Key result
A multifaceted quality improvement strategy achieved blood pressure <140/90 mmHg in 62.6% and <130/80 mmHg in 24.47% of patients within 12 months, with further improvements sustained at 10 months.
Why the study?
Approximately 80% of hypertensive patients in an Internal Medicine Clinic had uncontrolled BP (>130/80 mmHg) by 2017 ACC/AHA guidelines, increasing morbidity and mortality.
Does a multifaceted quality improvement strategy improve blood pressure control in primary care patients with hypertension?
Does a multifaceted quality improvement strategy improve blood pressure control in primary care patients with hypertension?
A multifaceted quality improvement intervention targeting physician inertia and patient adherence significantly improved blood pressure control rates in a primary care setting.
Supports multifaceted QI for hypertension in primary care; hypothesis-generating pending randomized confirmation.
BACKGROUND: Approximately 80% of patients with hypertension in the Internal Medicine Clinic were uncontrolled (BP > 130/80 mmHg), according to the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines, leading to increased morbidity and mortality. The aim of this quality improvement (QI) was to improve BP control <130/80 from the baseline rates of 20%-30% and <140/90 from the baseline rates of 40%-60% between ages of 18-75 years, within 12 months. METHODS: We used the Plan-Do-Study-Act method. A multidisciplinary QI team identified barriers by fish bone diagram. Barriers included: 1) Physicians' knowledge gap and clinical inertia in optimization of medications, and 2) Patients' nonadherence to medication and appointments. The outcome measures were the percentage of patients with BP < 140/90 and < 130/80. Process measures included: 1) attendance rates of physician and nurses at educational sessions, 2) medication reconciliation completion rates and 3) care guide order rates. Key interventions were: 1) physicians and nurses' education regarding ACC/AHA guidelines, 2) patient education and engagement and 3) enhancement of health information technology. Data analysis was performed using monthly statistical process control charts. RESULTS: We achieved 62.6% (n = 885/1426) for BP < 140/90 and 24.47% (n = 349/1426) for BP < 130/80 within 12 months project period. We sustained and exceeded at 72.64% (n = 945/1301) for BP < 140/90 and 44.58% (n = 580/1301) for BP < 130/80 during the 10 months post-project period. CONCLUSIONS: Overcoming physician clinical inertia, enhancing patient adherence to appointments and medications, and a high functioning multidisciplinary team were the key drivers for the success.
No takes yet. Share an insight, caveat, or question.
Sadeghi et al. (2020) studied Hypertension (n=1,426). Multifaceted quality improvement strategies vs. Baseline (historical control) was evaluated on Percentage of patients with BP < 140/90 mmHg. A multifaceted quality improvement strategy achieved blood pressure <140/90 mmHg in 62.6% and <130/80 mmHg in 24.47% of patients within 12 months, with further improvements sustained at 10 months.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: