Leveraging Patient-Entered Flowsheets to Effectively Capture Home Blood Pressure Readings and Improve Blood Pressure Management

Controlling high blood pressure (BP) is important due to its impact on cardiovascular and renal health. A joint policy statement from the American Heart Association and American Medical Association established self-measured BP as a cost-effective way to manage hypertension (HTN). The literature states self-measured BP can diagnose white coat HTN, reflect a response to antihypertensive therapy, and potentially improve patient adherence to therapy. A large percentage of patients self-monitor, but barriers exist to the use of patient’s readings in the healthcare setting including lack of institutional infrastructure, providers fearing increased electronic or phone communications if home BP measurements are encouraged, and patients thinking their provider doesn't care about their self-measured results.

This project successfully developed a standardized approach to incorporate self-measured BP readings into the medical record, which yielded usable data for patient care and quality metrics. The preferred workflow utilized a patient-entered flowsheet (PEF) where patients electronically entered their self-measured BP readings. Nurses and providers collaborated to provide feedback on this tool and identified improvements needed to meet the clinic’s needs.

Evaluation of the PEF project yielded positive results and highlighted its potential to capture home BP readings, improve blood pressure management, and enhance patient involvement in health care. Utilization of home BP readings is not a new practice, but the PEF standardized the documentation and utilization of them.

Overall, 51% of patients who agreed to use the PEF, entered their data. This is comparable to the 52% of patients who follow through with a future nurse visit for BP recheck when ordered. Of those that entered data, 51% of those patients had a BP that was in range by the end of the 2-month pilot period, which contributed to a commendable average increase of 3.67% in the controlling high BP metric for the team. Utilization of the PEF led to a 24% reduction in nurse visits for BP rechecks, which opened access to other types of nurse visits and emphasized the PEF’s effectiveness in providing patients with a more convenient way to manage their health.

The project highlighted that patients were more likely to engage in the PEF when it was discussed during a provider visit, compared to receiving only a portal message, and emphasized the importance of provider-patient communication in promoting engagement. To address initial patient engagement challenges, the development and introduction of patient education materials, delivered electronically or in-person, played a pivotal role in increasing patient understanding and participation. Outcomes demonstrated the success of the PEF in promoting patient engagement, improving BP control, and streamlining healthcare processes. The positive results from this pilot supported the broader implementation of PEF for home BP readings throughout our clinics and paved the way for enhanced patient-centered care.