Keep this in mind to engage patients, measure BP accurately

Jennifer Lubell , Contributing News Writer

Two key components of blood pressure control are measuring blood pressure accurately and partnering with patients to engage them in their care. These include interventions such as repeat readings and follow-up appointments, according to an AMA MAP™ Hypertension learning series webinar.

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AMA MAP Hypertension is an evidence-based quality improvement program that provides a clear path to significant, sustained improvements in BP control. With the AMA MAP Hypertension program, health care organizations can increase BP-control rates quickly. The program has demonstrated a 10% increase in BP control in six months with sustained results at one year.

The AMA and Azara Healthcare are collaborating to give organizations access to AMA MAP Hypertension metrics, reports, quality improvement tools and resources. Azara DRVS is a centralized, scalable data reporting and analytics platform for population-health management and quality improvement. The detailed analytics allow care teams to access a more comprehensive view of their patient population, including the socioeconomic challenges their patients are experiencing.

Organizations can view these data trends and use actionable reports to better manage patients with hypertension. The platform has additional options to filter information by location or physician/provider. Filters can identify care gaps—pinpointing certain patients that didn’t have a follow-up appointment, for example.

During the webinar, Laken Barkowski, RN, senior program manager for health systems improvement at the AMA, discussed the AMA MAP Hypertension program evidence, strategies, action steps and metrics which are designed to empower care teams to measure accurately and partner with patients.

The MAP program’s “measure accurately” component addresses errors in BP measurements. At least 27 errors can take place when measuring BP, negatively impacting accuracy, said Barkowski.

Care teams can take three steps to avoid such errors:

  • Use automated, validated blood pressure devices that are calibrated regularly.
  • Properly prepare and position patients for measurement.
  • Use a standardized measurement protocol, which includes taking repeat measurements when indicated.

Incorrect cuff size is the No. 1 error Barkowski sees. That is why all devices should have a wide variety of cuffs available that are easily accessible to the team. 

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Care teams may use the “repeat BP measurement” metric to track their progress. The metric looks at patients with hypertension who had an uncontrolled blood pressure reading, who then had additional measurements taken.

Doing multiple measurements offers a more reliable and representative BP that better represents what a patient's blood pressure is outside of the clinical setting, said Barkowski.

“It’s their true blood pressure,” she said, emphasizing teams should make sure their protocol includes repeat measurements when indicated. This includes clarifying what BP value warrants them to take additional measurements.

“We do have a 50% suggested goal, but we really do recommend that teams take a look at their current performance and adjust accordingly,” Barkowski said.

How you document the readings is another important element of your BP protocol, she advised. Both the initial blood pressure and the confirmatory average need to go into a structured, discoverable field in your EHR, such as a vitals field.

Physicians and care team members may miss opportunities to engage with patients about their care and involve them in it.

It’s important to follow up with patients until their BP is controlled, stressed Barkowski. One of the MAP metrics looks at the percentage of patients with hypertension who had a high blood pressure reading then had follow-up within four weeks.

“What percentage of the time that is happening? We have the suggested goal of 50%, but again … customize that for your team. How can you improve in this area?” said Barkowski.

Other strategies to engage patients in self-management of their hypertension is through lifestyle change, self-measured blood pressure.

Watch other episodes in the webinar series to learn more about AMA MAP Hypertension and how Azara Healthcare can leverage the program through DRVS.