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Evaluation of an Email Blood Pressure Measurement Outreach Program
Beverly B Green1,2, Laurel D Hansell1, Clarissa W Hsu1
1Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States.
Insights
A healthcare outreach program improved blood pressure (BP) follow-up for hypertension patients. However, disparities in home BP monitoring use persist, highlighting needs for enhanced patient engagement and education.
Area of Science:
- Cardiovascular Health
- Health Informatics
- Health Services Research
Background:
- Hypertension management often lacks adequate follow-up for patients with uncontrolled blood pressure.
- A mixed-methods evaluation was conducted on a healthcare system's email and secure message outreach program to enhance blood pressure (BP) follow-up.
Purpose of the Study:
- To evaluate the effectiveness of a digital outreach program in improving BP follow-up rates.
- To identify patient characteristics associated with program reach and BP measurement types (home vs. clinic).
- To understand patient experiences and identify areas for improvement in BP outreach.
Main Methods:
- A cohort of patients with hypertension and uncontrolled BP received secure messages prompting for home BP measurement (HBPM) or clinic BP checks.
- Program reach was assessed by BP recording in the electronic health record (EHR) within 3 months.
- Qualitative data from 22 patient interviews and Rapid Group Analysis explored patient experiences.
Main Results:
- Over half (53.8%) of contacted patients had a BP recorded in the EHR within 3 months.
- Follow-up rates were lower among younger, male, Asian, Black, and Hispanic patients.
- Home BP measurements were less common (18.9%) than clinic-based ones (81.1%), with Black patients showing the lowest HBPM use (9.9%). Home BP readings were more likely to be below 140/90 mmHg.
Conclusions:
- The outreach program successfully increased follow-up BP recordings for over half of patients.
- Significant disparities exist in home BP monitoring use, particularly among minority groups.
- Patient interviews indicated a need for improved patient education on BP measurement, targets, and feedback mechanisms.
Background:
People with hypertension and uncontrolled blood pressure (BP) at their last clinic visit often do not receive follow-up care. We performed a mixed methods evaluation of a healthcare system email and secure message outreach program to improve BP follow-up.
Methods:
In July of 2022, patients with hypertension and high BP at their last clinical encounter were sent secure messages asking them to reply with a home BP measurement (HBPM) or have an in-clinic BP check. We assessed the "reach of the program" defined as the proportion and characteristics of patients with versus without a BP in the electronic health record (EHR) within 3 months; and the proportion and characteristics of patients with HBPM versus clinic BPs. Qualitative assessments included 22 patient interviews and Rapid Group Analysis to understand patient experiences with the BP outreach program.
Results:
Of 6489 patients contacted by email, 3489 (53.8%) patients had a BP recorded in the EHR within 3 months. Follow up rates were lower rates among younger, male, Asian, Black, and Hispanic patients. Most measurements were clinic-based (81.1%) versus home (18.9%), with Black patients having the lowest HBPM use (9.9%). Home BP measurements were more likely to be <140/90 mm Hg than clinic BPs (adjusted relative risk 1.39, 95% confidence interval, 1.29-1.49). Interview themes highlighted patients wanting more information on BP measurement, targets, and feedback after sending HBPM.
Conclusions:
Outreach was associated with over half of patients having follow-up BPs, with disparities in HBPM use. Patient interviews revealed opportunities to enhance patient engagement in HBPM.
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