Connecting Rheumatology Patients to Primary Care for High Blood Pressure: Specialty Clinic Protocol Improves Follow-up and Population Blood Pressures.
Connecting Rheumatology Patients to Primary Care for High Blood Pressure: Specialty Clinic Protocol Improves Follow-up and Population Blood Pressures.
复制标题
DOI：
10.1002/acr.23612
复制
发表时间：
2019-04
影响因子：
4.7
通讯作者：
McBride PE
中科院分区：
文献类型：
--
作者：
Bartels CM;Ramly E;Johnson HM;Lauver DR;Panyard DJ;Li Z;Sampene E;Lewicki K;McBride PE
认识到高血压（BP）是风湿病患者和所有成年人中最普遍的心血管危险因素，专家建议临床方案以改善BP控制。我们的目的是调整和实施一个专业的诊所协议，BP连接，以改善及时的初级保健随访后，高血压在风湿病诊所。我们在三个学术风湿病诊所进行了为期6个月的准实验设计和24个月的随访，对BP Connect进行了检查。医疗助理和护士接受培训，以（1）检查，重新测量BP ≥140/90，（2）建议，将风湿性和心血管疾病联系起来，（3）使用协议电子健康记录（EHR）订单连接，及时（<4周）进行初级保健随访。我们使用EHR数据和多变量logistic回归来检查网络内初级保健患者及时进行初级保健随访的主要结局。工作人员调查评估了看法。中断时间序列分析检查了可持续性和临床人群BP趋势。在4，683例实施前和689例实施后高血压的风湿病就诊中，2，789例（57%）有资格接受网络内初级保健随访。实施后，及时进行初级保健BP随访的几率增加了一倍（OR 2.0，95% CI 1.4-2.9）。中位随访时间从71天降至38天。此外，24个月内，高血压患者的血液流变学就诊率从17%下降到8%，表明人群水平显著下降（p<0.01）。在风湿病诊所实施BP Connect专科诊所方案改善了及时随访，并降低了人群水平的高血压率。调查结果强调了一个及时的战略，以改善BP后续行动中的新的指导方针和质量措施。
Recognizing high blood pressure (BP) as the most prevalent cardiovascular risk factor in rheumatology patients and all adults, experts recommend clinic protocols to improve BP control. We aimed to adapt and implement a specialty clinic protocol, BP Connect, to improve timely primary care follow-up after high BPs in rheumatology clinics. We examined BP Connect in a six-month pre- post- quasi-experimental design with 24-month follow-up in three academic rheumatology clinics. Medical assistants and nurses were trained to (1) check, re-measuring BPs ≥140/90, (2) advise, linking rheumatic and cardiovascular diseases, and (3) connect, timely (<4 weeks) primary care follow-up using protocolled electronic health record (EHR) orders. We used EHR data and multivariable logistic regression to examine the primary outcome of timely primary care follow-up for patients with in-network primary care. Staff surveys assessed perceptions. Interrupted time-series analysis examined sustainability and clinic population BP trends. Across both 4,683 pre-implementation and 689 post-implementation rheumatology visits with high BP, 2,789 (57%) were eligible for in-network primary care follow-up. Post-implementation, the odds of timely primary care BP follow-up doubled (OR 2.0, 95% CI 1.4–2.9). Median time to follow-up declined from 71 to 38 days. Moreover, rheumatology visits with high BP declined from 17% to 8% over 24-months, suggesting significant population-level declines (p<0.01). Implementing the BP Connect specialty clinic protocol in rheumatology clinics improved timely follow-up and demonstrated reduced population-level high BP rates. Findings highlight a timely strategy to improve BP follow-up amid new guidelines and quality measures.
登录
查看更多内容
影响因子：
5.5
作者：
Glasgow, RE;Nelson, CC;King, DK
通讯作者：
King, DK
DOI：
10.1177/106286069901400607
发表时间：
1999-11-01
期刊：
American journal of medical quality : the official journal of the American College of Medical Quality
影响因子：
--
作者：
Hebert, P L;Geiss, L S;McBean, A M
通讯作者：
McBean, A M
影响因子：
5.5
作者：
Farley, Thomas A.;Dalal, Mehul A.;Frieden, Thomas R.
通讯作者：
Frieden, Thomas R.
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
影响因子：
120.7
作者：
MacLean, CH;Louie, R;Shekelle, PG
通讯作者：
Shekelle, PG