Addressing Health Disparities in HTN Management Using a QI Process

Introduction: Hypertension has been identified as the most common medical diagnosis in the US and individuals with social, economic, and cultural factors have higher prevalence and poor control of their ability to self-manage the disease. Hypertension has also been associated with the highest risk for mortality related to cardiovascular disease. Nurse leaders partner with chronic disease teams to develop and implement evidence-based nursing interventions using telehealth to achieve positive quality outcomes. Addressing social determinants of health (SDOH), such as financial concerns and food and housing insecurities can improve overall health and well-being. Quality improvement specialists are an essential member of the team for ensuring team engagement and the use of productivity tools for data gathering and analysis and supporting planning, implementation, and sustainment processes.
Interventions: Using the plan, do, study, act methodology, the following quality improvement research project was implemented: Using the March 2023 chronic disease dashboard, two chronic disease RNs identified patients aged 40-75 years with uncontrolled hypertension (clinic blood pressure 140/90 after two PCP visits) (n=61). Using the principles of motivational interviewing, 16% of patients did not express or exhibit signs of readiness to engage in hypertension self-management, which was used as exclusion criteria (n=10). Evidence-based targeted nursing interventions were developed and implemented for the remaining patients over a 3-month period from April 2023 to June 2023 (n=51) including comprehensive patient education with use of visual resources by the American Heart Association based on preferred language and tailored to the individual patient’s needs; home B/P monitoring with log book; collaborative care planning; monthly outreach/ telehealth check-ins; screening for SDOH; and referrals for internal/external resources as indicated, including CHWs.
Results and discussion: Within a 3-month period, 76% of patients with uncontrolled hypertension reduced their clinic B/P from ≥140/90 to 130/80 (n=34). Monthly telehealth outreach/education and SDOH screening were completed in 100% of the patients (n=51). SDOH which could potentially impact the self-care management and overall well-being of patients were identified or self-reported and addressed via the provision of grant-funded home B/P machines for patients with financial needs (n=12; 24%) and referrals for resources as indicated, including to CHWs for the following: housing; food; transportation; smartphone access for care team communication via the patient portal; and educational, employment, and legal assistance (n=7; 14%).
Conclusion: This quality improvement project showed that 76% of patients with uncontrolled hypertension improved their blood pressure rates to less than or equal to 130/80. Increasing access to care using telehealth outreach services, providing individualized person-centered care, and identifying and addressing SDOH without stigma or bias as part of a standardized workflow can support patient engagement, improve self-care management, enhance the trusting patient-nurse relationship, and support quality care outcomes. Using quality improvement tools supports the development, implementation, and sustainment of best practices which can yield positive care experience results.