Implementing Panel Management for Hypertension in a Low-Income, Urban, Primary Care Setting

Abstract

Panel management is a system of care that targets groups of patients with similar needs to improve their quality of care. The purpose of this pilot was to determine whether panel management could improve blood pressure control in patients with previously uncontrolled hypertension and to explore how panel management can be integrated in an urban, low-income, primary care setting. The practice coach model was used to assist a clinical site in forming a quality improvement team to implement panel management. The team created a patient registry to track hypertensive patients over time and to recall patients with uncontrolled hypertension for planned care visits during which evidence-based interventions for hypertension were delivered. Percent of patients gaining control of blood pressure and change in blood pressure were measured between 6 and 9 months after enrollment. Qualitative interviews of clinic staff were completed to explore strengths and weaknesses of program implementation. Forty patients with uncontrolled hypertension were enrolled in the pilot, and 27.5% gained blood pressure control by 9 months after enrollment (P < .001). The average systolic blood pressure decreased by 16 mm Hg from 156.5 to 140.5 mm Hg (P < .001), and the average diastolic blood pressure decreased by 3.8 mm Hg from 85 to 81.2 mm Hg (P = .03). Staff interviews were generally positive; however, several areas for improvement were identified. Panel management for hypertension can be effective and can be implemented in a low-income, urban, primary care clinic setting given appropriate staffing allocation.