National Healthcare Quality and Disparities Report
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Topics
- (-) Blood Pressure (15)
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- Community-Based Practice (1)
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- Diagnostic Safety and Quality (3)
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- (-) Primary Care (15)
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- Quality of Care (2)
- Screening (3)
- Telehealth (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 15 of 15 Research Studies DisplayedLindner SR, Balasubramanian B, Marino M
Estimating the cardiovascular disease risk reduction of a quality improvement initiative in primary care: findings from EvidenceNOW.
The purpose of this study was to estimate decreases in 10-year atherosclerotic cardiovascular disease (ASCVD) risk associated with EvidenceNOW, an initiative spanning multiple states that sought to improve cardiovascular preventive care by providing supportive interventions such as practice facilitation to address the “ABCS”: (A)spirin for high-risk patients, (B)lood pressure control for hypertensive people, (C)holesterol management, and (S)moking screening and cessation counseling. The researchers conducted an analytic modeling study that combined 1) data from 1,278 EvidenceNOW practices collected from 2015 to 2017; (2) patient-level information of 1,295 individuals who participated in the 2015 to 2016 National Health and Nutrition Examination Survey; and (3) 10-year ASCVD risk prediction equations. The study found the average 10-year ASCVD risk of these patients before intervention was 10.11%. Improvements in ABCS due to EvidenceNOW reduced their 10-year ASCVD risk to 10.03% which would prevent 3,169 ASCVD events over 10 years and $150 million in 90-day direct medical costs.
AHRQ-funded; HS023940.
Citation: Lindner SR, Balasubramanian B, Marino M .
Estimating the cardiovascular disease risk reduction of a quality improvement initiative in primary care: findings from EvidenceNOW.
J Am Board Fam Med 2023 May 8; 36(3):462-76. doi: 10.3122/jabfm.2022.220331R1..
Keywords: Cardiovascular Conditions, Primary Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Quality Improvement, Quality of Care, Blood Pressure
Boyd R, Carter E, Moise N
Awareness, knowledge, and attitudes toward screening and treatment of masked hypertension in primary care.
The purpose of this qualitative study was to explore primary care provider (PCP) awareness, knowledge, and attitudes toward masked hypertension (MHT.) The researchers conducted 3 focus groups which included 30 PCPs from 3 medical centers in New York. The analysis and thematic content analysis found that there was low knowledge about the prevalence and impact of MHT, awareness of MHT among the participants varied, and only 2 providers had diagnosed MHT. While some PCPs were receptive to MHT screening after learning about its significance, others perceived the current evidence as insufficient to change practice. There was broad consensus for lifestyle changes for MHT but concerns about a lack of randomized trial evidence for antihypertensive medication, and the possibility of harmful side effects. The researchers concluded that limited PCP knowledge about MHT, insufficient evidence, already overburdened PCPs, and concerns about the accuracy and accessibility of screening tests were key barriers to screening and treatment for MHT.
AHRQ-funded; HS024262.
Citation: Boyd R, Carter E, Moise N .
Awareness, knowledge, and attitudes toward screening and treatment of masked hypertension in primary care.
Am J Hypertens 2021 Dec;34(12):1322-27. doi: 10.1093/ajh/hpab115..
Keywords: Blood Pressure, Screening, Primary Care
Cohen DJ, Sweeney SM, Miller WL
Improving smoking and blood pressure outcomes: the interplay between operational changes and local context.
This study identified conditions and operational changes linked to improvements in smoking and blood pressure (BP) outcomes in primary care using samples and interviews from a subset of 104 practices participating in EvidenceNOW, a multisite cardiovascular disease prevention initiative. The authors calculated Clinical Quality Measure improvements, with targets of 10-point or greater absolute improvements in the proportion of patients with smoking screening, and if relevant, counseling and the proportion of hypertensive patients with adequately controlled BP. Primary care staff were surveyed and interviewed. In clinician-owned practices, implementing a workflow to routinely screen and counsel patients on smoking cessation resources, or implementing a documentation change or a referral to a resource alone led to an improvement of at least 10 points in the smoking outcome. These improvements did not occur though in health- or hospital system-owned practices or in Federally Qualified Health Centers. BP outcome improved by at least 10 points among solo practices after medical assistants learned how to take an accurate BP. Among larger, clinician-owned practices, BP outcomes improvement took place when staff took a second BP measurement after the first measurement was elevated and when staff learned where to document this information in the electronic health record. For larger and health- and hospital system-owned practices, 50 or more hours of facilitation was needed to improve BP outcomes.
