Reducing Clinical Inertia in Hypertension Treatment: A Pragmatic Trial

Health Promotion Outreach To Overcome Clinical Inertia In The Treatment Of Patients With Poorly-Controlled Hypertension

The goal of this project is to use health information technology and team-based care in novel ways to support the establishment of a Patient-Centered Medical Home model of care aimed at improving the diagnosis and management of hypertension. Compared with patients who receive usual care, patients who receive intervention will have a lower average systolic blood pressure 9 months after randomization.

Inclusion Criteria:

• Adult men and women age 18-79
• At least 2 Blood Pressure readings from separate days on record
• Average of last 3 Blood Pressure readings (or last 2 if only 2 available) with (Systolic Blood Pressure ≥140 or Diastolic Blood Pressure ≥90) and (last Systolic Blood Pressure ≥135 or last Diastolic Blood Pressure ≥85), recorded by any University of Colorado Hospital clinic within the last 18 months
• No clinic visit in the past month
• At least one Primary Care Physician visit in the past 18 months
• First Primary Care Physician visit at least 6 months in the past

Exclusion Criteria:

• Serious comorbidities, including active cancer diagnosis, hospice care, nursing home residence
• Diagnosis of diabetes (these patients are enrolled in a separate study that also targets Blood Pressure control)
• End-stage renal disease / hemodialysis
• Primary Care Physician appointment pending
• Patient instructed to monitor Blood Pressure at home / documentation of white coat hypertension
• Blood Pressure managed by specialist or outside provider