Abstract P380: Blood Pressure Control Rates When Measured in a Specialty Clinic versus Primary Care Within a Large Integrated Health System

Abstract

Background: Treating patients with hypertension to goal blood pressure (BP) values is a pillar of cardiovascular risk reduction. Its importance is prominent in quality metrics used in public reporting, accreditation, and value-based reimbursement programs. We hypothesized that BP measurements performed in a specialty (SP) clinic would be less likely to be at goal compared to when measured in a primary care (PC) clinic. Objective(s): Identify differences in rates of BP control for patients with hypertension using measurements performed in a SP clinic versus a PC clinic. Methods: Clinic-based BP measurement performed in 2016 for adults in Colorado’s UCHealth Clinically Integrated Network with a hypertension diagnosis were included. The most recent measurement for each patient was classified as controlled (<140/90 mm Hg) or uncontrolled, and from a PC or SP clinic. Logistic regression was used to calculate the OR and 95% CI for the likelihood of having controlled BP in a SP versus PC clinic, controlling for age and gender. A secondary analysis of patients with measurements done in both clinic types used conditional logistic regression to compare the likelihood of control based upon each patient’s most recent SP versus PC measurement. Results: Of the 86,632 hypertensive adults with BP measurements in 2016, 51% (43,850/86,632) had their most recent measurement performed in a SP clinic. Control rates for BP were lower in SP versus PC clinics (63% (27,771/43,850) vs 67% (28,843/42,782), OR=0.84 (95% CI 0.81-0.86)). Among patients with measurements performed in both clinics in 2016, control rates for the same patients were lower in SP compared to PC clinics (63% (17,900/28,455) vs. 71% (20,077/28,455), OR=0.64 (0.61-0.66)). This pattern persisted even in patients whose measurements were done within 7 days of each other (63% (1,634/2,593) vs 69% (1,781/2,593), OR=0.70 (0.61-0.80)). Conclusions: BP measurements performed in SP clinics are significantly less likely to be controlled compared to those in PC clinics, even between measurements performed on the same patient within a short time. This has significant treatment and quality measurement implications for health systems. Investigation is needed to identify underlying reasons and to resolve discrepancies.