title: Quality improvement initiatives improve hypertension care among veterans.
abstract: BACKGROUND
  We implemented a quality improvement initiative to improve hypertension care at Veterans Affairs-Tennessee Valley Healthcare System.
  
  
  RESULTS
  We implemented multiple interventions among 2 teaching hospitals, 5 community-based outpatient clinics, and 4 contract clinic sites. Goals of the program were to (1) improve measurement and documentation of blood pressure (BP), (2) initiate outpatient patient education, (3) emphasize VA/Department of Defense hypertension treatment algorithms to providers, (4) emphasize external peer review program performance goals, and (5) initiate feedback of each clinic's performance. The primary outcome was the proportion of patients seen each week with a diagnosis of hypertension who had their last available BP in control (< or =140/90 mm Hg). Observation time was 40 weeks (14 weeks preintervention, 8 weeks intervention implementation, and 18 weeks postintervention), during which there were 55 586 unique clinic visits for hypertension. After intervention deployment, there was an absolute improvement of 4.2% in BP control (preintervention 61.5% [12 245/19 908] versus postintervention 65.7% [15 809/24 059], P<0.0001). Teaching hospital A had an absolute improvement of 1.4% (63.4% [3544/5591] versus 64.8% [4581/7073], P=0.108). Teaching hospital B showed a 0.8% absolute improvement in BP control (59.7% [2577/4315] versus 60.5% [3416/5650], P=0.456). The community-based outpatient clinics had a combined absolute improvement of 8.6% (60.2% [5252/8728] versus 68.8% [6895/10025], P<0.0001). The contract clinics had a combined improvement of 1.5% (68.4% [872/1274] versus 69.9% [917/1311], P=0.409). Results were sustained 1 year after intervention.
  
  
  CONCLUSIONS
  After implementing small, focused, and inexpensive interventions, BP control improved 4.2%, thereby improving the quality of hypertension care.
authors.affiliation: Veterans Affairs-Tennessee Valley Healthcare System, Tennessee Valley Geriatric Research Education Clinical Center, Nashville, Tenn., USA.
authors.forename: Neesha N
authors.initials: NN
authors.lastname: Choma
authors.forename: Robert L
authors.initials: RL
authors.lastname: Huang
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
authors.forename: Kathy E
authors.initials: KE
authors.lastname: Burnham
authors.forename: Christianne L
authors.initials: CL
authors.lastname: Roumie
mesh_terms: D000553:Ambulatory Care / Q000592:standards; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D019983:Guideline Adherence / Q000592:standards; D006784:Hospitals, Teaching / Q000592:standards; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008485:Medical Audit; D016347:Medical Records Systems, Computerized; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010353:Patient Education as Topic / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods*; D011787:Quality of Health Care; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use; D013714:Tennessee; D014481:United States; D014728:Veterans
chemical_list: D000959:Antihypertensive Agents; D049993:Sodium Chloride Symporter Inhibitors