title: The impact of a measurement and feedback intervention on blood pressure control in ambulatory cardiology practice.
abstract: BACKGROUND
  Although hypertension is a modifiable cardiovascular risk factor, up to one-third of ambulatory patients have uncontrolled blood pressure (BP). We evaluated the impact of a targeted provider feedback intervention on rates of BP control.
  
  
  METHODS
  Clinic BP readings were aggregated among approximately 3,000 hypertensive patients followed up in 42 outpatient cardiology clinic practices at a large quaternary care academic medical center. Physician practices received quarterly reports on BP control rates. Provider-specific reports were benchmarked vs overall peer performance and distributed quarterly between September 2011 and September 2012. Rates of BP control were evaluated before and after the intervention. Medical record reviews were performed for a subset of patients with uncontrolled BP before (n = 300) and after (n = 300) the intervention to evaluate provider responses and interventions.
  
  
  RESULTS
  At baseline, 27.9% of clinic patients had uncontrolled BP. After one 1 of reports, the rate of uncontrolled BP remained unchanged (27.7%, P = .86). Analysis of provider performance revealed a subset of providers who consistently outperform their peers. In the sample of patients selected for medical record reviews, at baseline (n = 300) and follow-up (n = 300), cardiologists discussed BP in 80% of clinic notes for patients with uncontrolled BP. Cardiologists more frequently documented repeat measurements after the intervention (28.0% vs 35.7%, P = .04). No other changes were found in documentation of provider responses to BP.
  
  
  CONCLUSIONS
  Clinician-specific audit and feedback reports as a stand-alone intervention did not affect overall BP control rates in cardiology clinics. Future BP control interventions should consider real-time patient-specific reminders, provider incentive programs, and patient engagement interventions.
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; Department of Medicine, Duke University Medical Center, Durham, NC. Electronic address: ann.navar@dm.duke.edu.
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Navar-Boggan
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Alexander
authors.initials: A
authors.lastname: Fanaroff
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Aparna
authors.initials: A
authors.lastname: Swaminathan
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Belasco
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors.forename: Judith
authors.initials: J
authors.lastname: Stafford
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Bimal
authors.initials: B
authors.lastname: Shah
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D054869:Clinical Audit; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D011785:Quality Assurance, Health Care
chemical_list: D000959:Antihypertensive Agents