There’s a scary subplot lurking in America’s hypertension epidemic, and it’s something many physicians and hospital administrators might not have an inkling of.
They already know about the staggering prevalence of high BP among patients from historically marginalized racial and ethnic groups. And they know only about one-quarter of adults with hypertension have their condition under control. No, it’s much closer to home than either of those.
It’s how many care teams are inaccurately measuring blood pressure.
Part of the reason for it is simple—lack of training—but no amount of training can make up for having inaccurate BP measurement devices. According to a study published in the Journal of Hypertension this year, 81 of the 100 best-selling BP devices sold on Amazon have not undergone adequate clinical validation testing.
The good news is there’s a website, the US Blood Pressure Validated Device Listing (VDL™), that details which BP measurement devices have been validated for clinical accuracy in the U.S.
But if you’re at a physician practice, hospital or health system, how exactly should you go about operationalizing validated devices? The folks at one Michigan-based health system have done it, and they have some tips.
Measurement is the foundation
The health system, Trinity Health, has embraced the VDL as part of its work with AMA MAP BP™, an evidence-based quality improvement program that provides a clear path to significant, sustained improvements in BP control. AMA MAP BP is named for its three key elements:
- Measure accurately.
- Act rapidly.
- Partner with patients.
“What we often hear from providers is that they don't act aggressively on blood pressures because they don't trust the readings,” said Dan Weiswasser, MD, vice president and chief medical officer in medical groups and clinical integration at Trinity Health, which has a presence in 26 states. “So it's important to have the tools and processes that they can rely on so they can act rapidly.”
Embrace change
Trinity Health starts by looking at its exam room configuration.
“If the rooms aren't set up to take a blood pressure accurately, there's no sense in doing the training,” said Jen Bailey, director of ambulatory clinical operations at Trinity Health. “So once we get the room set up, that tells us how many devices we're going to need.”
The health system only purchases validated devices. Once the devices are delivered, they are tested and tagged by the biomedical engineering team. They are then delivered to ambulatory office settings on specific dates and at specific times so clinical leads can coordinate training every staff member who will be taking blood pressures.
Biomedical engineering supports clinical operations by testing the devices on an annual basis.
“This is about change management,” Bailey said. “We’re used to taking blood pressures manually within ambulatory office settings. Now we’re moving to using automated devices—not just for confirmatory measures but for initial measures as well.”
Even though many physicians don’t trust the readings they’re getting from their old BP-measurement devices, there are still lots who do. And the latter might be surprised to learn they shouldn’t.
“Every go-live, we add more patients to the denominator of those with a diagnosis of hypertension,” Bailey said. “The numbers always get worse at first, but then they improve. It’s because we find patients with blood pressure that we thought was well managed but isn’t.”
