• Shari D Bolen, Thomas E Love, Douglas Einstadter, Jonathan Lever, Steven Lewis, Harry Persaud, Jordan Fiegl, Rujia Liu, Wanda Ali-Matlock, David Bar-Shain, Aleece Caron, James Misak, Todd Wagner, Erick Kauffman, Lloyd Cook, Christopher Hebert, Suzanne White, Nana Kobaivanova, and Randall Cebul.
• Center for Health Care Research and Policy, Population Health Research Institute, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA. sdb73@case.edu.
• J Gen Intern Med. 2021 Jun 1; 36 (6): 159115971591-1597.

BackgroundAccelerated translation of real-world interventions for hypertension management is critical to improving cardiovascular outcomes and reducing disparities.ObjectiveTo determine whether a positive deviance approach would improve blood pressure (BP) control across diverse health systems.DesignQuality improvement study using 1-year cross sections of electronic health record data over 5 years (2013-2017).ParticipantsAdults ≥ 18 with hypertension with two visits in 2 years with at least one primary care visit in the last year (N = 114,950 at baseline) to a primary care practice in Better Health Partnership, a regional health improvement collaborative.InterventionsIdentification of a "positive deviant" and dissemination of this system's best practices for control of hypertension (i.e., accurate/repeat BP measurement; timely follow-up; outreach; standard treatment algorithm; and communication curriculum) using 3 different intensities (low: Learning Collaborative events describing the best practices; moderate: Learning Collaborative events plus consultation when requested; and high: Learning Collaborative events plus practice coaching).Main MeasuresWe used a weighted linear model to estimate the pre- to post-intervention average change in BP control (< 140/90 mmHg) for 35 continuously participating clinics.Key ResultsBP control post-intervention improved by 7.6% [95% confidence interval (CI) 6.0-9.1], from 67% in 2013 to 74% in 2017. Subgroups with the greatest absolute improvement in BP control included Medicaid (12.0%, CI 10.5-13.5), Hispanic (10.5%, 95% CI 8.4-12.5), and African American (9.0%, 95% CI 7.7-10.4). Implementation intensity was associated with improvement in BP control (high: 14.9%, 95% CI 0.2-19.5; moderate: 5.2%, 95% CI 0.8-9.5; low: 0.2%, 95% CI-3.9 to 4.3).ConclusionsEmploying a positive deviance approach can accelerate translation of real-world best practices into care across diverse health systems in the context of a regional health improvement collaborative (RHIC). Using this approach within RHICs nationwide could translate to meaningful improvements in cardiovascular morbidity and mortality.

9 keywords...

hide…