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BACKGROUND: We implemented a quality improvement initiative to improve hypertension care at Veterans Affairs-Tennessee Valley Healthcare System. METHODS AND RESULTS: We implemented multiple interventions among 2 teaching hospitals, 5 community-based outpatient clinics, and 4 contract clinic sites. Goals of the program were to (1) improve measurement and documentation of blood pressure (BP), (2) initiate outpatient patient education, (3) emphasize VA/Department of Defense hypertension treatment algorithms to providers, (4) emphasize external peer review program performance goals, and (5) initiate feedback of each clinic's performance. The primary outcome was the proportion of patients seen each week with a diagnosis of hypertension who had their last available BP in control (< or =140/90 mm Hg). Observation time was 40 weeks (14 weeks preintervention, 8 weeks intervention implementation, and 18 weeks postintervention), during which there were 55 586 unique clinic visits for hypertension. After intervention deployment, there was an absolute improvement of 4.2% in BP control (preintervention 61.5% 12 245/19 908 versus postintervention 65.7% 15 809/24 059, P<0.0001). Teaching hospital A had an absolute improvement of 1.4% (63.4% 3544/5591 versus 64.8% 4581/7073, P=0.108). Teaching hospital B showed a 0.8% absolute improvement in BP control (59.7% 2577/4315 versus 60.5% 3416/5650, P=0.456). The community-based outpatient clinics had a combined absolute improvement of 8.6% (60.2% 5252/8728 versus 68.8% 6895/10025, P<0.0001). The contract clinics had a combined improvement of 1.5% (68.4% 872/1274 versus 69.9% 917/1311, P=0.409). Results were sustained 1 year after intervention. CONCLUSIONS: After implementing small, focused, and inexpensive interventions, BP control improved 4.2%, thereby improving the quality of hypertension care.
Choma et al. (Wed,) studied this question.