AHRQ-funded; HS023940.
Citation: Cohen DJ, Sweeney SM, Miller WL .
Improving smoking and blood pressure outcomes: the interplay between operational changes and local context.
Ann Fam Med 2021 May-Jun;19(3):240-48. doi: 10.1370/afm.2668..
Keywords: Blood Pressure, Tobacco Use, Primary Care, Quality Improvement, Cardiovascular Conditions, Quality of Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Prevention, Outcomes
Howland C, Despins L, Sindt J
Primary care clinic nurse activities with a telehealth monitoring system.
The purpose of this study was to evaluate differences in the types of nursing activities and communication processes reported in a primary care clinic between patients using a home-based monitoring system to electronically communicate self-monitored blood glucose and blood pressure values and those assuming usual care. Significant differences were identified for the direct care nursing activities of providing lifestyle and health education, medication adjustments, and patient follow-up, providing evidence of greater nursing activity reported in a primary care clinic in patients who utilized a home-based monitoring system.
AHRQ-funded; HS017035.
Citation: Howland C, Despins L, Sindt J .
Primary care clinic nurse activities with a telehealth monitoring system.
West J Nurs Res 2021 Jan;43(1):5-12. doi: 10.1177/0193945920923082..
Keywords: Telehealth, Health Information Technology (HIT), Blood Pressure, Primary Care, Clinician-Patient Communication, Communication, Patient Self-Management, Nursing, Patient-Centered Healthcare, Diabetes
Huguet N, Kaufmann J, O'Malley J
Using electronic health records in longitudinal studies: estimating patient attrition.
This study’s objective was to estimate overall and among adults with diabetes or hypertension: 1) patient attrition over a 3-year period at community health centers; and 2) the likelihood that patients with Medicaid switched their primary care source. Data was collected from the retrospective cohort study of 2012-2017 claims data Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Data Research Network of community health centers. This study focused on Oregon Medicaid enrollees with a total of 232,891 patients aged 19-64 with a gap of 6 months or more following a claim for a visit billed to a primary care source. The authors theorized the reason was due to patients with Medicaid permanently changing their primary care source. They found that attrition over 3 years averaged 33.5% but patients with diabetes or hypertension was lower (25% or less). Among Medicaid patients the attrition rate 12% for community health center patients compared with 39% for single-provider practice patients.
AHRQ-funded; HS025962.
Citation: Huguet N, Kaufmann J, O'Malley J .
Using electronic health records in longitudinal studies: estimating patient attrition.
Med Care 2020 Jun;58(Suppl 1):S46-S52. doi: 10.1097/mlr.0000000000001298...
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diabetes, Blood Pressure, Chronic Conditions, Primary Care, Medicaid
Liyanage-Don N, Fung D, Phillips E
Implementing home blood pressure monitoring into clinical practice.
The purpose of this study was to review data that supports the use of home blood pressure monitoring (HBPM) and to provide practical guidance to clinicians who wish to incorporate HBPM into their practice. Home blood pressure monitoring more accurately reflects the risk of cardiovascular events than office blood pressure measurements, and evidence supports the hypothesis that HBPM combined with clinical support improves blood pressure control. In spite of this, HBPM use remains low due to barriers between patients, clinicians, and healthcare system levels; understanding these barriers is crucial for the development of strategies to implement HBPM. This article considers how recommended best practices can facilitate the successful and effective implementation of HBPM.
AHRQ-funded; HS024262.
Citation: Liyanage-Don N, Fung D, Phillips E .
Implementing home blood pressure monitoring into clinical practice.
