Hypertension
Conditions
Brief summary
BP-MAP is a cluster randomized controlled trial (RCT) designed to compare the effectiveness of BP lowering from a clinic-based quality improvement program with Full Support (dedicated practice facilitation) vs. a Self-Guided version of the program. The American Medical Association (AMA) developed the framework for the interventions.
Detailed description
BP-MAP is a cluster randomized controlled trial (RCT) designed to compare the effectiveness of BP lowering from a clinic-based quality improvement program with Full Support (dedicated practice facilitation) vs. a Self-Guided version of the program. The American Medical Association (AMA) developed the framework for the interventions. The trial will be conducted within the National Patient-Centered Clinical Research Network (PCORnet) that enables distributed querying of electronic health record data in a common data model. The primary outcome will be change in clinic-level blood pressure (BP) control at 6 months. Secondary outcomes will include other blood pressure (BP) control metrics, other time points (12 and 18 months), and process measures such as BP measurement accuracy, medication intensification, and average systolic blood pressure (SBP) reduction after a medication intensification, and repeat visit within 4 weeks after a visit with elevated BP. The investigators hypothesize clinics randomized to the Full Support version will achieve a larger increase from baseline in the proportion of their hypertensive patients with controlled BP at 6 months as compared to clinics randomized to the Self-Guided version, and also as compared with usual care. The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating Usual Care institutions in PCORnet. This study was submitted to the IRB at UCSF, determined to be quality improvement and exempt from further review.
Interventions
OTHERSelf-Guided M.A.P. BP Improvement Program
Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.
OTHERFull Support M.A.P. BP Improvement Program
Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA Improvement Advisor, the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.
Sponsors
OCHIN, Inc.
Louisiana Public Health Institute
American Medical Association
American Heart Association
University of California, San Francisco
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
ACTIVE CLINICS For inclusion as an Active Clinic in this study, clinics may participate must be able to identify: * A Site Champion who works at the clinic and who is willing to take primary responsibility for implementing the M.A.P. intervention * A Physician Champion who works at the clinic and who is willing to advocate actively for the M.A.P. intervention * A Practice Change Facilitator willing to attend a 1-day training and help guide implementation of the M.A.P intervention for Full Support sites, with the support of AMA staff (may be the Site Champion or Physician Champion, or a person with regional responsibilities who can support multiple sites) Sites will be excluded if they: * Have implemented any high blood pressure quality improvement component from the M.A.P. BP improvement program as part of Target: BP or from the AMA or Target: BP websites * Are currently involved in an ongoing clinical trial or grant funded project related to high blood pressure or hypertension USUAL CARE CLINICS: Usual Care Clinics will include PCORnet Datamarts participating in BP TRACK, a concurrently-running BP Control Registry within PCORnet that will provide quarterly datamart-level estimates of BP control and other aggregate metrics relevant to BP control. All participating datamarts will be included, with the following exceptions: * Datamarts with any Active Clinics participating in BP MAP will be excluded * Datamarts that obscure dates via date-shifting will be excluded, as this will not allow for control of concurrent secular trends PATIENTS Within clinics (Active or Usual Care), patients will be eligible (and identified from the electronic health record) if they meet National Quality Forum BP Control Metric (NQF 0018) criteria: * Age 18-85 on the date of analysis * At least one outpatient encounter with a diagnosis of hypertension during the first six months of the measurement year (ending on the date of analysis) * No diagnosis or evidence of end-stage renal disease on or prior to the end of the measurement year * No pregnancy during the measurement year * No admission to an inpatient setting during the measurement year
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Blood Pressure Control, % of Patients | baseline and 6 months | The primary outcome will be clinic-level change in the proportion of patients with controlled BP from baseline to 6 months after the start of the intervention. BP control will be defined according to NQF 0018 as the percent of eligible patients (defined below) with SBP \<140 mmHg and DBP \< 90 mmHg, based on measurements obtained at the most recent ambulatory clinical encounter at baseline (using the lowest measures of SBP and DBP at that encounter) and similarly at the 6-month time point after initiation of the intervention. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Confirmatory Repeated Blood Pressure Measurement, % of Visits | baseline and 6 months | This process measure is designed to capture the practice of repeating a blood pressure measurement in the same visit when the first measurement done in clinic is high (SBP≥140 mmHg or DBP≥90 mmHg). |
