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Improvement in Blood Pressure Control in Safety Net Clinics Receiving 2 Versions of a Scalable Quality Improvement Intervention: BP MAP A Pragmatic Cluster Randomized Trial.

Publication ,  Journal Article
Fontil, V; Modrow, MF; Cooper-DeHoff, RM; Wozniak, G; Rakotz, M; Todd, J; Azar, K; Murakami, L; Sanders, M; Chamberlain, AM; O'Brien, E ...
Published in: J Am Heart Assoc
February 7, 2023

Background Uncontrolled blood pressure (BP) remains a leading cause of death in the United States. The American Medical Association developed a quality improvement program to improve BP control, but it is unclear how to efficiently implement this program at scale across multiple health systems. Methods and Results We conducted BP MAP (Blood Pressure Measure Accurately, Act Rapidly, and Partner With Patients), a comparative effectiveness trial with clinic-level randomization to compare 2 scalable versions of the quality improvement program: Full Support (with support from quality improvement expert) and Self-Guided (using only online materials). Outcomes were clinic-level BP control (<140/90 mm Hg) and other BP-related process metrics calculated using electronic health record data. Difference-in-differences were used to compare changes in outcomes from baseline to 6 months, between intervention arms, and to a nonrandomized Usual Care arm composed of 18 health systems. A total of 24 safety-net clinics in 9 different health systems underwent randomization and then simultaneous implementation. BP control increased from 56.7% to 59.1% in the Full Support arm, and 62.0% to 63.1% in the Self-Guided arm, whereas BP control dropped slightly from 61.3% to 60.9% in the Usual Care arm. The between-group differences-in-differences were not statistically significant (Full Support versus Self-Guided=+1.2% [95% CI, -3.2% to 5.6%], P=0.59; Full Support versus Usual Care=+3.2% [-0.5% to 6.9%], P=0.09; Self-Guided versus Usual Care=+2.0% [-0.4% to 4.5%], P=0.10). Conclusions In this randomized trial, 2 methods of implementing a quality improvement intervention in 24 safety net clinics led to modest improvements in BP control that were not statistically significant. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03818659.

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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

February 7, 2023

Volume

12

Issue

3

Start / End Page

e024975

Location

England

Related Subject Headings

  • United States
  • Safety-net Providers
  • Quality Improvement
  • Hypertension
  • Humans
  • Blood Pressure Monitoring, Ambulatory
  • Blood Pressure
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

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Fontil, V., Modrow, M. F., Cooper-DeHoff, R. M., Wozniak, G., Rakotz, M., Todd, J., … Pletcher, M. J. (2023). Improvement in Blood Pressure Control in Safety Net Clinics Receiving 2 Versions of a Scalable Quality Improvement Intervention: BP MAP A Pragmatic Cluster Randomized Trial. J Am Heart Assoc, 12(3), e024975. https://doi.org/10.1161/JAHA.121.024975
Fontil, Valy, Madelaine Faulkner Modrow, Rhonda M. Cooper-DeHoff, Gregory Wozniak, Michael Rakotz, Jonathan Todd, Kristen Azar, et al. “Improvement in Blood Pressure Control in Safety Net Clinics Receiving 2 Versions of a Scalable Quality Improvement Intervention: BP MAP A Pragmatic Cluster Randomized Trial.J Am Heart Assoc 12, no. 3 (February 7, 2023): e024975. https://doi.org/10.1161/JAHA.121.024975.
Fontil V, Modrow MF, Cooper-DeHoff RM, Wozniak G, Rakotz M, Todd J, et al. Improvement in Blood Pressure Control in Safety Net Clinics Receiving 2 Versions of a Scalable Quality Improvement Intervention: BP MAP A Pragmatic Cluster Randomized Trial. J Am Heart Assoc. 2023 Feb 7;12(3):e024975.
Fontil, Valy, et al. “Improvement in Blood Pressure Control in Safety Net Clinics Receiving 2 Versions of a Scalable Quality Improvement Intervention: BP MAP A Pragmatic Cluster Randomized Trial.J Am Heart Assoc, vol. 12, no. 3, Feb. 2023, p. e024975. Pubmed, doi:10.1161/JAHA.121.024975.
Fontil V, Modrow MF, Cooper-DeHoff RM, Wozniak G, Rakotz M, Todd J, Azar K, Murakami L, Sanders M, Chamberlain AM, O’Brien E, Lee A, Carton T, Pletcher MJ. Improvement in Blood Pressure Control in Safety Net Clinics Receiving 2 Versions of a Scalable Quality Improvement Intervention: BP MAP A Pragmatic Cluster Randomized Trial. J Am Heart Assoc. 2023 Feb 7;12(3):e024975.
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

February 7, 2023

Volume

12

Issue

3

Start / End Page

e024975

Location

England

Related Subject Headings

  • United States
  • Safety-net Providers
  • Quality Improvement
  • Hypertension
  • Humans
  • Blood Pressure Monitoring, Ambulatory
  • Blood Pressure
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology