scholarly journals Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a “chart closure” hard stop

2018 ◽  
Vol 25 (9) ◽  
pp. 1167-1174 ◽  
Author(s):  
Magaly Ramirez ◽  
Richard Maranon ◽  
Jeffery Fu ◽  
Janet S Chon ◽  
Kimberly Chen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Best Practice ◽  
High Specificity ◽  
Pressure Control ◽  
Treatment Providers ◽  
Before And After ◽  
Practice Advisory ◽  
Patients With Diabetes ◽  
Primary Care Practices

Abstract Objective To evaluate provider responses to a narrowly targeted “Best Practice Advisory” (BPA) alert for the intensification of blood pressure medications for persons with diabetes before and after implementation of a “chart closure” hard stop, which is non-interruptive but demands an action or dismissal before the chart can be closed. Materials and Methods We designed a BPA that fired alerts within an electronic health record (EHR) system during outpatient encounters for patients with diabetes when they had elevated blood pressures and were not on angiotensin receptor blocking medications. The BPA alerts were implemented in eight primary care practices within UCLA Health. We compared data on provider responses to the alerts before and after implementing a “chart closure” hard stop, and we conducted chart reviews to adjudicate each alert’s appropriateness. Results Providers responded to alerts more often after the “chart closure” hard stop was implemented (P < .001). Among 284 alert firings over 16 months, we judged 107 (37.7%) to be clinically unnecessary or inappropriate based on chart review. Among the remainder, which represent clear opportunities for treatment, providers ordered the indicated medication more often (41% vs 75%) after the “chart closure” hard stop was implemented (P = .001). Discussion The BPA alerts for diabetes and blood pressure control achieved relatively high specificity. The “chart closure” hard stop improved provider attention to the alerts and was effective at getting patients treated when they needed it. Conclusion Targeting specific omitted medication classes can produce relatively specific alerts that may reduce alert fatigue, and using a “chart closure” hard stop may prompt providers to take action without excessively disrupting their workflow.

Abstract P183: Minimal Impact of JAMA 2014 Guidelines on Blood Pressure Control in a Large Health System

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Alex R Chang ◽  
J E Hartle ◽  
Lawrence Appel ◽  
Morgan Grams
Keyword(s):  
Blood Pressure ◽  
Health System ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Mixed Effects Models ◽  
System Level ◽  
Minimal Impact ◽  
Before And After ◽  
Patients With Diabetes ◽  
Using Data

Background: JAMA 2014 blood pressure (BP) guidelines raised BP goals for adults older than 60 years (from <140/90 to <150/90) and adults with chronic kidney disease (CKD) or diabetes (from < 130/80 to <140/90). It is unknown whether there were changes in BP control at the health system level after guideline publication. Methods: Using data from 288,962 adults receiving primary care in the Geisinger Health System, we compared blood pressure control over 1-year time periods before and after the February 2014 publication of the JAMA 2014 BP guidelines (i.e. Aug 2012-July 2013 vs Aug 2014-July 2015). Mixed effects models were used, allowing intercepts to vary by individual, adjusted for age, gender, and race. Results: Mean age was 49.2 ± 18.3 y, 56.7% were female, and 2.5% were black. Prevalence of diagnoses for hypertension, diabetes, and CKD were 40.0%, 15.1%, and 11.4%, respectively. Overall, distributions of systolic BP were similar before and after JAMA 2014 BP guidelines (Figure). BP control <140/90 was also similar between the two periods for adults 18-59 y (90.9% vs. 90.3%; OR 1.01, 95% CI: 0.99-1.02; p=0.3), adults ≥ 60 y (81.8% vs 82.2%; OR 1.01, 95% CI: 1.00-1.03; p=0.05), and adults with diabetes (83.2% vs. 82.7%; OR 1.00, 95% CI: 0.99-1.02; p=0.7) whereas BP control <140/90 improved slightly for adults with CKD (81.7% vs. 82.1%; OR 1.06, 95% CI: 1.04-1.08; p<0.001). BP control <130/80 was marginally worse after JAMA 2014 BP guidelines in patients with diabetes (53.5% vs. 51.8%; OR 0.98, 95% CI: 0.96-0.99; p=0.01). Trends were similar in analyses only including patients with hypertension diagnoses (overall 78.6% vs. 78.2%, OR 1.00, 95% CI: 0.99-1.02; p=0.5), and when using a goal of < 130/80 for patients with CKD (53.3% vs. 53.5%; OR 1.06, 95% CI: 1.04-1.08; p<0.001). Conclusion: There was little change in blood pressure control in a large integrated health system after publication of the JAMA 2014 BP guidelines. These findings are reassuring given recent findings from the SPRINT trial supporting lower BP goals.

scholarly journals Blood Pressure Control in Hypertensive Patients in Irish Primary Care Practices

2009 ◽  
Vol 11 (8) ◽  
pp. 432-440 ◽  
Author(s):  
Brendan Buckley ◽  
Eamonn Shanahan ◽  
Niall Colwell ◽  
Eva Turgonyi ◽  
Peter Bramlage ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Hypertensive Patients ◽  
Care Practices ◽  
Primary Care Practices

scholarly journals Assessing Quality Improvement Capacity in Primary Care Practices

