.4% to 4.5%, P =0.10). Conclusions In this randomized trial, 2 methods of implementing a quality improvement intervention in 24 safety net clinics led to modest improvements in BP control that were not statistically significant. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03818659.
Fontil et al. (Wed,) conducted a rct in Hypertension (n=23,608). BP MAP program (Full Support vs Self-Guided) vs. Self-Guided program and Usual Care was evaluated on Change in clinic-level blood pressure control (<140/90 mm Hg) from baseline to 6 months (Difference-in-differences +1.2%, 95% CI -3.2 to 5.6, p=0.59). Two scalable versions of the BP MAP quality improvement program (Full Support and Self-Guided) implemented in 24 safety net clinics led to modest improvements in blood pressure control that were not statistically significant (difference-in-differences +1.2%, p=0.59).
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