- Health data exchange may help to enable healthcare organizations to identify common disparities in hypertension care across facilities for better-informed quality improvement efforts and more effective practice-based interventions.
This finding comes from a recent Journal of the American Board of Family Medicine (JABFM) study by Selby, et al.
Selby and his team standardized EHR data collection from three California health systems participating in the San Francisco Bay Collaborative Research Network. Participating health systems included one academic health system and two county-run primary healthcare systems. Two health systems part of the study used Epic EHR, while one used an eClinicalWorks system.
Researchers compared rates and predictors of uncontrolled blood pressure among adult patients with hypertension across health systems to identify opportunities for regional collaboration in quality improvement.
The team conducted a retrospective cohort study using de-identified EHR data from 169,793 primary care patients aged 18 to 85 who had visited their physician at least once in a two-year period.
Researchers found 31 percent — or 53,133 study participants — had received a diagnosis of hypertension from their primary care physician. Of the study participants with a hypertension diagnosis, 35 percent had uncontrolled blood pressure at their last primary care visit.
The proportion of patients with uncontrolled blood pressure varied widely by health system. At the academic health system, 29 percent of patients had uncontrolled blood pressure, compared to 44 percent of patients at one of the county-run health systems. The proportion of patients with uncontrolled blood pressure further varied by clinical site within each health system.
“Across health systems, hypertensive patients were more likely to have uncontrolled blood pressure if they were uninsured, African Americans, current smokers, obese, or had fewer than 2 primary care visits during the 2-year measurement period,” stated researchers.
The team also found that patients 60 years of age and older without comorbidities were the least likely patient population to have uncontrolled blood pressure at their last office visit.
“This finding likely reflects the higher target threshold for this group of patients (<150/90 mm Hg), demonstrating how shifting blood pressure guidelines might influence which patients are targeted by health system and/or whether health systems can achieve quality metrics,” the team wrote.
Researchers also noted in the report that the health system with the lowest proportion of hypertensive patients with uncontrolled blood pressure was a safety net system focused on advancing quality improvement initiatives addressing hypertension control.
“Results of this quality improvement initiative also indicate that this health system measurably increased the proportion of patients with controlled hypertension by the time the intervention was completed in 2016,” researchers said.
Comparatively, the other two health system participants with higher rates of patients with uncontrolled blood pressure were not implementing comprehensive quality improvement initiatives at the time of the study.
“These results suggest the potential benefits of hypertension quality improvement initiatives at the practice level and the opportunity for clinical teams both within and across health systems to benefit from sharing best practices,” wrote researchers.
Ultimately, researchers determined the Hypertension Data Collaborative serves as a successful example of the advantages of sharing EHR data to identify common disparities in hypertension care.
“Future studies with this dataset will examine patterns of treatment with antihypertensive medications within these health systems to explore the relationship between medication underuse and deviation from guideline-based treatment algorithms,” researchers noted.
In addition to sharing EHR data to identify disparities in hypertension care, sharing best practices about quality improvement initiatives may help health systems enhance care quality across regions and facilities.