Improvement in Hypertension Control Among Adults Seen in Federally Qualified Health Center Clinics in the Stroke Belt: Implementing a Program with a Dashboard and Process Metrics
Attain 75% hypertension (HTN) control and improve racial equity in control with the American Medical Association Measure accurately, Act rapidly, Partner with patients blood pressure (AMA MAP BP™) quality improvement program, including a monthly dashboard and practice facilitation.
Eight federally qualified health center clinics from the HopeHealth network in South Carolina participated. Clinic staff received monthly practice facilitation guided by a dashboard with process metrics (measure [repeat BP when initial systolic ≥140 or diastolic ≥90 mmHg; Act [number antihypertensive medication classes prescribed at standard dose or greater to adults with uncontrolled BP]; Partner [follow-up within 30 days of uncontrolled BP; systolic BP fall after medication added]) and outcome metric (BP <140/<90). Electronic health record data were obtained on adults ≥18 years at baseline and monthly during MAP BP. Patients with diagnosed HTN, ≥1 encounter at baseline, and ≥2 encounters during 6 months of MAP BP were included in this evaluation.
Among 45,498 adults with encounters during the 1-year baseline, 20,963 (46.1%) had diagnosed HTN; 12,370 (59%) met the inclusion criteria (67% black, 29% white; mean (standard deviation) age 59.5 (12.8) years; 16.3% uninsured. HTN control improved (63.6% vs. 75.1%, p<0.0001), reflecting positive changes in Measure, Act, and Partner metrics (all p<0.001), although control remained lower in non-Hispanic black than in non-Hispanic white adults (73.8% vs. 78.4%, p<0.001).
With MAP BP, the HTN control goal was attained among adults eligible for analysis. Ongoing efforts aim to improve program access and racial equity in control.
The excess stroke mortality rate in the southeast United States led to its designation as the nation’s Stroke Belt.1,2 For all but one decade between 1930 and 1990,3 South Carolina had the highest per capita stroke mortality rate in the southeast, that is, the “buckle” of the Stroke Belt.4 Within South Carolina, the Pee Dee Region, located in the northeast section of the state, has a very high rate of stroke-related deaths.5 HopeHealth, designated as a federally qualified health center (FQHC) in 2007, has 15 clinical sites in the Pee Dee Region of South Carolina serving a primarily rural area with multiple sociodemographic risk factors for adverse cardiovascular outcomes.6
HopeHealth established goals to attain a hypertension (HTN) control rate of 75% and improve racial equity in control before discussions with the American Medical Association (AMA). Previous experience documented that the AMA MAP BP™ program (Measure accurately, Act rapidly, Partner with patients) could enable a rapid and sustained improvement in HTN control within clinical sites serving patients with sociodemographic risk for HTN-related morbidity and mortality rate.7–9
Given the burden of HTN in our patients, HopeHealth partnered with the AMA on their MAP BP quality improvement program.7 The eight clinical sites at HopeHealth, which provided primary care to ∼45,000 adults with encounters in the past year, participated in the MAP BP program described in this report. The other seven HopeHealth sites, which did not participate in MAP BP, predominantly provide medical services to children or other adult nonprimary care medical services.
The MAP BP program includes monthly dashboards and practice facilitation to promote efficient implementation and maintenance of key process changes that raise HTN control.9 The monthly dashboards with process metrics and HTN control metric at the clinic level were provided to the eight HopeHealth sites individually, and at the patient level for providers at each clinical site. This current report presents changes in HTN control, blood pressure (BP, mmHg), and process metrics during the 6-month MAP BP quality improvement program…..
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