Disparities in Hypertension Control Across and Within Three Health Systems Participating in a Data-Sharing Collaborative

Abstract

Introduction: We aimed to standardize data collection from 3 health systems (HS1, HS2, HS3) participating in the San Francisco Bay Collaborative Research Network, and compare rates and predictors of uncontrolled blood pressure among hypertensive adults to identify opportunities for regional collaboration in quality improvement. Methods: Retrospective cohort study using deidentified electronic health record data from all primary care patients with at least 1 visit in a 2-year period, using standard data definitions in a common data repository. Primary outcome was uncontrolled blood pressure at the most recent primary care visit. Results: Of 169,793 adults aged 18 to 85 years, 53,133 (31.3%) had a diagnosis of hypertension. Of these, 18,751 (35%) had uncontrolled blood pressure at their last visit, with the proportion varying by system (29%, HS1; 31%, HS2; and 44%, HS3) and by clinical site within each system. In multivariate analyses, differences between health systems persisted, with HS2 and HS3 patients having a 1.15 times (95% CI, 1.11 to 1.19) and 1.46 times (95% CI, 1.42 to 1.50) greater relative risk of uncontrolled blood pressure compared with HS1. Across health systems, hypertensive patients were more likely to have uncontrolled blood pressure if they were uninsured, African Americans, current smokers, obese, or had fewer than 2 primary care visits during the 2-year measurement period. Conclusions: After controlling for standard individual predictors of hypertension control, significant and substantial differences in hypertension control persisted between health systems, possibly due to local quality improvement programs among other factors. There may be opportunities to share best practices and address common disparities across health systems.

Practice-based Research Network (PBRN) Engagement: 20+ Years and Counting

“…The articles in this 2018 JABFM theme issue highlight that practice-based research is alive and well; however, we are concerned about the state of PBRNs. In this issue, only 4 articles report PBRN research 23,25,40,42 and the others report non-PBRN practice-based research. So, how important are PBRNs to practice-based research?…”

“…Obtaining analyzable data from different EMRs is a huge barrier, especially if there are different vendors, but it remains a priority with PBRNs. Selby et al 40 were able to compare hypertension control data by using a common data repository from 3 different health systems with 2 different EMRs, a laudable accomplishment. They compared risk for uncontrolled hypertension between and within health systems, which can inform future QI interventions.…”

Long-term Outcomes of a 1-year Hypertension Quality Improvement Initiative in a Large Health System

“…Site-specific characteristics, such as the inclination to intensify medication, were related to the site’s levels of BP control. An analysis of 3 health systems participating in the San Francisco Bay Collaborative Research found the percentage of patients in control varied by as much as 32% across sites 30. A study in Great Britain identified that smaller practice size was associated with uncontrolled BP; however, much of the variation was uncharacterized 31.…”

Differences in Hypertension Medication Prescribing for Black Americans and Their Association with Hypertension Outcomes

“…Further details on our methods to define our research cohorts and extract/clean/link data from the EHR data can be found in an earlier publication. 25 The Institutional Review Board approved the study at the University of California, San Francisco, with a waiver for informed consent.…”