Factors Associated With Evidence of Self-Measured Blood Pressure Adoption in an Urban Safety-Net Health System

Uncontrolled hypertension is a leading cause of preventable cardiovascular mortality. Although self-measured blood pressure (SMBP) monitoring is recommended by evidence-based guidelines, adoption remains uneven in safety-net health systems. We conducted a cross-sectional analysis in an urban safety-net health system to assess factors associated with documented SMBP adoption. Using electronic health record (EHR) data from patients included in a safety-net health system's hypertension registry, we defined documented SMBP adoption as documentation of at least one patient-reported value in the EHR. We evaluated factors associated with documented SMBP adoption using sequential multivariable logistic regression and hierarchical modeling to estimate patient-, provider-, and clinic-level variation. We analyzed 15 937 patients cared for by 283 providers across 12 clinics. Twenty-six percent (4186) of patients had documented SMBP adoption. In the full model, patients aged 75 years and older [vs. 18-34 years old] (aOR 2.37, 95% CI 1.62-3.55) and those with an activated patient portal (aOR 1.36, 95% CI 1.25-1.49) were more likely to have documented SMBP adoption, while patients experiencing homelessness (aOR 0.72, 95% CI 0.60-0.87) were less likely. Substantial variation in documented SMBP adoption was observed across clinics. In the hierarchical model, 75% of the variance in documented SMBP adoption was attributable to patient-level factors, 19% to clinics, and 6% to providers. Given that nearly one-quarter of the variation in documented SMBP adoption was attributable to nonpatient factors, clinic- and provider-level workflows may be modifiable targets to improve equitable uptake and documentation of SMBP monitoring in safety-net health systems.