ABSTRACT
Background Hypertension control is critical to reducing cardiovascular disease, challenging to achieve, and exacerbated by socioeconomic inequities. Few states have established statewide quality improvement (QI) infrastructures to improve blood pressure (BP) control across economically disadvantaged populations. In this study, we aimed to improve BP control by 15% for all Medicaid recipients and by 20% for non-Hispanic Black participants. Methodology This QI study used repeated cross-sections of electronic health record data and, for Medicaid enrollees, linked Medicaid claims data for 17,672 adults with hypertension seen at one of eight high-volume Medicaid primary care practices in Ohio from 2017 to 2019. Evidence-based strategies included (1) accurate BP measurement; (2) timely follow-up; (3) outreach; (4) a standardized treatment algorithm; and (5) effective communication. Payers focused on a 90-day supply (vs. 30-day) of BP medications, home BP monitor access, and outreach. Implementation efforts included an in-person kick-off followed by monthly QI coaching and monthly webinars. Weighted generalized estimating equations were used to estimate the baseline, one-year, and two-year implementation change in the proportion of visits with BP control (<140/90 mm Hg) stratified by race/ethnicity. Results For all practices, the percentage of participants with controlled BP increased from 52% in 2017 to 60% in 2019. Among non-Hispanic Whites, the odds of achieving BP control in year one and year two were 1.24 times (95% confidence interval: 1.14, 1.34) and 1.50 times (1.38, 1.63) higher relative to baseline, respectively. Among non-Hispanic Blacks, the odds for years one and two were 1.18 times (1.10, 1.27) and 1.34 times (1.24, 1.45) higher relative to baseline, respectively. Conclusions A hypertension QI project as part of establishing a statewide QI infrastructure improved BP control in practices with a high volume of disadvantaged patients. Future efforts should investigate ways to reduce inequities in BP control and further explore factors associated with greater BP improvements and sustainability.
ABSTRACT
The application and incomplete removal of a computer-aided design/computer-aided manufacture imaging powder may affect the dentin surface prior to bonding a ceramic restoration. The purpose of this study was to compare the effect of imaging powder residue on the shear bond strength of a self-adhesive resin cement to dentin. Mounted human third molars were sectioned coronally with a diamond saw to expose the dentin, which was then prepared with a diamond bur mounted in a custom jig. The dentin surface was sprayed with 3 different imaging powders. The 3 powder groups were then divided into 3 subgroups based on the method of powder removal: no rinse, 1-second rinse, and 10-second rinse. A control group was created that had no application of imaging powder. A self-adhesive resin cement was bonded to the surfaces and loaded to failure in a universal testing machine after 24 hours of storage. Data was analyzed with Kruskal-Wallis and Mann-Whitney nonparametric tests. The bonding to dentin surfaces of the powder groups that were rinsed for 1 or 10 seconds were not significantly different from each other or the nonpowdered control. The type of imaging powder did not significantly affect the bond strength. The nonrinsed powdered dentin surface had a significant reduction in bond strength compared to both the control and the rinsed powdered surfaces.
