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Feasibility and Outcomes of an Electronic Health Record Intervention to Improve Hypertension Management in Immigrant-Serving Primary Care Practices
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6 2019
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Source: Med Care. 57(Suppl 6 2):S164-S171
[PDF-182.15 KB]
Details:
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Alternative Title:Med Care
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Personal Author:
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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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Pubmed ID:31095056
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Pubmed Central ID:PMC6527132
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Volume:57
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