Assessing Gaps in Blood Pressure Control: Results from a Quality Improvement Program Implemented at Cook County Health

BACKGROUND: This study assessed differences in blood pressure control rates and systolic blood pressure (SBP) values at Cook County Health (CCH) implementing the AMA MAP™ Hypertension quality improvement program, with the goal of identifying variations across demographic subgroups including race, ethnicity, sex and age. METHODS: We conducted a retrospective cohort study at CCH, comparing a 2-year historical pre-intervention with a subsequent 2-year period encompassing implementation and post implementation. Within each demographic subgroup, control rates were calculated as proportion of patients with controlled blood pressure. Univariate analyses assessed changes in blood pressure (BP) control over time. Prevalence ratio estimates were calculated to understand likelihood of having controlled blood pressure. Paired t-tests evaluated within-group changes in SBP, and an ANCOVA was conducted to compare SBP changes between groups while adjusting for baseline SBP. RESULTS: Overall, blood pressure control rates increased over time. However, Black patients were less likely than White patients to have controlled blood pressure both before (PR 0.91 [CI: 0.87-0.96]) and after (PR 0.96 [0.92-0.99]) the implementation of the program. SBP improved across all demographic groups, including Hispanic (-5.74 [CI:6.19- -5.29]) and Non-Hispanic patients (-4.92 [-5.21- -4.63]), White (-5.96 [CI: -6.45- -5.47]) and Black (-4.80 [CI: -5.11- -4.49]) patients, and patients 45-64 years of age (-5.79 [CI: -6.12- -5.46]) and patients 65-85 years of age (-4.31 [CI: -4.68- -3.94]). CONCLUSIONS: The AMA MAP™ Hypertension quality improvement program led to improvements in blood pressure control; however, gaps persisted in SBP values between ethnicity, race and age.