Ann Marie Navar-Boggan1, Alexander Fanaroff2, Aparna Swaminathan2, Adrienne Belasco2, Judith Stafford3, Bimal Shah4, Eric D Peterson4. 1. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; Department of Medicine, Duke University Medical Center, Durham, NC. Electronic address: ann.navar@dm.duke.edu. 2. Department of Medicine, Duke University Medical Center, Durham, NC. 3. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. 4. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; Department of Medicine, Duke University Medical Center, Durham, NC.
Abstract
BACKGROUND: Although hypertension is a modifiable cardiovascular risk factor, up to one-third of ambulatory patients have uncontrolled blood pressure (BP). We evaluated the impact of a targeted provider feedback intervention on rates of BP control. METHODS:Clinic BP readings were aggregated among approximately 3,000 hypertensive patients followed up in 42 outpatient cardiology clinic practices at a large quaternary care academic medical center. Physician practices received quarterly reports on BP control rates. Provider-specific reports were benchmarked vs overall peer performance and distributed quarterly between September 2011 and September 2012. Rates of BP control were evaluated before and after the intervention. Medical record reviews were performed for a subset of patients with uncontrolled BP before (n = 300) and after (n = 300) the intervention to evaluate provider responses and interventions. RESULTS: At baseline, 27.9% of clinic patients had uncontrolled BP. After one 1 of reports, the rate of uncontrolled BP remained unchanged (27.7%, P = .86). Analysis of provider performance revealed a subset of providers who consistently outperform their peers. In the sample of patients selected for medical record reviews, at baseline (n = 300) and follow-up (n = 300), cardiologists discussed BP in 80% of clinic notes for patients with uncontrolled BP. Cardiologists more frequently documented repeat measurements after the intervention (28.0% vs 35.7%, P = .04). No other changes were found in documentation of provider responses to BP. CONCLUSIONS: Clinician-specific audit and feedback reports as a stand-alone intervention did not affect overall BP control rates in cardiology clinics. Future BP control interventions should consider real-time patient-specific reminders, provider incentive programs, and patient engagement interventions.
RCT Entities:
BACKGROUND: Although hypertension is a modifiable cardiovascular risk factor, up to one-third of ambulatory patients have uncontrolled blood pressure (BP). We evaluated the impact of a targeted provider feedback intervention on rates of BP control. METHODS: Clinic BP readings were aggregated among approximately 3,000 hypertensivepatients followed up in 42 outpatient cardiology clinic practices at a large quaternary care academic medical center. Physician practices received quarterly reports on BP control rates. Provider-specific reports were benchmarked vs overall peer performance and distributed quarterly between September 2011 and September 2012. Rates of BP control were evaluated before and after the intervention. Medical record reviews were performed for a subset of patients with uncontrolled BP before (n = 300) and after (n = 300) the intervention to evaluate provider responses and interventions. RESULTS: At baseline, 27.9% of clinic patients had uncontrolled BP. After one 1 of reports, the rate of uncontrolled BP remained unchanged (27.7%, P = .86). Analysis of provider performance revealed a subset of providers who consistently outperform their peers. In the sample of patients selected for medical record reviews, at baseline (n = 300) and follow-up (n = 300), cardiologists discussed BP in 80% of clinic notes for patients with uncontrolled BP. Cardiologists more frequently documented repeat measurements after the intervention (28.0% vs 35.7%, P = .04). No other changes were found in documentation of provider responses to BP. CONCLUSIONS: Clinician-specific audit and feedback reports as a stand-alone intervention did not affect overall BP control rates in cardiology clinics. Future BP control interventions should consider real-time patient-specific reminders, provider incentive programs, and patient engagement interventions.
Authors: Gerald S Bloomfield; Tracy Y Wang; L Ebony Boulware; Robert M Califf; Adrian F Hernandez; Eric J Velazquez; Eric D Peterson; Jennifer S Li Journal: Glob Heart Date: 2015-03
Authors: Carina Aguilar Martín; Alessandra Queiroga Gonçalves; Carlos López-Pablo; José Fernández-Sáez; Emma Forcadell Drago; Zojaina Hernández Rojas; Josep Maria Pepió Vilaubí; Dolores Rodríguez Cumplido; Josep Lluis Piñol; Jordi Bladé-Creixenti; Maria Rosa Dalmau Llorca Journal: Int J Environ Res Public Health Date: 2019-11-05 Impact factor: 3.390