2019 ◽  
Author(s):  
Michael Parchman ◽  
Melissa L. Anderson ◽  
Katie F Coleman ◽  
LeAnn Michaels ◽  
Linnaea Schuttner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Primary Care ◽  
Quality Improvement ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Prior Experience ◽  
Pressure Control ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background: Healthy Hearts Northwest (H2N) is a study of external support strategies to build quality improvement (QI) capacity in primary care with a focus on cardiovascular risk factors: appropriate aspirin use, blood pressure control, and tobacco screening/cessation. Methods: To guide practice facilitator support, experts in practice transformation identified seven domains of QI capacity and mapped items from a previously validated medical home assessment tool to them. A practice facilitator (PF) met with clinicians and staff in each practice to discuss each item on the Quality Improvement Capacity Assessment (QICA) resulting in a practice-level response to each item. We examined the association between the QICA total and sub-scale scores, practice characteristics, a measure of prior experience with managing practice change, and performance on clinical quality measures (CQMs) for the three cardiovascular risk factors. Results: The QICA score was associated with prior experience managing change and moderately associated with two of the three CQMs: aspirin use (r=0.16, p=0.049) and blood pressure control (r=0.18, p=0.013). Rural practices and those with 2-5 clinicians had lower QICA scores. PFs notes provide examples of high scoring practices devoting time and attention to quality improvement whereas low scoring practices did not. Conclusions: The QICA is useful for assessing QI capacity within a practice and may serve as a guide for both facilitators and primary care practices in efforts to build this capacity and improve measures of clinical quality.

scholarly journals Implementing Home Blood Glucose and Blood Pressure Telemonitoring in Primary Care Practices for Patients with Diabetes: Lessons Learned

2014 ◽  
Vol 20 (3) ◽  
pp. 253-260 ◽  
Author(s):  
Richelle J. Koopman ◽  
Bonnie J. Wakefield ◽  
Jennifer L. Johanning ◽  
Lynn E. Keplinger ◽  
Robin L. Kruse ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Blood Glucose ◽  
Lessons Learned ◽  
Patients With Diabetes ◽  
Care Practices ◽  
Primary Care Practices

scholarly journals Effect of Home Telemonitoring on Glycemic and Blood Pressure Control in Primary Care Clinic Patients with Diabetes

2014 ◽  
Vol 20 (3) ◽  
pp. 199-205 ◽  
Author(s):  
Bonnie J. Wakefield ◽  
Richelle J. Koopman ◽  
Lynn E. Keplinger ◽  
Marilee Bomar ◽  
Beth Bernt ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Blood Pressure Control ◽  
Primary Care Clinic ◽  
Pressure Control ◽  
Care Clinic ◽  
Home Telemonitoring ◽  
Patients With Diabetes

scholarly journals Assessing Quality Improvement Capacity in Primary Care Practices

2019 ◽  
Author(s):  
Michael Parchman ◽  
Melissa L. Anderson ◽  
Katie F Coleman ◽  
LeAnn Michaels ◽  
Linnaea Schuttner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Primary Care ◽  
Quality Improvement ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Prior Experience ◽  
Pressure Control ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background: Healthy Hearts Northwest (H2N) is a study of external support strategies to build quality improvement (QI) capacity in primary care with a focus on cardiovascular risk factors: appropriate aspirin use, blood pressure control, and tobacco screening/cessation. Methods: To guide practice facilitator support, experts in practice transformation identified seven domains of QI capacity and mapped items from a previously validated medical home assessment tool to them. A practice facilitator (PF) met with clinicians and staff in each practice to discuss each item on the Quality Improvement Capacity Assessment (QICA) resulting in a practice-level response to each item. We examined the association between the QICA total and sub-scale scores, practice characteristics, a measure of prior experience with managing practice change, and performance on clinical quality measures (CQMs) for the three cardiovascular risk factors. Results: The QICA score was associated with prior experience managing change and moderately associated with two of the three CQMs: aspirin use (r=0.16, p=0.049) and blood pressure control (r=0.18, p=0.013). Rural practices and those with 2-5 clinicians had lower QICA scores. PFs notes provide examples of high scoring practices devoting time and attention to quality improvement whereas low scoring practices did not. Conclusions: The QICA is useful for assessing QI capacity within a practice and may serve as a guide for both facilitators and primary care practices in efforts to build this capacity and improve measures of clinical quality.

High-dose Cholecalciferol Supplementation Reducing Morning Blood Pressure in Normotensive DM1 Patients

2020 ◽  
Vol 16 ◽  
Author(s):  
Natércia Neves Marques de Queiroz ◽  
Franciane Trindade Cunha de Melo ◽  
Fabrício de Souza Resende ◽  
Luísa Corrêa Janaú ◽  
Norberto Jorge Kzan de Souza Neto ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Vitamin D ◽  
Blood Pressure Monitoring ◽  
Vitamin D Supplementation ◽  
High Dose ◽  
Before And After ◽  
Patients With Diabetes ◽  
Morning Blood Pressure ◽  
Cholecalciferol Supplementation ◽  
Lipids Profile

Background: Vitamin D (VD) deficiency has been related to several endocrine metabolic and cardiovascular diseases. Effect of VD supplementation on blood pressure (BP) in patients with diabetes is controversial. Objective: The aim of this study was to evaluate high-dose vitamin D supplementation effects on blood pressure of normotensive type 1 diabetes mellitus (T1DM) patients by 24-hour ambulatory blood pressure monitoring (ABPM). Methods: We performed a clinical trial including 35 T1DM normotensive patients, who received doses of 4,000 or 10,000 IU/day of cholecalciferol for 12 weeks according to previous VD levels. They underwent 24-hour ABPM, along with glycated hemoglobin, creatine, lipids profile and PCRus dosage before and after VD supplementation. Results and discussion: We found an expressive reduction of systolic and diastolic morning blood pressures (117±14 vs 112±14, p<0,05; 74±9 vs 70±10 mmHg, p<0,05, respectively) with no changes in other pressoric markers. Besides, we noticed a relation between levels of VD after supplementation and diastolic morning blood pressure (r= -0,4; p<0.05). Conclusion: Our study suggests an association between supplementation of high doses of vitamin D and the reduction of morning blood pressure in normotensive T1DM patients.

Sign in / Sign up

Export Citation Format

Share Document