Connecting rheumatology patients to primary care for high blood pressure
Connecting rheumatology patients to primary care for high blood pressure
High blood pressure is the most prevalent cardiovascular risk factor for rheumatology patients, yet blood pressures are not frequently addressed in specialty visits. Dr. Christie Bartels et al. developed the BP Connect Health protocol to address this issue by training medical assistants and nurses to (1) re-check high blood pressures, (2) advise patients about the link betweeen rheumatic and cardiovascular diseases, and (3) connect patients with timely primary care follow-up using electronic health record orders. In an analysis of the intervention, investigators found that the odds of timely primary care follow-up doubled and the media time to follow-up declined by nearly half, from 71 to 38 days. Additionally, the number of rheumatology visits with high blood pressure declined from 17% to 8% in the 2 years after the protocol was implemented, which suggests that the protocol resulted in population-level declines in high blood pressure. A free toolkit with the BP Connect Health protocol and tools to successfully implement it is available on HIPxChange here.
Frequency and predictors of communication about high blood pressure in RA visits
Frequency and predictors of communication about high blood pressure in RA visits
Patients with rheumatoid arthritis (RA) have a heightened risk of cardiovascular disease. Dr. Christie Bartels et al. conducted a retrospective cohort study to determine whether having high blood pressure increased the likelihood of communication about blood pressure in rheumatology visits. The investigators identified patients in the electronic health record who had both RA and uncontrolled hypertension and who received both primary and rheumatology care, and then trained abstractors reviewed the RA visit notes to determine whether blood pressure communication occurred. They found that only 22% of RA clinic visits contained documented communication about blood pressure, and that patients with stage II elevation of blood pressure were not singificantly more likely to have documented communication. Action steps recommending follow-up for high blood pressure were documented in less than 10% of eligible visits.
Press about the article was featured in Rheumatology News and Healio.
Assessing unwanted variations in rheumatology clinic previsit rooming
Assessing unwanted variations in rheumatology clinic previsit rooming
Edmond Ramly et al. conducted a cross-sectional time-study and work-system analysis to measure rooming workflows in three rheumatology clinics to assess the current capacity for population management in the clinics. They found that total room duration varied by clinic, with a median of 6.75-8.25 minutes, and vital sign measurement and medication reconciliation took up more than half of the rooming time. Additionally, two of 15 tasks varied significantly in duration across clinics, and 9 tasks varied in frequency. Due to these variations, clinic leaders modified their policies and procedures regarding 6 high-variation tasks, which streamlined the assessment of weight, height, pain scores, tobacco use, disease activity, and refill needs.
Primary care colorectal cancer screening correlates with breast cancer screening
Primary care colorectal cancer screening correlates with breast cancer screening
In a retrospective cohort study, Dr. Jennifer Weiss et al. examined 90 primary care providers (PCPs) and over 33,000 patients eligible for colorectal cancer (CRC) screening to determine whether PCP colorectal cancer screening practices correlate with other preventive and chronic care needs. The investigators looked at CRC screening rates in comparison to five other PCP quality metrics—breast cancer screening, cervical cancer screening, HgbA1c and LDL testing, and blood pressure control—and found that PCP CRC screening rates have a strong correlation with breast cancer screening rates and a weak correlation with the other metrics. These results indicate that efforts to increase PCPs' CRC screening rates could be bundled with breast cancer screening improvement interventions to increase their impact.
Hypertension control after an initial cardiac event among Medicare patients with diabetes
Hypertension control after an initial cardiac event among Medicare patients with diabetes
In this study co-authored by Drs. Heather Johnson and Maureen Smith, investigators used EHR and Chronic Conditions Warehouse Medicare data to determine rates & predictors of achieving hypertension control among patients with diabetes and hypertension after they were discharged from the hospital for an initial cardiac event. They found that Medicare patients with diabetes were more likely to achieve hypertension control when prescribed beta-blockers at discharge, or if they had a history of more specialty visits., and adults who were 80 years or older were more likely to achieve control with diuretics.
Hospitalizations for ambulatory care-sensitive conditions among children with chronic and complex diseases
Hospitalizations for ambulatory care-sensitive conditions among children with chronic and complex diseases
Ambulatory-care sensitive (ACS) hospitalizations are those in which high quality outpatient care could have potentially prevented the need for hospitalization. In this study, Dr. Ryan Coller et al. evaluated ACS hospitalizations for children with non-complex chronic diseases and children with medical complexity, and sought to identify ambulatory care predictors of ACS hospitalizations. The authors found that among children with non-complex chronic diseases, 14.6% of hospitalizations were ACS hospitalizations and ACS hospitalizations were more likely with no outpatient visits in the prior year and less likely with timely well checks and phone encounters in the month before the admission. Among children with medical complexity, 5.3% of hospitalizations were ACS hospitalizations, and provider continuity was associated with fewer ACS hospitalizations.
Stratifying patients with diabetes into clinically relevant groups by combination of chronic conditions
Stratifying patients with diabetes into clinically relevant groups by combination of chronic conditions
Dr. Elizabeth Magnan et al. looked at combinations of chronic conditions among patients with diabetes to examine their relationships with diabetes quality metrics. They analyzed 12 conditions concordant with diabetes care to define classes based on co-occurrence: severe cardiac, cardiac, noncardiac vascular, risk factors, and no concordant comorbidities. Patients had distinct quality metric achievement by condition class, and patients in less sever chronic condition classes were less likely to achieve diabetes metrics.
Implementing a mobile health system to integrate the treatment of addiction into primary care
Implementing a mobile health system to integrate the treatment of addiction into primary care
Dr. Andrew Quanbeck et al. implemented a mobile health (mHealth) system to help treat patients with substance use disorders. The investigators evaluated the effect of the system on patients and clinicians using the RE-AIM framework and found that the system improved care among primary care patients with substance use disorders and that patients using the system supported one another in their recovery. However, among clinicians, use of the technology was less robust than the use by patients, and ongoing funding and lack of availibility of the data in the electronic health record were challenges.
The importance of frequent return visits and hypertension control among young adults
The importance of frequent return visits and hypertension control among young adults
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This study by Cecile King and several HIP investigators evaluated the relationship between ambulatory blood pressure encounter intervals and hypertension control rates among young adults. A retrospective analysis showed that shorter encounter intervals were associated with higher hypertension control. Young adults with more frequent visits also had lower medication initiation, supporting the effectiveness of lifestyle modifications.
Risk prediction for heterogeneous populations with application to hospital admission prediction
Risk prediction for heterogeneous populations with application to hospital admission prediction
There is an increasing need to model risk for large hospital and health care systems that provide services to diverse and complex patients. In this paper co-authored by Drs. Menggang Yu and Maureen Smith, the investigators imposed structural constraints on the importance of variables in predicting outomes such as hospital admission, and demonstrated that their method performs well upon application in hospital admission prediction and validation for the Medicare population of a large helath care provider.