Integrating a High Blood Pressure Advisory Across a Primary Care Network

• DOI: 10.1001/jamanetworkopen.2025.7313
• Publication Date: 2025-04-25T15:30:44Z
• Authors: Anuradha Phadke; Yingjie Weng; Cati Brown Johnson; Marcy Winget; Megan Mahoney; Christopher Sharp; Amelia Sattler; Shreya Shah; Manisha Desai; Stanley Ng; Jonathan G. Shaw
• Keywords: Medical record; Electronic medical record

Importance Leveraging technology to prompt team-based care might improve ambulatory hypertension care. Objective To assess whether an electronic medical record (EMR) high blood pressure (BP) advisory improves control. Design, Setting, and Participants This quality improvement study assessed control in patients presenting primary office visits from March 2018 February 2020. Data were included 28 clinics (8 contributed data toward the objective secondary objectives) a single academic health system California before after intervention concurrent team observations interviews assessing implementation. analyzed November 2019 October Intervention An EMR BP combined with training, audit, feedback. entry of elevated (systolic ≥140 mm Hg or diastolic ≥90 Hg) prompted interruptive assistant–facing recheck BP. Persistently second clinician-facing order panel link. Main Outcomes Measures The outcome was lower than 140 systolic 90 during visit within 6 months initial visit. Secondary outcomes value, antihypertensive medication change, new diagnoses. Qualitative focused on implementation barriers facilitators. Results 2760 3018 preexisting (mean [SD] age, 66.5 [14.4] years; 2847 [49.2%] women, 1746 [30.2%] Asian, 619 [10.7%] Hispanic, 2407 [41.7%] White). likelihood increased 18.3% per month average (odds ratio [OR], 1.18; 95% CI, 1.10-1.27; P < .001) vs groups. Modeled rates adjusted over 82.3% 92.3% for cohort decreased 71.5% 70.3% (preintervention) cohort. rate (from 37.6% 77.9%; OR, 4.76; 4.45-5.10; .001), while ordered medications unchanged. New diagnosis 12.1% 20.6% (OR, 1.34; 1.13-1.58; = .01). In 34 members (clinicians, assistants, managers) clinics, competing priorities time rechecks, complexity, mixed clinician engagement; facilitators visibility, integration, approach. Conclusions Relevance found significantly improved due combination technology.