| Change in Medication Intensification, % of Visits | baseline and 6 months | This process measure captures the proportion of visits where BP is uncontrolled where a medication is ordered that is of a different class of medication than had previously been used. Note that this explicitly does not give credit for ordering a simple refill or medication dose increase, or use of a different medication in the same class. |
| Change in Average Systolic Blood Pressure (SBP) Reduction After a Medication Intensification Visit, mmHg | baseline and 6 months | This continuous metric describes the change in SBP (+/- standard deviation) observed between a visit with a medication intensification to the subsequent visit occurring at least 10 days later. |
| Change in Repeat Visit in 4 Weeks After a Visit With Elevated BP, % of Visits | baseline and 6 months | This process measure captures the proportion of persons who had uncontrolled HTN who made a subsequent visit within the following 4 weeks. |
| Change in Improvement in Blood Pressure, % of Patients | baseline and 12 months | This overall measure of BP improvement implements CMS065v4\[ref\], which defines BP improvement as either a reduction of 10 mmHg in SBP or achievement of SBP that is adequately controlled (SBP \< 140 mmHg) in months 12 of the measurement period, among hypertensive patients not previously controlled. |
| Change in Use of a CCB or Thiazide or Thiazide-like Diuretic Among African-American Patients on at Least One Medication, % of Patients | baseline and 6 months | Use of calcium channel blockers (CCB) OR a thiazide or thiazide-like diuretic medication classes is recommended to treat black or African American patients as first line monotherapy due to increased efficacy. This metric, which is limited to African-American patients with a diagnosis of hypertension taking at least one medication class, describes the prevalence of those receiving the recommended drug class. |
| Change in Terminal Digit = Zero, % of Measurements | baseline and 6 months | Inappropriate rounding of blood pressure measurements (usually to zero) leads to measurement error and worse treatment decisions. This continuous metric is calculated for a clinic as the percent of measurements at that clinic (for hypertensive patients) where the terminal digit of the measurement is zero. A percent greater than 10% (if an automated BP monitor is used) or greater than 20% (if a manual BP monitor is used with recommended rounding to even digits) indicates evidence of inappropriate rounding. Unlike most of our metrics, lower is better, down to an ideal value of 10-20%, which would be expected if no rounding were occurring. For this study we calculated the change in this continuous metric for each clinic from baseline to 6 months, and then described the mean change across clinics by group. As with our other outcomes, the unit of analysis in the study is a clinic. |
| Change in Blood Pressure Controlled to 2017 Guideline Goal, % of Patients | baseline and 6 months | This alternative overall measure of BP control is identical to Metric 1, except that attainment of BP Control is defined by SBP \< 130 mmHg and DBP \< 80 mmHg, as per the goal stated in the 2017 ACC/AHA Hypertension Guideline\[ref\]. Note that while the treatment threshold varies in the Guideline, depending on cardiovascular risk, the goal applies to all patients. |
| Change in Use of Fixed Dose Combination Product Among Patients Taking 2 or More Classes of Medications, % of Patients | baseline and 6 months | Use of fixed dose combination medications helps with adherence, promotes rational combinations of medications, and increases likelihood of achieving BP control. This metric, which is limited to patients taking more than one medication class, describes the prevalence of fixed dose combination pill use. |
Countries
United States
Participant flow
Recruitment details
The unit of randomization was the participating clinical unit.
Pre-assignment details
24 clinic leaders agreed to participate in a BP control quality improvement program and 24 clinics were randomized and assigned to one of the intervention arms. We included 18 PCORnet clinics in our Blood Pressure Control Laboratory Surveillance Program (BP Track) for our control arms. No individuals were consented. This study was exempt from IRB review as a quality improvement program not human subjects research.
Participants by arm
| Arm | Count |
|---|---|
| Full Support Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA Improvement Advisor, the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.
Full Support M.A.P. BP Improvement Program: Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA Improvement Advisor, the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control. | 11,821 |
| Full Support Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA Improvement Advisor, the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.
Full Support M.A.P. BP Improvement Program: Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA Improvement Advisor, the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control. | 12 |
| Self-Guided Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.
Self-Guided M.A.P. BP Improvement Program: Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group. | 14,454 |
| Self-Guided Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.
