Abstract 10335: Implementation of a Population Health Infrastructure for Hypertension in a Primary Care Clinic Setting

Abstract

Introduction: In 2021, 48% of patients in the Hartford Hospital Adult Primary Care (APC) Clinic with a diagnosis of hypertension had controlled blood pressures of <140/90 compared to 63% in Hartford Healthcare (HHC) as a whole. This demonstrates potential healthcare disparities within the APC clinic, whose patient panel consists primarily of an underserved Hispanic population with Medicare, Medicaid or are uninsured and lack overall health literacy. The aim of this project is to have 75% of APC patients with hypertension to have blood pressures of <140/90 by 2023. Methods: The team implemented standardized staff and resident training regarding blood pressure measurement and ACC/AHA Hypertension Guidelines with pre- and post- training surveys. Residents reviewed their patient roster to schedule appointments for those with uncontrolled hypertension. The team created an Epic SmartPhrase to incorporate standard work by all providers for initial and follow-up hypertension visits. This included blood pressure-lowering medications, environmental risk factors, evaluation for obstructive sleep apnea, and recommendations for nonpharmacological interventions. Staff implemented standardized workflow which included: repeat blood pressure measurement after 5 minutes of rest for blood pressures >140/90, ensuring proper documentation of repeat blood pressure in correct field in Epic, and scheduling 3-week follow-up appointments for blood pressure management. The clinic has been approved for a grant for BP monitors for those without health insurance. Results: In May 2022, 52% (727/1409) of patients at APC had blood pressures of <140/90 compared to 38% (104453/272615) at HHC. Conclusion: Implementation of standardized staff and resident training, Epic SmartPhrases, and clinic workflow may lead to improved blood pressure control in an academic primary care clinic. Future direction includes assessing if optimizing BP control leads to improved patient outcomes.