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Sustained Improvement in Blood Pressure Control for a Multiracial Cohort: Results of a Patient-centered Medical Home Quality Improvement Initiative

Elizabeth Kirkland, Jingwen Zhang, Elisha Brownfield, Marc Heincelman, Samuel Schumann, Andrew Schreiner, Kinfe Bishu, Patrick D Mauldin, William P Moran

Background: Patient-centered medical homes incorporate strategies to increase healthcare access as a means of improving health at the patient and population level. We hypothesized that quality improvement initiatives based in a patient-centered medical home would improve hypertension control for adult patients, regardless of race.

Methods: This prospective cohort study included patients of a hospital-based Internal Medicine practice in the southeastern U.S. whose systolic blood pressure was uncontrolled (criteria ≥ 140 mm Hg) prior to patient-centered medical home certification. Mean systolic blood pressure and hypertension control rates were calculated from the average of the four quarterly means prior to patient-centered medical home designation and again from the last 4 quarters of the fiveyear study period (final). Quality improvement interventions included patient identification, multidisciplinary team meetings, targeted outreach and dedicated office visits for addressing hypertension. Primary outcomes included the change in systolic blood pressure and the change in the proportion of the cohort with hypertension control. Chi-square, two sample t-tests and ANOVA were used for comparison (SAS 9.3).

Results: The inception cohort had 1,702 patients (64% nonwhite, 36% white) with systolic blood pressure ≥ 140 mm Hg. Mean systolic blood pressure significantly decreased while hypertension control rates increased in both races after patient-centered medical home certification. White adults had lower mean systolic blood pressure and higher control rates at baseline and study conclusion compared to nonwhite adults. Similar trends persisted regardless of the number of office visits.

Conclusion: The analysis of blood pressure before and after designation of an Internal Medicine clinic as a patientcentered medical home reveals disparities in rates of chronic disease control. Team-based outreach improves hypertension control for patients regardless of race or visit number. These findings suggest that patient-centered medical homes and a multidisciplinary care approach, not limited to increased access, improve chronic disease control and should be considered for diverse outpatient clinics.