Reducing Clinical Inertia in Hypertension Treatment: A Pragmatic Trial

Not Applicable

Completed

Brief Summary: The goal of this project is to use health information technology and team-based care in novel ways to support the establishment of a Patient-Centered Medical Home model of care aimed at improving the diagnosis and management of hypertension. Compared with patients who receive usual care, patients who receive intervention will have a lower average systolic blood pressure 9 months after randomization.

Recruitment & Eligibility

Inclusion Criteria

Adult men and women age 18-79
At least 2 Blood Pressure readings from separate days on record
Average of last 3 Blood Pressure readings (or last 2 if only 2 available) with (Systolic Blood Pressure ≥140 or Diastolic Blood Pressure ≥90) and (last Systolic Blood Pressure ≥135 or last Diastolic Blood Pressure ≥85), recorded by any University of Colorado Hospital clinic within the last 18 months
No clinic visit in the past month
At least one Primary Care Physician visit in the past 18 months
First Primary Care Physician visit at least 6 months in the past

Exclusion Criteria

Serious comorbidities, including active cancer diagnosis, hospice care, nursing home residence
Diagnosis of diabetes (these patients are enrolled in a separate study that also targets Blood Pressure control)
End-stage renal disease / hemodialysis
Primary Care Physician appointment pending
Patient instructed to monitor Blood Pressure at home / documentation of white coat hypertension
Blood Pressure managed by specialist or outside provider

Primary Outcome Measures

Name	Time	Method
Blood Pressure	Baseline, 9 months	Hypothesis: compared with patients who receive usual care, patients who receive intervention will have an average systolic blood pressure that is at least 5 points lower 9 months after randomization.

Secondary Outcome Measures

Name	Time	Method
Clinical Inertia	Baseline, 9 months	Definition of clinical inertia: failure of a primary care physician to initiate/intensify anti-hypertensive medications AND the failure to provide behavioral counseling to lower blood pressure during a clinic visit where blood pressure is elevated above 140/90 mm Hg. The clinical inertia measure is the percentage of clinic visits with clinical inertia present divided by the total number of clinic visits. We report a change in group mean levels of clinical inertia from baseline to 9 months post-randomization. Negative values for clinical inertia represent a decrease in the percentage of clinic visits where clinical inertia was present. Pre-randomization clinical inertia was assessed in the last 2 clinic visits prior to randomization, and post-randomization inertia was assessed in the first 2 post-randomization visits. Hypothesis: clinical inertia will be significantly greater in the usual care compared with intervention group in the post-randomization period.