Undiagnosed hypertension in rural healthcare

Abstract

Hypertension is a disease that affects numerous people worldwide. It often goes undiagnosed, causing an increased risk of cardiovascular events. This project aimed to reduce the number of patients with undiagnosed hypertension within the observed population. This project occurred within a network of clinics associated with a 25-bed critical access hospital in rural Western Montana. Participants included clinic staff, physicians, nurse practitioners, physician assistants, registered nurses, licensed practical nurses, medical assistants, and a licensed clinical social worker. The Plan-Do-Check-Act was used as the framework for this quality improvement (QI) project. Hypertension was defined using the 2017 American College of Cardiology and American Heart Association Clinical Practice Guidelines. The Electronic Medical Record system was used to identify out-of-range blood pressures in the last 2 years and add these patients to a registry. Clinical personnel performed chart reviews to eliminate patients who did not meet the criteria defined by the stakeholders. EHR message functionality alerted providers offering to schedule patients for an office visit to rule in or out hypertension. The identified patients were contacted by a licensed clinical social worker and invited to schedule an appointment with a provider to address the possibility of undiagnosed hypertension. The final numbers were assessed 6 weeks after the undiagnosed hypertension project implementation. The multistep PDCA process resulted in a significant reduction in the overall number of potentially undiagnosed hypertensive patients. The initial data collection produced 3,617 patients between the ages of 18 and 85, and the last revealed only 1,210 patients that met the criteria. The most significant decrease in number was seen in the 56-65 age group, dropping from 700 to 188 patients. This quality improvement project aimed to identify potentially undiagnosed hypertensive patients and establish a system to assess those patients by a provider. This project accomplished that objective. This quality improvement project was structured on innovative research, a trusted conceptual framework, and current practice guidelines. If the quality improvement team were to extend this project, the next step would be implementing clinical practice guidelines and monitoring hypertension outcomes within the patient population.