Using electronic health record to drive quality improvement in blood pressure control and other million hearts measures for disparate populations

INTRODUCTION: As part of CDC's Community Transformation Grant program, the Massachusetts Department of Public Health (MDPH) entered into a partnership with the Massachusetts League (League) of Community Health Centers (CHC) to increase preventive care in primary care settings. By adopting a quality improvement (QI) strategy, we promoted positive change in national Million HeartsTM ABCS measures (ABCS: Aspirin, Blood Pressure, Cholesterol, and Smoking). METHODS: Each quarter, the League transfers encounter-level electronic health records data (EHR) to MDPH which includes every adult medical encounter from participating CHCs. Using this data, feedback reports are created with input from the QI coach that focus on ABCS measures for individual providers and teams. Data on race/ethnicity and preferred language is used to identify areas for improvement especially for disparate populations. RESULTS: With each new data set, we evaluate change in the baseline ABCS measures for each center participating in the CTG QI initiative. For hypertension, the analysis focuses on tracking the number of patients with hypertension under control (<140/90 mmHg). Initial analyses indicate significant “blind spots” in the delivery of preventive care to specific disparity populations. In particular Hispanic, black non-Hispanic, and Asian patients with hypertension were less likely to have their blood pressure under control at their last visit compared to white patients (p<0.01). DISCUSSION: EHR data can be used to drive change at the provider-level through the creation of individualized and team feedback reports. QI coaches working in conjunction with MDPH and providers ensure that reports reflect the concerns of care teams. EHR data that can be customized for in-depth data exploration can support quality improvement efforts in primary care settings. In the long-term, feedback reports will focus on improved health outcomes.