Feasibility and Outcomes of an Electronic Health Record Intervention to Improve Hypertension Management in Immigrant-Serving Primary Care Practices

Details

• Journal Article:
  Med Care
• Personal Author:
  Lopez, Priscilla M. ; Divney, Anna ; Goldfeld, Keith ; Zanowiak, Jennifer ; Gore, Radhika ; Kumar, Rashi ; Laughlin, Phoebe ; Sanchez, Ronald ; Beane, Susan ; Trinh-Shevrin, Chau ; Thorpe, Lorna ; Islam, Nadia
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• Description:
  Background ; South Asians (SAs) experience a disproportionate burden of high blood pressure (BP) in the US, arguably the most preventable risk factor for cardiovascular disease. ; Objective ; We report 12-month results of an electronic health record (EHR)-based intervention, as a component of a larger project, “IMPACT”. The EHR intervention included launching hypertension patient registries and implementing culturally-tailored alerts and order sets to improve hypertension control among patients treated in 14 New York City practices located in predominantly SA immigrant neighborhoods. ; Design ; Using a modified stepped wedge quasi-experimental study design, practice-level EHR data were extracted, and individual-level data were obtained on a subset of patients insured by a Medicaid insurer via their data warehouse. The primary aggregate outcome was change in proportion of hypertensive patients with controlled BP; individual-level outcomes included average systolic BP (SBP) and diastolic BP (DBP) at last clinic visit. Qualitative interviews were conducted to assess intervention feasibility. ; Measures ; Hypertension was defined as having at least one hypertension ICD-9/10 code. Well-controlled hypertension was defined as SBP<140 mmHg and DBP<90 mmHg. ; Results ; Post-intervention, we observed a significant improvement in hypertension control at the practice level, adjusting for age and sex patient composition (aRR: 1.09, 95% CI: 1.04–1.14). Among the subset of Medicaid patients, we observed a significant reduction in average SBP and DBP adjusting for time, age, and sex, by 1.71 mmHg and 1.13 mmHg, respectively (p<0.05). Providers reported feeling supported and satisfied with EHR components. ; Conclusions ; EHR initiatives in practices serving immigrants and minorities may enhance practice capabilities to improve hypertension control.
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• Subjects:
  • Adult
  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents
  • Asian People
  • Blood Pressure
  • Disease Management
  • Electronic Health Records
  • Emigrants and Immigrants
  • Feasibility Studies
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• Keywords:
  • Health information technology (HIT)
  • Electronic health record (EHR)
  • Community-clinical linkages
  • Hypertension
  • Million Hearts® Initiative
  • Immigrant Health
  • South Asians
• Source:
  Med Care. 57(Suppl 6 2):S164-S171
• DOI:
  http://dx.doi.org/10.1097/MLR.0000000000000994
• Pubmed ID:
  31095056
• Pubmed Central ID:
  PMC6527132
• Document Type:
  Text ; Journal Article
• Funding:
  UL1 TR001445/TR/NCATS NIH HHSUnited States/ ; U48DP005008/ACL/ACL HHSUnited States/ ; U54 MD000538/MD/NIMHD NIH HHSUnited States/ ; U48 DP005008/DP/NCCDPHP CDC HHSUnited States/ ; U58 DP005621/DP/NCCDPHP CDC HHSUnited States/ ; P60 MD000538/MD/NIMHD NIH HHSUnited States/ ; R01 DK110048/DK/NIDDK NIH HHSUnited States/
• Genre:
  Journal Article
• Volume:
  57
• Download URL:
  https://stacks.cdc.gov/view/cdc/78651/cdc_78651_DS1.pdf
• File Type:
  [PDF - 182.15 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:3cf95029e1c959ef7e1bf31c72254498ee1eb9221d4ab1b9009e28d41808dda1aae55f9a0a72d07428415e012e8904a4309e807af474777a8c78747ca3674e7a