Curr Hypertens Rep 2019 Feb 12;21(2):14. doi: 10.1007/s11906-019-0916-0..
Keywords: Blood Pressure, Diagnostic Safety and Quality, Primary Care, Screening
Ramirez M, Maranon R, Fu J
Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a "chart closure" hard stop.
The purpose of this study was to evaluate provider responses to a narrowly targeted Best Practice Advisory (BPA) alert regarding the intensification of blood pressure medications for persons with diabetes before and after implementation of a ‘chart closure’ hard stop. Researchers designed a BPA that sent alerts via an electronic health record system during outpatient encounters when patients with diabetes had elevated blood pressures and were not on angiotensin receptor blocking medications. These alerts were implemented in eight primary care practices within UCLA Health. Data on provider responses to the alerts was compared before and after implementing a ‘chart closure’ hard stop. Providers responded to alerts more often after the ‘chart closure’ hard stop was implemented. The researchers conclude that targeting specific omitted medication classes can produce specific alerts that may reduce alert fatigue, and that using a ‘chart closure’ hard stop may prompt providers to take action without major disruptions to their workflow.
AHRQ-funded; HS000046.
Citation: Ramirez M, Maranon R, Fu J .
Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a "chart closure" hard stop.
J Am Med Inform Assoc 2018 Sep;25(9):1167-74. doi: 10.1093/jamia/ocy073..
Keywords: Blood Pressure, Diabetes, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Care Management
Egan BM, Li J, Davis RA
Differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States.
The US Preventive Services Task Force cholesterol guideline recommended statins for fewer adults than the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline by setting a higher 10-year atherosclerotic cardiovascular disease threshold and requiring concomitant diabetes mellitus, hypertension, dyslipidemia, or cigarette smoking. The 2017 ACC/AHA hypertension guideline lowered the hypertension threshold, increasing 2016 guideline statin-eligible adults. This article discusses differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States.
AHRQ-funded; P30 HS021667.
Citation: Egan BM, Li J, Davis RA .
Differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States.
J Clin Hypertens 2018 Jun;20(6):991-1000. doi: 10.1111/jch.13314..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Evidence-Based Practice, Guidelines, Blood Pressure, Medication, Prevention, Primary Care, U.S. Preventive Services Task Force (USPSTF)
Henderson KH, DeWalt DA, Halladay J
Organizational leadership and adaptive reserve in blood pressure control: the Heart Health NOW study.
The purpose of this study was to assess whether a practice's adaptive reserve and high leadership capability in quality improvement are associated with population blood pressure control. Its findings showed that adaptive reserve and leadership capability in quality improvement implementation are not statistically associated with achieving top quartile practice-level hypertension control at baseline in the Heart Health NOW project.
AHRQ-funded; HS023912.
Citation: Henderson KH, DeWalt DA, Halladay J .
Organizational leadership and adaptive reserve in blood pressure control: the Heart Health NOW study.
Ann Fam Med 2018 Apr;16(Suppl 1):S29-s34. doi: 10.1370/afm.2210.
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Keywords: Blood Pressure, Cardiovascular Conditions, Patient-Centered Outcomes Research, Primary Care, Quality Improvement
Kronish IM, Kent S, Moise N
Barriers to conducting ambulatory and home blood pressure monitoring during hypertension screening in the United States.
The goal of the study was to determine the most important barriers to primary care providers' ordering ambulatory and home BP monitoring in the United States. The study found that top-ranked barriers to home BP monitoring were concerns about compliance with the correct test protocol, accuracy of tests results, out-of-pocket costs of home BP devices, and time needed to instruct patients on home BP monitoring protocol.
AHRQ-funded; HS024262.
Citation: Kronish IM, Kent S, Moise N .
Barriers to conducting ambulatory and home blood pressure monitoring during hypertension screening in the United States.
J Am Soc Hypertens 2017 Sep;11(9):573-80. doi: 10.1016/j.jash.2017.06.012..
Keywords: Blood Pressure, Primary Care, Diagnostic Safety and Quality, Screening
Bello JK, Mohanty N, Bauer V
Pediatric hypertension: provider perspectives.
