title: Using a multidisciplinary team and clinical redesign to improve blood pressure control in patients with diabetes.
abstract: OBJECTIVE
  Optimal blood pressure (BP) control in patients with diabetes poses a challenge in primary care clinics because of the complexity of the disease and competing patient care demands. We used a multidisciplinary team to standardize and improve hypertension care for patients with diabetes by implementing a visual and action-oriented high BP prompt, collaborative practice agreement, medication intensification protocol, and home BP monitoring machine loan program.
  
  
  METHODS
  Prospective, pre-/poststudy.
  
  
  METHODS
  General medicine clinic affiliated with a large academic healthcare system.
  
  
  METHODS
  Two hundred sixty-three patients with type 2 diabetes mellitus.
  
  
  RESULTS
  Hypertension control (ie, BP < 135/80 mm Hg) in patients with diabetes improved from 53.6% to 69.3% (P < .001) after implementing a standardized BP assessment and treatment process. There was also a significant decrease of 4 mm Hg in both the mean systolic and diastolic BPs after the intervention. The improvement in BP control was associated with an increase in the average number of antihypertensive medications from 1.56 to 1.93.
  
  
  CONCLUSIONS
  The use of a process-oriented clinical redesign and a multidisciplinary team approach resulted in improved BP management in patients with diabetes in a primary care setting.
authors.affiliation: College of Pharmacy, University of Michigan, Ann Arbor, Michigan 48109, USA. haemi@umich.edu
authors.forename: Hae Mi
authors.initials: HM
authors.lastname: Choe
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Bernstein
authors.forename: David
authors.initials: D
authors.lastname: Cooke
authors.forename: David
authors.initials: D
authors.lastname: Stutz
authors.forename: Connie
authors.initials: C
authors.lastname: Standiford
mesh_terms: D000368:Aged; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome