Home blood pressure monitoring is a critical complement to care provided during regular office visits. Through the use of self-measured blood pressure (SMBP) monitors, a major Texas health system experienced a sizable impact on BP control. A pilot program targeting 2,550 adults with uncontrolled BP and a history of persistently uncontrolled hypertension was able to achieve hypertension control for 79 percent of the patients, with 67 percent achieving BP control by the third office visit.
As part of a $117,500 grant from the American Heart Association (AHA), SWHP implemented a home BP monitoring initiative at 13 pilot sites across five geographical regions. The patients in the intervention cohort were identified by their provider, medical record review, or self as having persistently uncontrolled hypertension at the time of enrollment. With little to no undue burden placed on the providers or their staff the system’s overall BP-control rate saw big gains.
“A retrospective review done six months after the intervention period ended found that by providing our members with the tools necessary to effectively engage in home BP monitoring, hypertension control rates continued to climb with 79 percent achieving and maintaining hypertension control,” said Roy Champion Jr., project lead and clinical quality registered nurse at SWHP.
“Additionally, considering the cost of the average office visit, by decreasing the average office visits by 1.2 visits per year, the $38.15 per patient in grant-funded tools was found to be cost-effective.” Here is how these results were achieved.
Identify barriers to control
The key to implementation involved addressing four barriers to hypertension management:
- Cost of home BP monitors.
- Underuse of SMBP by patients and physicians.
- Inadequate EHR documentation of patient-physician conversations on SMBP monitoring.
- A lack of referrals from primary care physicians to hypertension specialists.
“One of the biggest barriers, especially amongst seniors living on a fixed budged, is that they can’t afford a quality blood-pressure monitor and yet they need it,” said Champion. “Additionally, because there are so many monitors available on the market, patients don’t know which ones are accurate.”
Identifying barriers to care allowed the team to provide appropriate resources for both patients and physicians while paving the way for success.
Provide monitors for patients
Thanks to the funding from the AHA Grant, SWHP was able to eliminate cost and access barriers, distributing one BP monitor and a set of engagement tools to each patient. There were three intervention cohorts: Patients who received their devices from their provider during an office visit, by mail with the permission of their provider, or at the members request during SWHP health and member-engagement fairs.
“Multiple studies have found a positive correlation between the use of home BP monitoring [HBPM] and ambulatory BP monitoring in the diagnosis and treatment of hypertension. They also found that HBPM costs less, is easier to use, and can be used for ongoing assessment and treatment of hypertension. This is because HBPM provides both the patient and the provider with actionable feedback regarding the member’s blood pressure during their ‘normal’ routines,” said Champion. “On the flip side, both they and their provider can see what happens when they take their medicine.”
Distribute educational resources
Educational handouts were created to promote compliance with the AHA/American College of Cardiology guidelines and best-practices including: a handout on how to properly assess and document home BP readings, a spreadsheet to document HBPM readings for those without access to the online logs, My Health Tracker (a simple comprehensive health workbook), and a refrigerator magnet asking, “Have you checked your BP today?” and reminding them of simple self-care activities they can do themselves.
Additionally, nursing staff reviewed the steps for effective HBPM, ensured the patient had a properly fitted cuff, and could successfully perform HBPM prior to discharge.
“With this grant, we showed that standardizing the messaging across the system worked really well and helped drive our goals,” said Champion.
In the wake of the pilot program’s success, the Baylor Scott & White Health System is fully committed to maintaining hypertension control rates for recognition by Target: BP™, a national initiative co-led by the AHA and AMA. For all of the system’s patients diagnosed with hypertension, the hypertension control rate is about 80 percent, Champion said.
In addition to direct access to trained field support specialists and a suite of evidence-based tools and resources offered by the AMA and the AHA, Target: BP offers annual, recurring recognition for all participating sites that submit data and those that achieve hypertension control rates of 70 percent or higher among their adult patient population year over year. Learn about the 300-plus organizations recognized by Target: BP in 2017.