TY - JOUR
T1 - Tracking blood pressure control performance and process metrics in 25 US health systems
T2 - The Pcornet blood pressure control laboratory
AU - Cooper-Dehoff, Rhonda M.
AU - Fontil, Valy
AU - Carton, Thomas
AU - Chamberlain, Alanna M.
AU - Todd, Jonathan
AU - O’Brien, Emily C.
AU - Shaw, Kathryn M.
AU - Smith, Myra
AU - Choi, Sujung
AU - Nilles, Ester K.
AU - Ford, Daniel
AU - Tecson, Kristen M.
AU - Dennar, Princess E.
AU - Ahmad, Faraz
AU - Wu, Shenghui
AU - McClay, James C.
AU - Azar, Kristen
AU - Singh, Rajbir
AU - Modrow, Madelaine Faulkner
AU - Shay, Christina M.
AU - Rakotz, Michael
AU - Wozniak, Gregory
AU - Pletcher, Mark J.
N1 - Funding Information:
The PCORnet Blood Pressure Control Laboratory is funded by a partnership including the Patient-Centered Outcomes Research Institute (PCORI contract PaCR-2017C2-8153), the American Medical Association (funding and in-kind support), and the American Heart Association (in-kind support). The American Medical Association and the American Heart Association are represented on the steering committee. The findings and conclusions are those of the authors and do not necessarily represent the views of Patient-Centered Outcomes Research Institute, the American Medical Association, or the American Heart Association.
Publisher Copyright:
© 2021 The Authors.
PY - 2021/11/2
Y1 - 2021/11/2
N2 - BACKGROUND: The National Patient-Centered Clinical Research Network Blood Pressure Control Laboratory Surveillance System was established to identify opportunities for blood pressure (BP) control improvement and to provide a mechanism for tracking improvement longitudinally. METHODS AND RESULTS: We conducted a serial cross-sectional study with queries against standardized electronic health record data in the National Patient-Centered Clinical Research Network (PCORnet) common data model returned by 25 participating US health systems. Queries produced BP control metrics for adults with well-documented hypertension and a recent encounter at the health system for a series of 1-year measurement periods for each quarter of available data from January 2017 to March 2020. Aggregate weighted results are presented overall and by race and ethnicity. The most recent measurement period includes data from 1 737 995 patients, and 11 956 509 patient-years were included in the trend analysis. Overall, 15% were Black, 52% women, and 28% had diabetes. BP control (<140/90 mm Hg) was observed in 62% (range, 44%-74%) but varied by race and ethnicity, with the lowest BP control among Black patients at 57% (odds ratio, 0.79; 95% CI, 0.66-0.94). A new class of antihypertensive medication (medication intensification) was prescribed in just 12% (range, 0.6%-25%) of patient visits where BP was uncontrolled. However, when medication intensification occurred, there was a large decrease in systolic BP (≈15 mm Hg; range, 5-18 mm Hg). CONCLUSIONS: Major opportunities exist for improving BP control and reducing disparities, especially through consistent medication intensification when BP is uncontrolled. These data demonstrate substantial room for improvement and opportunities to close health equity gaps.
AB - BACKGROUND: The National Patient-Centered Clinical Research Network Blood Pressure Control Laboratory Surveillance System was established to identify opportunities for blood pressure (BP) control improvement and to provide a mechanism for tracking improvement longitudinally. METHODS AND RESULTS: We conducted a serial cross-sectional study with queries against standardized electronic health record data in the National Patient-Centered Clinical Research Network (PCORnet) common data model returned by 25 participating US health systems. Queries produced BP control metrics for adults with well-documented hypertension and a recent encounter at the health system for a series of 1-year measurement periods for each quarter of available data from January 2017 to March 2020. Aggregate weighted results are presented overall and by race and ethnicity. The most recent measurement period includes data from 1 737 995 patients, and 11 956 509 patient-years were included in the trend analysis. Overall, 15% were Black, 52% women, and 28% had diabetes. BP control (<140/90 mm Hg) was observed in 62% (range, 44%-74%) but varied by race and ethnicity, with the lowest BP control among Black patients at 57% (odds ratio, 0.79; 95% CI, 0.66-0.94). A new class of antihypertensive medication (medication intensification) was prescribed in just 12% (range, 0.6%-25%) of patient visits where BP was uncontrolled. However, when medication intensification occurred, there was a large decrease in systolic BP (≈15 mm Hg; range, 5-18 mm Hg). CONCLUSIONS: Major opportunities exist for improving BP control and reducing disparities, especially through consistent medication intensification when BP is uncontrolled. These data demonstrate substantial room for improvement and opportunities to close health equity gaps.
KW - Health equity
KW - High blood pressure
KW - Hypertension
KW - Quality and outcomes
KW - Race and ethnicity
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U2 - 10.1161/JAHA.121.022224
DO - 10.1161/JAHA.121.022224
M3 - Article
C2 - 34612048
AN - SCOPUS:85121477290
SN - 2047-9980
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 21
M1 - e022224
ER -