Introduction: Home blood pressure monitoring (HBPM) has been shown to outperform traditional office readings in its association with cardiovascular disease (CVD) risk and ability to identify patients with white coat or masked hypertension. For these reasons, the 2017 ACC/AHA Guidelines included HBPM as part of its recommendations for hypertension management. Our project focused on improving the implementation of HBPM in an urban primary care practice with an end goal of increasing the number of patients that actively use home blood pressure cuffs and have access to them for future telemedicine visits.
Methods: A patient outreach process to increase HBPM uptake and improve hypertension control was developed and evaluated using a remote PDSA cycle approach. Outreach candidates consisted of Jefferson Family Medicine Associates (JFMA) patients ages 16-85 with active hypertension diagnoses who were insured by Keystone First or Keystone VIP. Candidates received an automated blood pressure cuff that was able to transmit home readings to their electronic medical record (EMR) in real time. Outcome and process measures were calculated using demographic and blood pressure data stored in each patient’s EMR.
Results: The first wave of outreach produced 54 patient recruits from 253 attempts (21.3%) with 24 patients being full participants, defined as reporting 10 or more HBPM readings. Patient recruits were predominantly black (79.6%), female (66.7%), and ages 45 – 64 (55.5%). Patient recruits aged 65 and older had the highest rate of full participation (83.3%) followed by ages 30 – 49 (63.2%), 50 – 64 (25.0%), and 16 – 29 (20.0%). Rates for non-participation, defined as no HBPM reading recorded, among men and women were 27.8% and 33.3%, respectively.
Conclusion: Analysis of the first patient outreach PDSA cycle revealed differences in full-participation based on age and sex. Future PDSA cycles will focus on improving follow-up efforts with patient groups that have lower rates of full-participation. This project was limited to patients insured by Keystone First or Keystone VIP due to their eligibility for low-cost HBPM coverage
