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Implementing a Blood Pressure Measurement Protocol to Improve the Diagnosis and Treatment of Hypertension

CP15 - Implementing a Blood Pressure Measurement Protocol to Improve the Diagnosis and Treatment of Hypertension

Poster Type: Research

Track/Topic: A. T. Still University; Quality of Care and Quality Improvement

Research Objectives: Workflow changes that enhance accurate blood pressure measurement can help with the diagnosis and treatment of hypertension and lead to improved health outcomes. The purpose of this project is to improve blood pressure measurement technique and workflow within the Family Health Centers at NYU Langone, a federally qualified health center.

Research Study Design/Methods: Patients with a known diagnosis of hypertension and/or elevated blood pressure visiting the ambulatory care practice have their blood pressure measured using American Heart Association (AHA) recommended patient preparation and measurement techniques. A dashboard to track multiple BP readings when values are outside of recommended BP target ranges was developed and a checklist documented in the electronic medical record is used to monitor adherence with the AHA guidelines in the initial patient triage by the medical assistant.

Research Principal Findings and Quantitative/Qualitative Results: Data analysis shows improved adherence to the AHA recommended patient preparation and measurement techniques within the pilot provider’s panel. During the first 16 weeks of project implementation, we noted that patients who had a BP measurement that was initially elevated during triage subsequently had a lower blood pressure when AHA recommended blood pressure measurement techniques were used to guide blood pressure measurement. For example, approximately 32% of patient encounters that showed an elevated blood pressure reading on initial triage were subsequently found to have a normal BP reading when AHA protocol was used to measure the blood pressure.

Research Conclusions on Impact on Health Centers: Accurate blood pressure measurement is essential to the diagnosis and treatment of hypertension. Inaccurate blood pressure measurement may lead to failure to identify patients with hypertension resulting in increased risk for cardiovascular disease, kidney disease, stroke, cognitive decline, and mortality. Alternatively, inaccurate blood pressure measurement may also lead to unfavorable outcomes such as adverse medication side effects, increased risk of falls in the elderly, and an increase in hospitalizations. This quality improvement project demonstrates the feasibility of implementing workflow changes that can enhance accurate blood pressure measurement techniques in an ambulatory care setting.

Authors:

Surekha Appikatla, MPH, Data Informatics Specialist, A.T. Still University

Oksana Genzer, MD, Internal Medicine Primary Care Physician/Adjunct Teaching Instructor, NYU Langone Sunset Park Family Health Center

Ebony Whisenant, MD, Assoc. Prof., Family Med and Public Health, Director, PCTE Fellowship, A. T. Still University, School Of Osteopathic Medicine in Arizona