RT Journal Article
SR Electronic
T1 Disparities in Hypertension Control Across and Within Three Health Systems Participating in a Data-Sharing Collaborative
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 897
OP 904
DO 10.3122/jabfm.2018.06.180166
VO 31
IS 6
A1 Selby, Kevin
A1 Michel, Martha
A1 Gildengorin, Ginny
A1 Karliner, Leah
A1 Pramanik, Rajiv
A1 Fontil, Valy
A1 Potter, Michael B.
YR 2018
UL http://www.jabfm.org/content/31/6/897.abstract
AB Introduction: We aimed to standardize data collection from 3 health systems (HS1, HS2, HS3) participating in the San Francisco Bay Collaborative Research Network, and compare rates and predictors of uncontrolled blood pressure among hypertensive adults to identify opportunities for regional collaboration in quality improvement.Methods: Retrospective cohort study using deidentified electronic health record data from all primary care patients with at least 1 visit in a 2-year period, using standard data definitions in a common data repository. Primary outcome was uncontrolled blood pressure at the most recent primary care visit.Results: Of 169,793 adults aged 18 to 85 years, 53,133 (31.3%) had a diagnosis of hypertension. Of these, 18,751 (35%) had uncontrolled blood pressure at their last visit, with the proportion varying by system (29%, HS1; 31%, HS2; and 44%, HS3) and by clinical site within each system. In multivariate analyses, differences between health systems persisted, with HS2 and HS3 patients having a 1.15 times (95% CI, 1.11 to 1.19) and 1.46 times (95% CI, 1.42 to 1.50) greater relative risk of uncontrolled blood pressure compared with HS1. Across health systems, hypertensive patients were more likely to have uncontrolled blood pressure if they were uninsured, African Americans, current smokers, obese, or had fewer than 2 primary care visits during the 2-year measurement period.Conclusions: After controlling for standard individual predictors of hypertension control, significant and substantial differences in hypertension control persisted between health systems, possibly due to local quality improvement programs among other factors. There may be opportunities to share best practices and address common disparities across health systems.