Improving Regional Blood Pressure Control: a Positive Deviance Tiered Intensity Approach.
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
24
05
2020
accepted:
15
12
2020
pubmed:
28
1
2021
medline:
29
6
2021
entrez:
27
1
2021
Statut:
ppublish
Résumé
Accelerated translation of real-world interventions for hypertension management is critical to improving cardiovascular outcomes and reducing disparities. To determine whether a positive deviance approach would improve blood pressure (BP) control across diverse health systems. Quality improvement study using 1-year cross sections of electronic health record data over 5 years (2013-2017). Adults ≥ 18 with hypertension with two visits in 2 years with at least one primary care visit in the last year (N = 114,950 at baseline) to a primary care practice in Better Health Partnership, a regional health improvement collaborative. Identification of a "positive deviant" and dissemination of this system's best practices for control of hypertension (i.e., accurate/repeat BP measurement; timely follow-up; outreach; standard treatment algorithm; and communication curriculum) using 3 different intensities (low: Learning Collaborative events describing the best practices; moderate: Learning Collaborative events plus consultation when requested; and high: Learning Collaborative events plus practice coaching). We used a weighted linear model to estimate the pre- to post-intervention average change in BP control (< 140/90 mmHg) for 35 continuously participating clinics. BP control post-intervention improved by 7.6% [95% confidence interval (CI) 6.0-9.1], from 67% in 2013 to 74% in 2017. Subgroups with the greatest absolute improvement in BP control included Medicaid (12.0%, CI 10.5-13.5), Hispanic (10.5%, 95% CI 8.4-12.5), and African American (9.0%, 95% CI 7.7-10.4). Implementation intensity was associated with improvement in BP control (high: 14.9%, 95% CI 0.2-19.5; moderate: 5.2%, 95% CI 0.8-9.5; low: 0.2%, 95% CI-3.9 to 4.3). Employing a positive deviance approach can accelerate translation of real-world best practices into care across diverse health systems in the context of a regional health improvement collaborative (RHIC). Using this approach within RHICs nationwide could translate to meaningful improvements in cardiovascular morbidity and mortality.
Sections du résumé
BACKGROUND
Accelerated translation of real-world interventions for hypertension management is critical to improving cardiovascular outcomes and reducing disparities.
OBJECTIVE
To determine whether a positive deviance approach would improve blood pressure (BP) control across diverse health systems.
DESIGN
Quality improvement study using 1-year cross sections of electronic health record data over 5 years (2013-2017).
PARTICIPANTS
Adults ≥ 18 with hypertension with two visits in 2 years with at least one primary care visit in the last year (N = 114,950 at baseline) to a primary care practice in Better Health Partnership, a regional health improvement collaborative.
INTERVENTIONS
Identification of a "positive deviant" and dissemination of this system's best practices for control of hypertension (i.e., accurate/repeat BP measurement; timely follow-up; outreach; standard treatment algorithm; and communication curriculum) using 3 different intensities (low: Learning Collaborative events describing the best practices; moderate: Learning Collaborative events plus consultation when requested; and high: Learning Collaborative events plus practice coaching).
MAIN MEASURES
We used a weighted linear model to estimate the pre- to post-intervention average change in BP control (< 140/90 mmHg) for 35 continuously participating clinics.
KEY RESULTS
BP control post-intervention improved by 7.6% [95% confidence interval (CI) 6.0-9.1], from 67% in 2013 to 74% in 2017. Subgroups with the greatest absolute improvement in BP control included Medicaid (12.0%, CI 10.5-13.5), Hispanic (10.5%, 95% CI 8.4-12.5), and African American (9.0%, 95% CI 7.7-10.4). Implementation intensity was associated with improvement in BP control (high: 14.9%, 95% CI 0.2-19.5; moderate: 5.2%, 95% CI 0.8-9.5; low: 0.2%, 95% CI-3.9 to 4.3).
CONCLUSIONS
Employing a positive deviance approach can accelerate translation of real-world best practices into care across diverse health systems in the context of a regional health improvement collaborative (RHIC). Using this approach within RHICs nationwide could translate to meaningful improvements in cardiovascular morbidity and mortality.
Identifiants
pubmed: 33501526
doi: 10.1007/s11606-020-06480-z
pii: 10.1007/s11606-020-06480-z
pmc: PMC8175516
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1591-1597Subventions
Organisme : CDC HHS
ID : DP14-1419PPHF14
Pays : United States
Références
JAMA Intern Med. 2018 Jun 1;178(6):858-860
pubmed: 29710186
Fam Pract. 2012 Oct;29(5):503-10
pubmed: 22234552
Med Care. 2006 Jul;44(7):646-57
pubmed: 16799359
Circulation. 2016 Jan 26;133(4):447-54
pubmed: 26811276
Cochrane Database Syst Rev. 2010 Mar 17;(3):CD005182
pubmed: 20238338
NCHS Data Brief. 2013 Oct;(133):1-8
pubmed: 24171916
BMC Health Serv Res. 2019 Sep 14;19(1):663
pubmed: 31521159
JAMA. 2000 Apr 19;283(15):1967-75
pubmed: 10789664
Am Heart J. 2011 Dec;162(6):981-987.e9
pubmed: 22137070
Health Aff (Millwood). 2018 Feb;37(2):266-274
pubmed: 29401005
N Engl J Med. 2015 Nov 26;373(22):2103-16
pubmed: 26551272
JAMA. 2013 Aug 21;310(7):699-705
pubmed: 23989679
BMJ Qual Saf. 2020 Mar;29(3):225-231
pubmed: 31473665
J Gen Intern Med. 2018 Dec;33(12):2027-2029
pubmed: 30066115
Implement Sci. 2009 May 08;4:25
pubmed: 19426507
BMJ. 2004 Nov 13;329(7475):1177-9
pubmed: 15539680
Hypertension. 2018 Jun;71(6):e13-e115
pubmed: 29133356
J Gen Intern Med. 2018 Nov;33(11):1968-1977
pubmed: 30066117
Health Aff (Millwood). 2015 Jul;34(7):1121-30
pubmed: 26153306