Self-Guided M.A.P. BP Improvement Program: Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group. | 12 |
| Usual Care The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating Usual Care institutions in PCORnet. | 1,212,560 |
| Usual Care The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating Usual Care institutions in PCORnet. | 18 |
| Total | 1,238,877 |
Baseline characteristics
| Characteristic | Full Support | Self-Guided | Usual Care | Total |
|---|---|---|---|---|
| Age, Continuous | 57.1 Age in years STANDARD_DEVIATION 2.49 | 57.1 Age in years STANDARD_DEVIATION 2.61 | 63.47 Age in years STANDARD_DEVIATION 1.76 | 63.46 Age in years STANDARD_DEVIATION 1.78 |
| Age, Customized 18-44 years | 16.0 percentage of participants STANDARD_DEVIATION 4.91 | 16.1 percentage of participants STANDARD_DEVIATION 5.33 | 9.3 percentage of participants STANDARD_DEVIATION 2.21 | 13.8 percentage of participants STANDARD_DEVIATION 5.42 |
| Age, Customized 45-64 years | 56.5 percentage of participants STANDARD_DEVIATION 4.5 | 56.5 percentage of participants STANDARD_DEVIATION 6.07 | 38.1 percentage of participants STANDARD_DEVIATION 4.58 | 50.4 percentage of participants STANDARD_DEVIATION 10.06 |
| Age, Customized 65+ years | 27.5 percentage of participants STANDARD_DEVIATION 8.03 | 27.4 percentage of participants STANDARD_DEVIATION 8.38 | 52.6 percentage of participants STANDARD_DEVIATION 6.14 | 35.8 percentage of participants STANDARD_DEVIATION 14.09 |
| COPD (%) | 6.6 percentage of participants STANDARD_DEVIATION 4.18 | 4.4 percentage of participants STANDARD_DEVIATION 2.43 | 5.7 percentage of participants STANDARD_DEVIATION 1.51 | 5.7 percentage of participants STANDARD_DEVIATION 1.51 |
| Depression, % | 17.0 percentage of participants STANDARD_DEVIATION 9.47 | 18.2 percentage of participants STANDARD_DEVIATION 16.4 | 14.5 percentage of participants STANDARD_DEVIATION 5.8 | 14.5 percentage of participants STANDARD_DEVIATION 5.83 |
| Diabetes, % | 29.9 percentage of participants STANDARD_DEVIATION 3.43 | 33.8 percentage of participants STANDARD_DEVIATION 9.89 | 26.7 percentage of participants STANDARD_DEVIATION 2.74 | 26.7 percentage of participants STANDARD_DEVIATION 2.78 |
| Heart Failure, % | 2.9 percentage of participants STANDARD_DEVIATION 1.51 | 2.6 percentage of participants STANDARD_DEVIATION 1.36 | 6.8 percentage of participants STANDARD_DEVIATION 1.3 | 6.8 percentage of participants STANDARD_DEVIATION 1.31 |
| Median total number of patients with hypertension | 517 number of participants | 1040 number of participants | 53266 number of participants | 2003 number of participants |
| Race/Ethnicity, Customized Asian, % | 1.6 percentage of participants STANDARD_DEVIATION 2.34 | 3.8 percentage of participants STANDARD_DEVIATION 5.69 | 1.7 percentage of participants STANDARD_DEVIATION 0.67 | 2.3 percentage of participants STANDARD_DEVIATION 3.72 |
| Race/Ethnicity, Customized Black, % | 34.9 percentage of participants STANDARD_DEVIATION 33.8 | 36.8 percentage of participants STANDARD_DEVIATION 34.6 | 13.4 percentage of participants STANDARD_DEVIATION 15.3 | 28.4 percentage of participants STANDARD_DEVIATION 31.12 |
| Race/Ethnicity, Customized LatinX, % | 10.3 percentage of participants STANDARD_DEVIATION 5.9 | 26.3 percentage of participants STANDARD_DEVIATION 28.3 | 3.1 percentage of participants STANDARD_DEVIATION 2.01 | 13.2 percentage of participants STANDARD_DEVIATION 19.36 |
| Race/Ethnicity, Customized Other, % | 3.0 percentage of participants STANDARD_DEVIATION 2.29 | 3.2 percentage of participants STANDARD_DEVIATION 2.69 | 2.5 percentage of participants STANDARD_DEVIATION 0.95 | 2.9 percentage of participants STANDARD_DEVIATION 2.14 |
| Race/Ethnicity, Customized White, % | 50.3 percentage of participants STANDARD_DEVIATION 33.8 | 29.8 percentage of participants STANDARD_DEVIATION 27.01 | 79.2 percentage of participants STANDARD_DEVIATION 15.56 | 53.1 percentage of participants STANDARD_DEVIATION 33.4 |
| Sex/Gender, Customized Female, % | 57.2 percentage of participants STANDARD_DEVIATION 5.8 | 60.7 percentage of participants STANDARD_DEVIATION 5.75 | 51.4 percentage of participants STANDARD_DEVIATION 3.08 | 56.4 percentage of participants STANDARD_DEVIATION 6.35 |
| Sex/Gender, Customized Male, % | 42.8 percentage of participants STANDARD_DEVIATION 5.8 | 39.3 percentage of participants STANDARD_DEVIATION 5.75 | 48.6 percentage of participants STANDARD_DEVIATION 3.08 | 43.6 percentage of participants STANDARD_DEVIATION 6.35 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
Primary
Change in Blood Pressure Control, % of Patients
The primary outcome will be clinic-level change in the proportion of patients with controlled BP from baseline to 6 months after the start of the intervention. BP control will be defined according to NQF 0018 as the percent of eligible patients (defined below) with SBP \<140 mmHg and DBP \< 90 mmHg, based on measurements obtained at the most recent ambulatory clinical encounter at baseline (using the lowest measures of SBP and DBP at that encounter) and similarly at the 6-month time point after initiation of the intervention.
