Clinician Fidelity with Hypertension Quality Improvement Program is Associated with Blood Pressure Control within a Clinician-Patient Panel.

BACKGROUND

Differences in clinician fidelity with hypertension quality improvement (QI) interventions may influence blood pressure (BP) control.

METHODS

This analysis included data from 35,115 patients with 89,230 clinical encounters during a calendar year conducted by 87 physicians, 7 advanced practice nurses, and 173 residents to examine the association of fidelity measures with QI interventions and BP control for a clinician-patient panel. BP control (BP < 140/90 mm Hg) was based on vital signs at last clinic visit. The QI program fidelity measures included (1) documented automated office BP (AOBP) to confirm initial elevated BP, (2) 30-day follow-up visits when clinic BP is uncontrolled, (3) appropriate escalation of medications during visits with uncontrolled BP, and (4) use of combination BP-lowering medications. Linear mixed-effects models were used to examine the association of QI program fidelity measure quartiles with patient panel BP control, while adjusting for patient panel characteristics.

RESULTS

The mean patient age was 63.2 years (SD 12.8), 45.1% were men; race/ethnicity was Non-Hispanic (NH) White in 60.5%, NH Black in 20.3%, and Hispanic in 14.0%. Average patient panel BP control rate was 69.1%. After adjustment, the highest AOBP and 30-day follow-up visit quartiles were associated with a 15.1% (95% CI, 8.9%-21.4%) and 12.3% (95% CI, 6.8%-17.7%) higher percentage of clinician-patient panels with controlled BP compared to the lowest quartile. No association was noted with other fidelity measures and BP control.

CONCLUSION

Increasing fidelity with hypertension QI interventions may help clinicians improve BP control rates within their patient panel.