title: Documentation and treatment of hypertension: quality of care and missed opportunities in a family medicine resident clinic.
abstract: BACKGROUND
  In the USA, uncontrolled hypertension contributes to 1000 deaths a day. However, little is known about the quality of hypertension management in family medicine resident clinics.
  
  
  OBJECTIVE
  To examine rates of documentation and treatment of elevated blood pressure, and to identify missed opportunities to address hypertension. Study design A cross-sectional chart review of 1011 adult patient visits between 2 January and 4 February 2013 was performed in a resident-run federally qualified health centre. For patients with elevated blood pressure at time of visit, we noted whether or not the residents had documented a diagnosis or discussion of hypertension and the presence or absence of a treatment plan. We compared these rates with those from a national sample of primary care physicians.
  
  
  RESULTS
  262/1011 (26%) of adult patients had elevated blood pressure at time of visit. Of those, 115/262 (44%) had documentation and a plan for treatment, 79/262 (30%) had documentation but no plan, and 68/262 (26%) had neither documentation nor plan. Nationally, 45% of patients are diagnosed and treated compared with 44% of study visits with documentation and treatment.
  
  
  CONCLUSIONS
  Fewer than half of visits of patients with elevated blood pressure resulted in both documentation and a treatment plan. Nevertheless, these rates are comparable to national providers. Elevated blood pressure was more likely to be missed during acute visits and in patients with less elevated blood pressure.
authors.affiliation: Wayne State University School of Medicine, Detroit, Michigan, USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: So
authors.affiliation: Division of General Medical Disciplines, Department of Medicine, Center for Education and Research in Family and Community Medicine, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Steven Y
authors.initials: SY
authors.lastname: Lin
mesh_terms: D000554:Ambulatory Care Facilities; D001795:Blood Pressure Determination; D002140:California / Q000453:epidemiology; D003430:Cross-Sectional Studies; D037001:Directive Counseling; D004282:Documentation; D005194:Family Practice / Q000592:standards; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D010353:Patient Education as Topic; D058996:Quality Improvement / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards
keywords: MEDICAL EDUCATION & TRAINING; PRIMARY CARE