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Innovations in Care

Quality Improvement Initiatives Improve Hypertension Care Among Veterans

Neesha N. Choma, MD; Robert L. Huang, MD, MPH; Robert S. Dittus, MD, MPH; Kathy E. Burnham, RN, MA, BSN and Christianne L. Roumie, MD, MPH

From the Veterans Affairs–Tennessee Valley Healthcare System (VA-TVHS) (N.N.C., R.L.H., R.S.D., C.L.R.), Tennessee Valley Geriatric Research Education Clinical Center (GRECC); HSR&D Targeted Research Enhancement Program Center for Patient Healthcare Behavior (N.N.C., R.L.H., R.S.D., C.L.R.); VA National Quality Scholars Fellowship Program (N.N.C., R.L.H., R.S.D.); VA-TVHS (K.E.B.), Quality Management Service; VA Tennessee Valley Clinical Research Training Center of Excellence (CRCoE) (C.L.R.); and the Department of Medicine (N.N.C., R.L.H., R.S.D., C.L.R.), Vanderbilt University Medical Center, Nashville, Tenn.

Correspondence to Christianne L. Roumie, MD, MPH, Nashville VA Medical Center, 1310 24th Ave S GRECC, Nashville TN 37212. E-mail christianne.roumie{at}vanderbilt.edu

Received February 9, 2009; accepted April 7, 2009.

Background— We implemented a quality improvement initiative to improve hypertension care at Veterans Affairs–Tennessee Valley Healthcare System.

Methods and 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 (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.

Key Words: hypertension • quality of healthcare • outcome assessment • guideline adherence

The online-only Data Supplement is available at http://circoutcomes.ahajournals.org/cgi/content/full/10.1161/CIRCOUTCOMES.109.862714/DC1.

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