Population Health Approach to Blood Pressure Control Using Advanced Practice Provider-Managed Remote Patient Monitoring.

BACKGROUND

Guidelines suggest that home blood pressure (BP) readings are more reliable than in-clinic measurements; however, quality metrics for patients with hypertension (HTN) primarily rely on in-clinic readings. To improve BP documentation and management, we implemented an advanced practice provider (APP)-managed remote patient monitoring (RPM) program.

METHODS

The electronic health records (EHR) of internal medicine patients with HTN and uncontrolled BP (≥140/90 mm Hg, per our institution's quality metric) were reviewed for more recent controlled (<140/90 mm Hg) home readings. If found, these values were imported into the chart's patient-reported vitals section. If not, patients were offered RPM. Participants (n = 472) received a BP monitor that automatically transmitted home readings to the EHR and had APP-led follow-up to guide lifestyle and medication adjustments until target BP was achieved. Lower targets (<130/80 mm Hg) were pursued for higher risk patients.

RESULTS

For 12 months, average systolic and diastolic BP of patients with initially uncontrolled HTN improved from 149.8 to 131.3 mm Hg and from 84.0 to 79.3 mm Hg, respectively ( p < .001). The percentage of patients with HTN and last documented BP < 140/90 mm Hg increased 7.94% compared with 1.75% at a comparison clinic providing standard care ( p = .022).

CONCLUSIONS

This APP-managed RPM program significantly improved BP outcomes and institutional quality metrics.