Time frame: baseline and 6 months
Population: The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the numerator and denominator for each metric.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Full Support | Change in Blood Pressure Control, % of Patients | 2.8 percentage of patients |
| Self-Guided | Change in Blood Pressure Control, % of Patients | 1.6 percentage of patients |
| Usual Care | Change in Blood Pressure Control, % of Patients | -0.4 percentage of patients |
Secondary
Change in Average Systolic Blood Pressure (SBP) Reduction After a Medication Intensification Visit, mmHg
This continuous metric describes the change in SBP (+/- standard deviation) observed between a visit with a medication intensification to the subsequent visit occurring at least 10 days later.
Time frame: baseline and 6 months
Population: The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the average reduction in patients with a recent medication intensification.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Full Support | Change in Average Systolic Blood Pressure (SBP) Reduction After a Medication Intensification Visit, mmHg | 2.3 mmHg |
| Self-Guided | Change in Average Systolic Blood Pressure (SBP) Reduction After a Medication Intensification Visit, mmHg | -1.6 mmHg |
| Usual Care | Change in Average Systolic Blood Pressure (SBP) Reduction After a Medication Intensification Visit, mmHg | -1.1 mmHg |
Secondary
Change in Blood Pressure Controlled to 2017 Guideline Goal, % of Patients
This alternative overall measure of BP control is identical to Metric 1, except that attainment of BP Control is defined by SBP \< 130 mmHg and DBP \< 80 mmHg, as per the goal stated in the 2017 ACC/AHA Hypertension Guideline\[ref\]. Note that while the treatment threshold varies in the Guideline, depending on cardiovascular risk, the goal applies to all patients.
Time frame: baseline and 6 months
Population: The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the numerator and denominator for each metric.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Full Support | Change in Blood Pressure Controlled to 2017 Guideline Goal, % of Patients | -1.5 percentage of patients |
| Self-Guided | Change in Blood Pressure Controlled to 2017 Guideline Goal, % of Patients | -1.1 percentage of patients |
| Usual Care | Change in Blood Pressure Controlled to 2017 Guideline Goal, % of Patients | -0.5 percentage of patients |
Secondary
Change in Confirmatory Repeated Blood Pressure Measurement, % of Visits
This process measure is designed to capture the practice of repeating a blood pressure measurement in the same visit when the first measurement done in clinic is high (SBP≥140 mmHg or DBP≥90 mmHg).
Time frame: baseline and 6 months
Population: The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the numerator and denominator for each metric.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Full Support | Change in Confirmatory Repeated Blood Pressure Measurement, % of Visits | 19.8 percentage of visits |
| Self-Guided | Change in Confirmatory Repeated Blood Pressure Measurement, % of Visits | 11.6 percentage of visits |
| Usual Care | Change in Confirmatory Repeated Blood Pressure Measurement, % of Visits | 0.1 percentage of visits |
Secondary
Change in Improvement in Blood Pressure, % of Patients
This overall measure of BP improvement implements CMS065v4\[ref\], which defines BP improvement as either a reduction of 10 mmHg in SBP or achievement of SBP that is adequately controlled (SBP \< 140 mmHg) in months 12 of the measurement period, among hypertensive patients not previously controlled.
Time frame: baseline and 12 months
Population: The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the numerator and denominator for each metric.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Full Support | Change in Improvement in Blood Pressure, % of Patients | -3.4 percentage of patients |
| Self-Guided | Change in Improvement in Blood Pressure, % of Patients | -5.4 percentage of patients |
| Usual Care | Change in Improvement in Blood Pressure, % of Patients | -3.1 percentage of patients |
Secondary
Change in Medication Intensification, % of Visits
This process measure captures the proportion of visits where BP is uncontrolled where a medication is ordered that is of a different class of medication than had previously been used. Note that this explicitly does not give credit for ordering a simple refill or medication dose increase, or use of a different medication in the same class.
