Improving Documentation and Follow-Up of Elevated Blood Pressure in a Family Clinic: A Quality Improvement Project

Introduction Hypertension is a common and clinically significant condition frequently encountered in primary care. However, challenges such as poor documentation and inconsistent follow-up planning in many outpatient settings can result in suboptimal outcomes, increasing the risk of missed care opportunities. This quality improvement project aimed at improving documentation and follow-up planning for patients with elevated blood pressure (BP) (>140/90 mmHg) at a family clinic in Michigan. Objective This quality improvement project is aimed at improving documentation and follow-up planning for elevated BP readings in adult patients seen during outpatient visits from 33% to 70% over a three-week period in a family medicine clinic. Methods The project was conducted at an outpatient family medicine clinic over a three-week period from June 9 to June 27. Adult patients aged 18 years and older with elevated BP were included, and a total of 60 patient charts were reviewed during the intervention period. The intervention consisted of a daily review of patient charts to identify elevated BP, ensuring that follow-up plans such as home BP monitoring, repeat BP checks, and lifestyle modification advice were documented in the electronic health record (EHR). Patients with elevated readings also received verbal counseling, and brief end-of-day team huddles were conducted to review documentation, and early in the cycle, brief staff education sessions were held to review the documentation standards. Data were collected through both EHR review and manual chart audits. A Plan-Do-Study-Act (PDSA) cycle was used to implement and evaluate the intervention. Results At baseline, only 33% (20 out of 60) of the patients with elevated BP had appropriate documentation and follow-up plan in the EHR. Following the three-week intervention, this increased to 80% (48 out of 60), surpassing the initial target of 70%. The documentation improvement was achieved using the iterative PDSA cycle approach, with adjustments made weekly to reinforce chart review, counselling, and end-of-day team huddles. Conclusion This quality improvement cycle led to a significant improvement in the documentation and follow-up plans, highlighting its importance in better management of hypertension. The intervention has been sustained in the daily clinic practice, with minor adjustments made to support long-term sustainability. This may also serve as a model for similar clinic-based quality improvement efforts.