The researchers aimed to gain insights into reasons for low rates of diagnosis and treatment from primary care providers. In interviews, providers reflected on numerous barriers to diagnosis, management, and follow-up; recommendations for educational content; and how community health center systems can be improved. Findings informed development of a multifaceted intervention.
AHRQ-funded; HS024100.
Citation: Bello JK, Mohanty N, Bauer V .
Pediatric hypertension: provider perspectives.
Glob Pediatr Health 2017 Jun 6;4:2333794x17712637. doi: 10.1177/2333794x17712637.
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Keywords: Children/Adolescents, Diagnostic Safety and Quality, Healthcare Delivery, Blood Pressure, Obesity, Primary Care
Fontil V, Bibbins-Domingo K, Nguyen OK
Management of hypertension in primary care safety-net clinics in the United States: a comparison of community health centers and private physicians' offices.
The researchers examined adherence to guideline-concordant hypertension treatment practices at community health centers (CHCs) compared with private physicians' offices.: Medicaid patients at CHCs were as likely as privately insured individuals to receive a new medication for uncontrolled hypertension, whereas Medicaid patients at private physicians' offices were less likely to receive a new medication.
AHRQ-funded; HS018090.
Citation: Fontil V, Bibbins-Domingo K, Nguyen OK .
Management of hypertension in primary care safety-net clinics in the United States: a comparison of community health centers and private physicians' offices.
Health Serv Res 2017 Apr;52(2):807-25. doi: 10.1111/1475-6773.12516.
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Keywords: Blood Pressure, Primary Care, Community-Based Practice, Guidelines, Evidence-Based Practice
O'Donnell AJ, Bogner HR, Cronholm PF
Stakeholder perspectives on changes in hypertension care under the patient-centered medical home.
The researchers investigated changes in hypertension care under patient-centered medical home (PCMH) implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control. They concluded that practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care.
AHRQ-funded; HS019150.
Citation: O'Donnell AJ, Bogner HR, Cronholm PF .
Stakeholder perspectives on changes in hypertension care under the patient-centered medical home.
Prev Chronic Dis 2016 Feb 25;13:E28. doi: 10.5888/pcd13.150383.
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Keywords: Care Management, Blood Pressure, Patient-Centered Healthcare, Primary Care
Smith JJ, Berman MD, Hiratsuka VY
The effect of regular primary care utilization on long-term glycemic and blood pressure control in adults with diabetes.
The researchers sought to assess the effect of primary care utilization on glycemic control and blood pressure control for a cohort of customer-owners with diabetes mellitus (DM) who received care from Southcentral Foundation, a tribal provider. They found that regular primary care utilization over 16 years was associated with higher rates of blood pressure control and glycemic control for adults with DM.
AHRQ-funded; HS019154.
Citation: Smith JJ, Berman MD, Hiratsuka VY .
The effect of regular primary care utilization on long-term glycemic and blood pressure control in adults with diabetes.
J Am Board Fam Med 2015 Jan-Feb;28(1):28-37. doi: 10.3122/jabfm.2015.01.130329..
Keywords: Primary Care, Diabetes, Healthcare Utilization, Blood Pressure, Prevention
Liss DT, Fishman PA, Rutter CM
Specialty use among patients with treated hypertension in a patient-centered medical home.
The researchers described changes in outpatient specialty use among patients with treated hypertension during and after patient-centered medical home (PCMH) practice transformation. Their results suggest that more comprehensive primary care in this PCMH redesign enabled primary care teams to deliver more hypertension care, and that many needs of low morbidity patients were within the scope of primary care practice.
AHRQ-funded; HS019129.
Citation: Liss DT, Fishman PA, Rutter CM .
Specialty use among patients with treated hypertension in a patient-centered medical home.
J Gen Intern Med 2014 May;29(5):732-40. doi: 10.1007/s11606-014-2776-2..
Keywords: Blood Pressure, Patient-Centered Healthcare, Primary Care, Healthcare Delivery