Specialty Clinic Protocol Improves Timely Primary Care Follow-up After High Blood Pressures
Gap in Specialty Care
Despite routinely recording high blood pressures (BP) during 423 million annual US specialty visits, follow-up is recommended in just one in ten specialty visits. This may be more harmful than not screening BP at all.
Click here to access the BP Connect video to see how medical assistant and nursing protocols can close gaps in minutes.
BP often overlooked in specialty visits. For example, in rheumatology visits where a blood pressure of ≥160/100 was taken, blood pressure was not discussed/documented in two-thirds of the visits, and only 1 in 10 received any advice to follow-up for high blood pressure.
US specialists outnumber primary care physicians, so specialty clinics have a key opportunity to improve cardiovascular prevention for patients most at risk.
How was it developed?
The BP Connect clinic protocol was developed by a multidisciplinary team at three rheumatology clinics at a large academic health system. We conducted a participatory work system redesign to develop the protocol using focus group sessions with staff medical assistants (MAs) and nurses to (a) assess current processes and needs, and (b) develop a streamlined electronic health record-based blood pressure alert and referral process. Diverse community partners have supported this process.
Does it work?
BP Connect implementation DOUBLED timely primary care follow-up after specialty visits with high blood pressures.
Additionally, in the BP Connect pilot study, the protocol increased blood pressure re-measurement from 2% to over 75% and staff orders for primary care follow-up improved from 0% to 76% averaged over the 6-month pilot, with a peak of >90% near the completion of the study.
Staff members who said that they were very or extremely confident in dealing with high blood pressure increased from 20% to 90%. Population rates of high BP visits also declined.
About the BP Connect Toolkit
Our free downloadable toolkit contains the following materials:
- BP Connect Manual
- Overview Slides on the Intervention
- EHR Build Guide
- Training Slides for Staff
- Training Handouts for Staff
- Medical Assistant/Nurse Instructions
- Scheduler Instructions
- Patient Brochure
- Time-study Observation Tool
Link to BP Toolkit: https://www.hipxchange.org/BPConnectHealth