title: Quality improvement strategies for hypertension management: a systematic review.
abstract: BACKGROUND
  Care remains suboptimal for many patients with hypertension.
  
  
  OBJECTIVE
  The purpose of this study was to assess the effectiveness of quality improvement (QI) strategies in lowering blood pressure.
  
  
  METHODS
  MEDLINE, Cochrane databases, and article bibliographies were searched for this study.
  
  
  METHODS
  Trials, controlled before-after studies, and interrupted time series evaluating QI interventions targeting hypertension control and reporting blood pressure outcomes were studied.
  
  
  METHODS
  Two reviewers abstracted data and classified QI strategies into categories: provider education, provider reminders, facilitated relay of clinical information, patient education, self-management, patient reminders, audit and feedback, team change, or financial incentives were extracted.
  
  
  RESULTS
  Forty-four articles reporting 57 comparisons underwent quantitative analysis. Patients in the intervention groups experienced median reductions in systolic blood pressure (SBP) and diastolic blood pressure (DBP) that were 4.5 mm Hg (interquartile range [IQR]: 1.5 to 11.0) and 2.1 mm Hg (IQR: -0.2 to 5.0) greater than observed for control patients. Median increases in the percentage of individuals achieving target goals for SBP and DBP were 16.2% (IQR: 10.3 to 32.2) and 6.0% (IQR: 1.5 to 17.5). Interventions that included team change as a QI strategy were associated with the largest reductions in blood pressure outcomes. All team change studies included assignment of some responsibilities to a health professional other than the patient's physician.
  
  
  CONCLUSIONS
  Not all QI strategies have been assessed equally, which limits the power to compare differences in effects between strategies.
  
  
  CONCLUSIONS
  QI strategies are associated with improved hypertension control. A focus on hypertension by someone in addition to the patient's physician was associated with substantial improvement. Future research should examine the contributions of individual QI strategies and their relative costs.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA.
authors.forename: Judith M E
authors.initials: JM
authors.lastname: Walsh
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: McDonald
authors.forename: Kaveh G
authors.initials: KG
authors.lastname: Shojania
authors.forename: Vandana
authors.initials: V
authors.lastname: Sundaram
authors.forename: Smita
authors.initials: S
authors.lastname: Nayak
authors.forename: Robyn
authors.initials: R
authors.lastname: Lewis
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Owens
authors.forename: Mary Kane
authors.initials: MK
authors.lastname: Goldstein
mesh_terms: D001795:Blood Pressure Determination; D002986:Clinical Trials as Topic; D004496:Education, Continuing / Q000379:methods / Q000458:organization & administration; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D007721:Knowledge of Results, Psychological; D008485:Medical Audit; D010348:Patient Care Team / Q000458:organization & administration; D010353:Patient Education as Topic / Q000379:methods / Q000458:organization & administration; D011785:Quality Assurance, Health Care / Q000379:methods*; D017010:Reminder Systems