Improving Blood Pressure Control for Hypertensive Patients at a University of Utah Family Medicine Residency Clinic: A Continuous Quality Improvement Project

Uncontrolled home blood pressure is associated with increased risk for cardiovascular events, stroke, and all-cause mortality, independent of office BP [USPSTF]. By implementing a process for initiating home blood pressure monitoring (HBPM), we hope to improve BP control for our hypertensive patients, thereby improving overall health and quality of life and decreasing health care costs. As of January 2016, only 67.73% of Madsen Family Medicine adult patients (ages 18-85 years) with hypertension had a controlled BP at their most recent clinic visit. At that time, 18.45% of our hypertensive patients had MyChart HBPM ordered (a flowsheet through our EMR Patient Portal). Of those patients, 9.1% had submitted at least one blood pressure reading. AIM: To improve the proportion of hypertensive adult patients (ages 18 to 85) at Madsen Family Medicine with controlled blood pressure by 15% over the three month period from February 3, 2016 to May 3, 2016. Conclusion: Improvement in BP control was statistically significant at the end of the post-intervention period (p < 0.0001 by chi- square and Fisher exact test) but not by our goal of 15%. Increase in MyChart HBPM orders and utilization were both statistically significant (both p < 0.0001 by chi-square and Fisher exact test). Our intervention was associated with improved BP control, likely due to patient involvement in reaching their goal, earlier recognition of poor control, and more values available for providers at follow up visits.