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

Abstract

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.