Time frame: baseline and 6 months
Population: The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the numerator and denominator for each metric.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Full Support | Change in Medication Intensification, % of Visits | -1.6 percentage of visits |
| Self-Guided | Change in Medication Intensification, % of Visits | -3.4 percentage of visits |
| Usual Care | Change in Medication Intensification, % of Visits | -0.1 percentage of visits |
Secondary
Change in Repeat Visit in 4 Weeks After a Visit With Elevated BP, % of Visits
This process measure captures the proportion of persons who had uncontrolled HTN who made a subsequent visit within the following 4 weeks.
Time frame: baseline and 6 months
Population: The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the numerator and denominator for each metric.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Full Support | Change in Repeat Visit in 4 Weeks After a Visit With Elevated BP, % of Visits | -0.8 percentage of visits |
| Self-Guided | Change in Repeat Visit in 4 Weeks After a Visit With Elevated BP, % of Visits | -2.0 percentage of visits |
| Usual Care | Change in Repeat Visit in 4 Weeks After a Visit With Elevated BP, % of Visits | -0.6 percentage of visits |
Secondary
Change in Terminal Digit = Zero, % of Measurements
Inappropriate rounding of blood pressure measurements (usually to zero) leads to measurement error and worse treatment decisions. This continuous metric is calculated for a clinic as the percent of measurements at that clinic (for hypertensive patients) where the terminal digit of the measurement is zero. A percent greater than 10% (if an automated BP monitor is used) or greater than 20% (if a manual BP monitor is used with recommended rounding to even digits) indicates evidence of inappropriate rounding. Unlike most of our metrics, lower is better, down to an ideal value of 10-20%, which would be expected if no rounding were occurring. For this study we calculated the change in this continuous metric for each clinic from baseline to 6 months, and then described the mean change across clinics by group. As with our other outcomes, the unit of analysis in the study is a clinic.
Time frame: baseline and 6 months
Population: The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the numerator and denominator for each metric.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Full Support | Change in Terminal Digit = Zero, % of Measurements | 0.8 percentage of measurements |
| Self-Guided | Change in Terminal Digit = Zero, % of Measurements | 0.9 percentage of measurements |
| Usual Care | Change in Terminal Digit = Zero, % of Measurements | -0.6 percentage of measurements |
Secondary
Change in Use of a CCB or Thiazide or Thiazide-like Diuretic Among African-American Patients on at Least One Medication, % of Patients
Use of calcium channel blockers (CCB) OR a thiazide or thiazide-like diuretic medication classes is recommended to treat black or African American patients as first line monotherapy due to increased efficacy. This metric, which is limited to African-American patients with a diagnosis of hypertension taking at least one medication class, describes the prevalence of those receiving the recommended drug class.
Time frame: baseline and 6 months
Population: The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the numerator and denominator for each metric.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Full Support | Change in Use of a CCB or Thiazide or Thiazide-like Diuretic Among African-American Patients on at Least One Medication, % of Patients | -0.9 percentage of patients |
| Self-Guided | Change in Use of a CCB or Thiazide or Thiazide-like Diuretic Among African-American Patients on at Least One Medication, % of Patients | -0.1 percentage of patients |
| Usual Care | Change in Use of a CCB or Thiazide or Thiazide-like Diuretic Among African-American Patients on at Least One Medication, % of Patients | 0.0 percentage of patients |
Secondary
Change in Use of Fixed Dose Combination Product Among Patients Taking 2 or More Classes of Medications, % of Patients
Use of fixed dose combination medications helps with adherence, promotes rational combinations of medications, and increases likelihood of achieving BP control. This metric, which is limited to patients taking more than one medication class, describes the prevalence of fixed dose combination pill use.
Time frame: baseline and 6 months
Population: The unit of measure in this study is a clinic. All patients with hypertension at each of the included clinics were analyzed and used to evaluate the numerator and denominator for each metric.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Full Support | Change in Use of Fixed Dose Combination Product Among Patients Taking 2 or More Classes of Medications, % of Patients | 1.6 percentage of patients |
| Self-Guided | Change in Use of Fixed Dose Combination Product Among Patients Taking 2 or More Classes of Medications, % of Patients | -0.1 percentage of patients |
| Usual Care | Change in Use of Fixed Dose Combination Product Among Patients Taking 2 or More Classes of Medications, % of Patients | -0.7 percentage of patients |