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Anxiety and Hypertension: Is There a Link? A Literature Review of the Comorbidity Relationship Between Anxiety and Hypertension

Anxiety and Hypertension: Is There a Link? A Literature Review of the Comorbidity Relationship Between Anxiety and Hypertension

There is increasing evidence of a positive association between comorbid anxiety and hypertension. This contemporaneous review by HIP Investigator, Dr. Heather Johnson supports similar findings in historical studies and provides mechanistic hypotheses for larger, longitudinal studies. The objective of this review is to summarize contemporaneous studies evaluating the relationship between prevalent anxiety and comorbid prevalent hypertension, or the development of incident (future) hypertension.

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Big Data Word Scramble

Evaluating care for high-need high-cost patients using the National Patient-Centered Clinical Research Network (PCORNet)

Evaluating care for high-need high-cost patients using the National Patient-Centered Clinical Research Network (PCORNet)

Case management programs for high-need high-cost patients are spreading rapidly among health systems. PCORNet has substantial potential to support learning health systems in rapidly evaluating these programs, but access to complete patient data on health care utilization is limited as PCORNet is based on electronic health records not health insurance claims data. Because matching cases to comparison patients on baseline utilization is often a critical component of high-quality observational comparative effectiveness research for high-need high-cost patients, limited access to claims may negatively affect the quality of the matching process. A team of authors including HIP Investigators Dr. Maureen Smith and Dr. Menggang Yu sought to determine whether the evaluation of programs for high-need high-cost patients required claims data to match cases to comparison patients.

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Rationale and study design of the MyHEART study: A young adult hypertension self-management randomized controlled trial

Rationale and study design of the MyHEART study: A young adult hypertension self-management randomized controlled trial

To address the unmet need in hypertensive care for young adults, we developed MyHEART (My Hypertension Education And Reaching Target), a multi-component, theoretically-based intervention designed to achieve self-management among young adults with uncontrolled hypertension. MyHEART is a patient-centered program, based upon the Self-Determination Theory, that uses evidence-based health behavior approaches to lower blood pressure. Therefore, HIP Investigator, Dr. Heather Johnson and a team of investigators including Dr. Maureen Smith, evaluated MyHEART's impact on changes in systolic and diastolic blood pressure compared to usual care after 6 and 12 months in 310 geographically and racially/ethnically diverse young adults with uncontrolled hypertension.

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Sociodemographics and hypertension control among young adults

Sociodemographics and hypertension control among young adults

Young adults ages 18-39 have low hypertension control rates compared to young adults. Using electronic health record data, Dr. Heather Johnson et al. evaluated the role of sociodemographic factors in hypertension control among young adults with primary care access and incident hypertension. They found that young men had a 39% lower rate of hypertension control compared to young women, and that people for whom English was not their primary language and unmarried people also had lower control rates.

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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.

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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.

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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.

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Can claims data algorithms identify the physician of record?

Can claims data algorithms identify the physician of record?

Eva DuGoff and co-authors investigated the agreement of primary care providers (PCPs) identified by claims algorithms and in EHR data. This study looked at Medicare fee-for-service beneficiaries with diabetes age 65+ and found agreement was higher for algorithms based on primary care visits. The algorithms perform less well among vulnerable populations and those experiencing fragmented care.

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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.

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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.

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