Abstract TAC118: Restructuring a Treat-To-Target Program In a Primary Care Setting To Improve Blood Pressure Control

Introduction: NYC Health + Hospitals/Harlem implemented the Treat-to-Target (T2T) program in 2013 to improve hypertension (HTN) management. Persistent gaps in blood pressure (BP) control led to a 2023 restructuring focused on standardized workflows with staff retraining, validated BP measurements, accurate referrals, reminders, timely scheduling, and free home BP monitor distribution. Hypothesis: We assessed the hypothesis that the restructuring of the T2T program improved overall patient capture and BP control rates. Methods: This retrospective cohort study analyzed de-identified Electronic Health Record data from 1,901 adult primary care patients with uncontrolled HTN referred to T2T in two periods: pre-restructuring (July 2021–June 2022) and post-restructuring (July 2023–June 2024). Inclusion required a T2T specific referral with documented BP>140/90 mmHg and a primary diagnosis of HTN. Outcomes included number of T2T referrals, proportion seen within 3 and 6 months, and proportion achieving BP control (<140/90 mmHg) at follow-up. Simple logistic regression was used to assess outcomes. Results: Demographics of the study cohort are shown in Table 1. Post-restructuring, there was a 3.6-fold increase in accurate referrals, reflecting improved capture and tracking fidelity. The proportion of patients seen at a T2T visit within 3 months of the referral decreased post-restructuring (pre: 55.3% vs post: 49.6%; OR 0.8 [0.64, 0.99]; p = 0.04), although the proportion with a documented BP during this time was unchanged (47.8% vs 46.7%) and more achieved BP control <140/90 (54.5% vs 62.9%; OR 1.41 [1.02, 1.94]; p = 0.03). By 6 months, follow-up rates were similar (59.2% vs 56.6%; OR 0.9 [0.72, 1.12]; p = 0.35) as was the proportion with a documented BP (35.5%) and BP control (58.5% vs 61.2%; OR 1.12 [0.77–1.63]; p = 0.56). Conclusion: The 2023 restructuring led to a nearly fourfold increase in referral fidelity and improved BP control at 3 months. Despite a lower proportion of patients seen within 3 months, potentially due to limited workforce or patient attrition, the increase in patients with BP control demonstrates the program’s potential. Next steps will include efforts to support expanded follow-up, reduce attrition, and offer a scalable framework for other safety-net systems.