title: A technology-based quality innovation to identify undiagnosed hypertension among active primary care patients.
abstract: OBJECTIVE
  The goal of this study was to develop a technology-based strategy to identify patients with undiagnosed hypertension in 23 primary care practices and integrate this innovation into a continuous quality improvement initiative in a large, integrated health system.
  
  
  METHODS
  In phase 1, we reviewed electronic health records (EHRs) using algorithms designed to identify patients at risk for undiagnosed hypertension. We then invited each at-risk patient to complete an automated office blood pressure (AOBP) protocol. In phase 2, we instituted a quality improvement process that included regular physician feedback and office-based computer alerts to evaluate at-risk patients not screened in phase 1. Study patients were observed for 24 additional months to determine rates of diagnostic resolution.
  
  
  RESULTS
  Of the 1,432 patients targeted for inclusion in the study, 475 completed the AOBP protocol during the 6 months of phase 1. Of the 1,033 at-risk patients who remained active during phase 2, 740 (72%) were classified by the end of the follow-up period: 361 had hypertension diagnosed, 290 had either white-coat hypertension, prehypertension, or elevated blood pressure diagnosed, and 89 had normal blood pressure. By the end of the follow-up period, 293 patients (28%) had not been classified and remained at risk for undiagnosed hypertension.
  
  
  CONCLUSIONS
  Our technology-based innovation identified a large number of patients at risk for undiagnosed hypertension and successfully classified the majority, including many with hypertension. This innovation has been implemented as an ongoing quality improvement initiative in our medical group and continues to improve the accuracy of diagnosis of hypertension among primary care patients.
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, Illinois mrakotz@nmh.org.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Rakotz
authors.affiliation: NorthShore University HealthSystem, Evanston, Illinois Pritzker School of Medicine, The University of Chicago, Chicago, Illinois.
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Ewigman
authors.affiliation: NorthShore University HealthSystem, Evanston, Illinois Pritzker School of Medicine, The University of Chicago, Chicago, Illinois.
authors.forename: Menaka
authors.initials: M
authors.lastname: Sarav
authors.affiliation: NorthShore University HealthSystem, Evanston, Illinois Pritzker School of Medicine, The University of Chicago, Chicago, Illinois.
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Ross
authors.affiliation: NorthShore University HealthSystem, Evanston, Illinois Pritzker School of Medicine, The University of Chicago, Chicago, Illinois.
authors.forename: Ari
authors.initials: A
authors.lastname: Robicsek
authors.affiliation: NorthShore University HealthSystem, Evanston, Illinois.
authors.forename: Chad W
authors.initials: CW
authors.lastname: Konchak
authors.affiliation: College of Medicine, University of Illinois, Chicago, Illinois.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Gavagan
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: David W
authors.initials: DW
authors.lastname: Baker
authors.affiliation: Baylor College of Medicine, Baylor University, Houston, Texas.
authors.forename: David J
authors.initials: DJ
authors.lastname: Hyman
authors.affiliation: NorthShore University HealthSystem, Evanston, Illinois Pritzker School of Medicine, The University of Chicago, Chicago, Illinois.
authors.forename: Kenneth P
authors.initials: KP
authors.lastname: Anderson
authors.affiliation: NorthShore University HealthSystem, Evanston, Illinois Pritzker School of Medicine, The University of Chicago, Chicago, Illinois.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Masi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination / Q000379:methods; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D058996:Quality Improvement; D055815:Young Adult
keywords: diagnosis; electronic health records; hypertension; informatics; methods