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Development of a Multistep Hypertension Quality Improvement Program in an Academic General Medicine Practice

Bui-Duy, Mai-Khanh; Wong, Shirley; Lam, Rosemary; Karliner, Leah S.

The Journal for Healthcare Quality (JHQ): May/June 2019 - Volume 41 - Issue 3 - p 172–179
doi: 10.1097/JHQ.0000000000000158
Original Article

ABSTRACT Hypertension is a common problem and a major risk factor for cardiovascular disease. It is unclear whether efforts to control blood pressure (BP) known to be effective in integrated healthcare systems can be successfully implemented in an academic setting. We describe our experience implementing a multistep quality improvement program within an academic general medicine practice aimed at improving BP among patients with uncontrolled hypertension. Ensuring medical assistants were correctly measuring BP provided the basis for accurate data entry into the electronic medical record (EMR); our EMR-based registry data allowed us to feedback primary care provider (PCP) level data on BP control for panel management, which resulted in improvements in BP for a substantial proportion of patients, particularly for those with more practice visits. However, due to PCP, patient, and system barriers, our initial attempt to integrate a pharmacist into our team for hypertension management was only successful for a small number of patients who engaged in pharmacist in-person visits. Future improvement efforts will focus on addressing the barriers to more intensive BP management, integrating lessons from this experience. As chronic disease management shifts to a population-based model, team change will be a necessary component for achieving clinical improvement.

For more information on this article, contact Leah S. Karliner at

Supported by a grant from the Mount Zion Health Fund (grant no. 20150955), which had no role in the design, implementation, or reporting of results.

The authors declare no conflicts of interest.

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© 2019 National Association for Healthcare Quality
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