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

Details

• Alternative Title:
  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
• 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.
  
  
• Subjects:
  Adult Aged Aged, 80 And Over Antihypertensive Agents Asian People Blood Pressure Disease Management Electronic Health Records Emigrants And Immigrants Feasibility Studies Female Humans Hypertension Male Medicaid Middle Aged New York City Primary Health Care Qualitative Research Quality Improvement United States

  More +
• Keywords:
  Community-clinical Linkages Electronic Health Record (EHR) Health Information Technology (HIT) Immigrant Health Million Hearts® Initiative South Asians
• Source:
  Med Care. 57(Suppl 6 2):S164-S171
• Pubmed ID:
  31095056
• Pubmed Central ID:
  PMC6527132
• Document Type:
  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/
• Volume:
  57
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:3cf95029e1c959ef7e1bf31c72254498ee1eb9221d4ab1b9009e28d41808dda1aae55f9a0a72d07428415e012e8904a4309e807af474777a8c78747ca3674e7a
• Download URL:
  https://stacks.cdc.gov/view/cdc/78651/cdc_78651_DS1.pdf
• File Type:
  [PDF - 182.15 KB ]