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Impact of COVID-19-related care disruptions on blood pressure management and control in community health centers.
Meador, Margaret; Coronado, Fátima; Roy, Debosree; Bay, R Curtis; Lewis, Joy H; Chen, Jessica; Cheung, Rachel; Utman, Christopher; Hannan, Judith A.
  • Meador M; Director of Clinical Integration and Education, National Association of Community Health Centers, Bethesda, MD, USA. mmeador@nachc.com.
  • Coronado F; Associate Director for Science, Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
  • Roy D; Post-doctoral Research Scholar, Department of Public Health, A.T. Still University-School of Osteopathic Medicine in Arizona, Mesa, AZ, USA.
  • Bay RC; Professor, Biostatistics, Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, USA.
  • Lewis JH; Professor of Medicine and Public Health; Chair, Department of Public Health, A.T. Still University-School of Osteopathic Medicine in Arizona, Mesa, AZ, USA.
  • Chen J; Quality Improvement Program Manager, The Health Federation of Philadelphia, Philadelphia, PA, USA.
  • Cheung R; Manager of Quality, Esperanza Health Centers, Chicago, IL, USA.
  • Utman C; , Assistant Director, Data Analytics, HealthEfficient, Albany, NY, USA.
  • Hannan JA; Million Hearts® Senior Advisor, Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
BMC Public Health ; 22(1): 2295, 2022 12 08.
Article in English | MEDLINE | ID: covidwho-2153554
ABSTRACT

BACKGROUND:

Uncontrolled hypertension is a leading risk factor for cardiovascular disease. To ensure continuity of care, community health centers (CHCs) nationwide implemented virtual care (telehealth) during the pandemic. CHCs use the Centers for Medicare & Medicaid Services (CMS) 165v8 Controlling High Blood Pressure measure to report blood pressure (BP) control performance. CMS 165v8 specifications state that if no BP is documented during the measurement period, the patient's BP is assumed uncontrolled.

METHODS:

To examine trends in BP documentation and control rates in CHCs as telehealth use increased during the pandemic compared with pre-pandemic period, we assessed documentation of BP measurement and BP control rates from December 2019 - October 2021 among persons ages 18-85 with a diagnosis of hypertension who had an in-person or telehealth encounter in 11 CHCs. Rates were compared between CHCs that did and did not implement self-measured BP monitoring (SMBP).

RESULTS:

The percent of patients with hypertension with no documented BP measurement was 0.5% in December 2019 and increased to 15.2% (overall), 25.6% (non-SMBP CHCs), and 11.2% (SMBP CHCs) by October 2021. BP control using CMS 165v8 was 63.5% in December 2019 and decreased to 54.9% (overall), 49.1% (non-SMBP), and 57.2% (SMBP) by October 2021. When assessing BP control only in patients with documented BP measurements, CHCs largely maintained BP control rates (63.8% in December 2019; 64.8% (overall), 66.0% (non-SMBP), and 64.4% (SMBP) by October 2021).

CONCLUSIONS:

The transition away from in-person to telehealth visits during the pandemic likely increased the number of patients with hypertension lacking a documented BP measurement, subsequently negatively impacting BP control using CMS 165v8. There is an urgent need to enhance the flexibility of virtual care, improve EHR data capture capabilities for patient-generated data, and implement expanded policy and systems-level changes for SMBP, an evidence-based strategy that can build patient trust, increase healthcare engagement, and improve hypertension outcomes.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Hypertension Type of study: Experimental Studies / Observational study / Prognostic study Limits: Adolescent / Adult / Aged / Humans / Middle aged / Young adult Country/Region as subject: North America Language: English Journal: BMC Public Health Journal subject: Public Health Year: 2022 Document Type: Article Affiliation country: S12889-022-14763-9

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Hypertension Type of study: Experimental Studies / Observational study / Prognostic study Limits: Adolescent / Adult / Aged / Humans / Middle aged / Young adult Country/Region as subject: North America Language: English Journal: BMC Public Health Journal subject: Public Health Year: 2022 Document Type: Article Affiliation country: S12889-022-14763-9