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Abstract Number: 0643

Tailored BP Connect Protocol with Implementation Support for Rheumatology Clinic Staff Exceeds Non-tailored Protocol at Improving Primary Care Referrals for Blood Pressure Follow-up

David Gazeley1, Monica Messina2, Edmond Ramly2, Ann Rosenthal1, Laurie Lapp2, Laura Stewart3 and Christie Bartels2, 1Medical College of Wisconsin, Milwaukee, WI, 2University of Wisconsin School of Medicine and Public Health, Madison, WI, 3Froedtert & Medical College of Wisconsin, Milwaukee, WI

Meeting: ACR Convergence 2021

Keywords: Cardiovascular, comparative effectiveness, Health Services Research, quality of care, risk factors

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Session Information

Date: Sunday, November 7, 2021

Session Title: Measures & Measurement of Healthcare Quality Poster (0623–0659)

Session Type: Poster Session B

Session Time: 8:30AM-10:30AM

Background/Purpose: Many rheumatic diseases increase risk of cardiovascular disease, yet an important modifiable cardiovascular risk factor, high blood pressure (BP), often remains unaddressed during rheumatology visits. BP follow-up and control are also ACR quality measures. Some clinics have hypertension (HTN) protocols for clinic staff, however, various factors related to time constraints, technology limits, and specialty clinic staff buy-in, threaten uptake and sustainability. Our objective was to implement a tailored EHR-supported specialty clinic staff HTN protocol to empower clinic staff to confirm high BP and connect patients through follow-up orders or direct scheduling with primary care to address high BP.

Methods: We engaged 2 groups of medical assistants at urban (Site 1) and suburban (Site 2) academic rheumatology clinics to participate in the ‘BP Connect’ protocol to compare effectiveness vs a prior institutional HTN protocol (Fig 1). Site 1 staff participated in a pre-intervention tailoring focus group and then monthly group audit-feedback on performance; Site 2 staff completed a pre-intervention tailoring checklist and monthly individual audit-feedback. EHR alerts instructed staff to re-measure BP if ≥ 140/90 and triggered education and offered scheduling of primary care follow-up if 2nd BP ≥ 140/90. Both groups received 1-hour education on HTN, cardiovascular risk in rheumatology, and hands-on BP measurement training and talking point practice. Using EHR data, we assessed how often staff re-measured high BPs, and if primary care follow-up was offered or accepted. The first 2 and last 2 months of the institutional process (protocol duration > 3 yrs) were compared to the 2 month BP Connect intervention period to report rate ratios (RR) and 95% CI’s.

Results: We compared 269 BP Connect eligible intervention period visits with BPs ≥ 140/90 to 310-322 baseline visits at Site 1, and 27 intervention period visits to 15-37 baseline visits at Site 2 (Table 1). Baseline versus BP Connect period BP re-measurement rates at Site 1 ranged from 56-79% vs 74%. At Site 2, re-measurement rose from 20-81% baseline to 96% with BP Connect. After confirmed high BP, primary care referral offer rates rose at both sites. Site 1 increased from 22-37% to 68%, and at Site 2 offers increased from 50-67% to 100%. Across both sites, offered (RR 1.74 [1.41, 2.17]) and accepted primary care follow-up visits increased (RR 2.00 [1.21, 3.31]) in the BP Connect period even post-COVID.

Conclusion: A tailored rheumatology clinic staff intervention at sub/urban academic rheumatology clinics improved frequency of BP re-measurement, offers, and accepted primary care follow-up beyond an untailored HTN protocol. It appears staff engagement with checklist tailoring was similar to a focus group (Site 2 vs. 1). Overall, BP Connect’s engagement, participatory education, and audit-feedback, components absent from the institutional protocol, appeared to improve performance. A trend suggests individual vs group audit-feedback may be more effective at improving performance which could inform future dissemination studies. BP Connect’s tailored implementation improved rheumatology staff performance to connect primary care follow-up of high blood pressures.

Figure 1: Comparison of protocol components for BP workflow implementation.

Table 1. Process and outcomes of BP Connect vs institutional (inst.) HTN protocol.


Disclosures: D. Gazeley, None; M. Messina, None; E. Ramly, None; A. Rosenthal, None; L. Lapp, None; L. Stewart, None; C. Bartels, Pfizer, Independent Grants for Learning and Change, 5.

To cite this abstract in AMA style:

Gazeley D, Messina M, Ramly E, Rosenthal A, Lapp L, Stewart L, Bartels C. Tailored BP Connect Protocol with Implementation Support for Rheumatology Clinic Staff Exceeds Non-tailored Protocol at Improving Primary Care Referrals for Blood Pressure Follow-up [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/tailored-bp-connect-protocol-with-implementation-support-for-rheumatology-clinic-staff-exceeds-non-tailored-protocol-at-improving-primary-care-referrals-for-blood-pressure-follow-up/. Accessed January 30, 2023.
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