Impact of a Centralized Quality Improvement Initiative on Repeat Blood Pressure Measurement at an Academic Medical Center.

BACKGROUND: Repeat blood pressure (BP) measurements help ensure accurate identification of controlled vs. uncontrolled BP. Within the Department of Medicine (DOM), the authors aimed to improve the rate of repeat BP measurement when the initial reading was ≥ 140/90 mmHg from the baseline of 40% to 50% between September 2022 and August 2023. METHODS: A DOM Quality, Process Improvement and Outcomes Committee, with representatives from each division, led a centralized improvement effort to create a common data infrastructure, electronic dashboard for local use, feedback of data to clinical leaders, and educational materials for clinic use. Control and run charts were used to analyze the impact of repeat BP measurements on the process and outcome measures. RESULTS: The 61 DOM clinics completed a total of 273,704 patient encounters between September 2022 and August 2023. A total of 74,614 encounters had an initial high BP reading ≥ 140/90 mmHg. In these encounters, the rate of repeat BP measurement increased from a mean 41% to 61%, and the BP control (< 140/90 mmHg) rate increased from a mean 74% to 78%. Similar improvements were seen in the subgroup with a known diagnosis of hypertension. In addition, the percentage of encounters reclassified from uncontrolled to controlled BP (< 140/90 mmHg) upon repeating the BP remained relatively stable with a median reclassification rate of 38%. CONCLUSION: This centralized, department-level intervention increased rates of repeat BP measurement. Improvement in BP control was observed prior to the implementation of interventions and continued to improve after. Using a system-level approach to quality improvement with centralized infrastructure, the study team facilitated changes in diverse clinics to improve clinical care.