A QI Approach to Lower Hypertension and Elevate Care in an Internal Medicine Residency Community Clinic

Hypertension affects nearly 47% of people in the United States, and it is a leading cause of cardiovascular disease. In our residency clinic, 39% of patients had uncontrolled hypertension (blood pressure ≥140/90 mm Hg) as of June 2024, with an even higher proportion above goal using American College of Cardiology/American Heart Association criteria (<130/80 mm Hg).

We aimed to reduce uncontrolled hypertension by 5% over 12 months through clinic-wide process improvements and education-focused interventions.

A random sample analysis and 3 Plan-Do-Study-Act cycles were implemented. Cycle 1 standardized the follow-up visit time frame to within 6 weeks for patients with 2 elevated office blood pressure readings. Cycle 2 addressed staff training and process standardization in blood pressure measurement. Cycle 3 introduced nurse-led patient education sessions. Staff surveys showed improved knowledge, and leadership observations reinforced adherence. Ten patient education sessions were completed during the initial rollout.

A 9% reduction in uncontrolled hypertension at 12 months and an 11% reduction at 14 months was achieved through simple workflow modifications and targeted patient education.