STANDARDIZING HYPERTENSION MANAGEMENT AS A STRATEGY TO IMPROVE RATE OF BLOOD PRESSURE CONTROL AND REDUCE RACIAL DISPARITIES IN AN URBAN PRIMARY CARE TEACHING PRACTICE

ABSTRACT

STATEMENT OF PROBLEM/QUESTION Although hypertension is a leading cause of preventable cardiovascular disease, rates of blood pressure (BP) control remain suboptimal, particularly among racial and ethnic minority groups. DESCRIPTION OF PROGRAM/INTERVENTION The COVID-19 pandemic has led to delays in chronic disease management and has exacerbated pre-existing racial disparities in BP control. Our quality improvement project aimed to improve BP control rates in our clinic. Our initial root cause analysis identified several contributors to suboptimal BP control in our clinic 1) lack of follow up, 2) patient nonadherence, and 3) lack of home BP monitoring capability for telehealth encounters. To address these, we designed a comprehensive intervention which included 1) a standardized 2 week follow up interval for patients with elevated BPs, 2) a standardized quicktext to be used at BP follow up appointments to reduce variability in provider management, and 3) home BP cuff distribution, free of cost, to those lacking this equipment. We followed the first 200 BP cuff recipients through a 6-month period. MEASURES OF SUCCESS Our outcome measure was the percent of patients with controlled BP (defined as <140/90) through the 6-month follow up period. Our process measure was the percent of patients who had a BP follow up appointment during this time. Race-stratified data was monitored to ensure we were not worsening racial disparities in BP control. FINDINGS TO DATE Three patients expired during the 6-month follow up period. Of the remaining 197 patients, the rate of overall BP control was 20% (39/197) at time of cuff distribution. This overall rate of BP control improved to 51% (101/197) at the 6-month time period. 85% (168/197) successfully followed up within the 6-month timeframe. In the initial cohort, 75% (147/197) identified as Black, 14% (27/197) identified as White, and the remaining 11% (23/197) identified as Hispanic/Latinx, Native American/Alaskan, biracial, multiple, or other;each of these groups achieved similar BP control rates during the 6-month follow up period [51% (75/147), 52% (14/27), and 52% (12/23), respectively]. KEY LESSONS FOR DISSEMINATION Standardization of care and successful follow up are key elements in improving BP control in the outpatient setting. Our results also suggest that standardizing provider workflows and reducing barriers to telehealth visits can also decrease racial disparities in BP control. Our next steps including identifying patients who remain uncontrolled and leveraging additional system resources, including community health workers, for continued support outside of the office setting.