Roughly a third of adults in the U.S have hypertension, yet almost one in five of these individuals remains unaware of the condition. Most patients with undiagnosed hypertension regularly use healthcare services but many are not diagnosed or treated due in part to concerns about the reliability of office-based blood pressure measurement and underuse of ambulatory-based monitoring.
The NorthShore University Health System affiliated with the University of Chicago, Pritzker School of Medicine, serves patients throughout the northern Chicago metropolitan area. The system has four hospitals and a medical group employing over 800 primary care physicians and specialists who work in more than 70 offices.
NorthShore operates a practice-based research network known as the Ambulatory Primary Care Innovations Group in partnership with the University of Chicago Institute for Translational Medicine. They received funds from NIH’s Clinical Translational Science Award to see if technology could be effectively used to identify at-risk primary care patients for undiagnosed hypertension.
In planning for the project, Michael Rakotz, MD a full time practicing family physician in the NorthShore Medical Group, met personally with physician leaders at 23 practices in the Primary Care Practice-Based Research Network (PBRN) to explain the program.
In addition, literature was reviewed on ambulatory blood pressure measurement devices. After identifying and reviewing evidence related to several automated office blood pressure products, they chose “BpTRU BPM-200” to be used by the practices.
Next, they developed the IT infrastructure to create search functions to identify at-risk patients and provide electronic alerts. At this point, training was provided to medical assistants, nurses, and physicians on how to use and interpret the results from automated office blood pressure measurements.
The use of information technology plus algorithm-based screening was able to identify those patients at risk for undiagnosed hypertension in 40 primary care practices. Practice-based staff proactively contacted these patients to schedule a standardized visit for blood pressure measurement and a primary care evaluation.
During the program’s first two years of operation in the 23 primary care practices, the program has reduced the proportion of at-risk patients remaining undiagnosed for hypertension by about 70 percent. The next goal is to make the program an ongoing part of operations and expand the program to 17 additional practices.
For further details, the AHRQ Snapshot on the case titled, “Information Technology-Facilitated Identification of At-Risk Primary Care Patients Combines with In-Office Automated Measurement Significantly Reduces Undiagnosed Hypertension” can be found on the AHRQ website at http://innovations.ahrq.gov.
For more information, email Bernard Ewigman, MD, Professor and Chair Department of Family Medicine at the University of Chicago and NorthShore University HealthSystem at bewigman@northshore.org or bewigman@uchicago.edu or call (847) 657-1827.