{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:53:54Z","timestamp":1790182434418,"version":"4.1.0"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Leveraging technology to prompt team-based care might improve ambulatory hypertension care.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess whether an electronic medical record (EMR) high blood pressure (BP) advisory improves hypertension control.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This quality improvement study assessed hypertension control in patients presenting to primary care office visits from March 2018 to February 2020. Data were included from 28 primary care clinics (8 clinics contributed data toward the primary objective and 28 contributed data toward secondary objectives) in a single academic health system in California before and after intervention and concurrent care team observations and interviews assessing implementation. Data were analyzed from November 2019 to October 2020.<\/jats:p><\/jats:sec>Intervention<\/jats:title>An EMR high BP advisory combined with team training, audit, and feedback. EMR entry of elevated BP (systolic BP \u2265140 mm Hg or diastolic BP \u226590 mm Hg) prompted an interruptive medical assistant\u2013facing advisory to recheck BP. Persistently elevated BP prompted a second interruptive clinician-facing advisory with order panel link.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was BP lower than 140 mm Hg systolic and lower than 90 mm Hg diastolic during an office visit within 6 months of an initial primary care visit. Secondary outcomes included BP recheck after initial elevated value, antihypertensive medication change, and new hypertension diagnoses. Qualitative outcomes focused on implementation barriers and facilitators.<\/jats:p><\/jats:sec>Results<\/jats:title>The primary outcome assessed 2760 control patients and 3018 intervention patients with preexisting hypertension (mean [SD] age, 66.5 [14.4] years; 2847 [49.2%] women, 1746 [30.2%] Asian, 619 [10.7%] Hispanic, and 2407 [41.7%] White). The likelihood of hypertension control increased 18.3% per month on average (odds ratio [OR], 1.18; 95% CI, 1.10-1.27; P<\/jats:italic>\u2009&amp;lt;\u2009.001) in the intervention vs control groups. Modeled rates of adjusted hypertension control over 6 months increased from 82.3% to 92.3% for the intervention cohort and decreased from 71.5% to 70.3% for the control (preintervention) cohort. BP recheck rate increased (from 37.6% to 77.9%; OR, 4.76; 95% CI, 4.45-5.10; P<\/jats:italic>\u2009&amp;lt;\u2009.001), while ordered antihypertensive medications was unchanged. New hypertension diagnosis increased from 12.1% to 20.6% (OR, 1.34; 95% CI, 1.13-1.58; P<\/jats:italic>\u2009=\u2009.01). In interviews of 34 care team members (clinicians, medical assistants, and managers) from 6 clinics, implementation barriers included competing priorities and time for BP rechecks, order panel complexity, and mixed clinician engagement; facilitators included intervention visibility, EMR integration, and team-based approach.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This quality improvement study of an EMR high BP advisory intervention found significantly improved primary care hypertension control and diagnosis due to the combination of team-based care and technology.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.7313","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T15:30:44Z","timestamp":1745595044000},"page":"e257313","source":"Crossref","is-referenced-by-count":5,"title":["Integrating a High Blood Pressure Advisory Across a Primary Care Network"],"prefix":"10.1001","volume":"8","author":[{"given":"Anuradha","family":"Phadke","sequence":"first","affiliation":[{"name":"Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingjie","family":"Weng","sequence":"additional","affiliation":[{"name":"Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cati Brown","family":"Johnson","sequence":"additional","affiliation":[{"name":"Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcy","family":"Winget","sequence":"additional","affiliation":[{"name":"Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Mahoney","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of California San Francisco, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Sharp","sequence":"additional","affiliation":[{"name":"Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia","family":"Sattler","sequence":"additional","affiliation":[{"name":"Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shreya","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manisha","family":"Desai","sequence":"additional","affiliation":[{"name":"Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley","family":"Ng","sequence":"additional","affiliation":[{"name":"University Medical Partners, Livermore, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan G.","family":"Shaw","sequence":"additional","affiliation":[{"name":"Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,4,25]]},"reference":[{"issue":"4","key":"zoi250276r1","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1038\/s41581-019-0244-2","article-title":"The global epidemiology of hypertension.","volume":"16","author":"Mills","year":"2020","journal-title":"Nat Rev Nephrol"},{"issue":"1","key":"zoi250276r2","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1038\/ajh.2011.179","article-title":"Underdiagnosis of hypertension using electronic health records.","volume":"25","author":"Banerjee","year":"2012","journal-title":"Am J Hypertens"},{"issue":"8","key":"zoi250276r3","doi-asserted-by":"publisher","first-page":"1224","DOI":"10.1007\/s11606-018-4452-4","article-title":"Patterns of systolic blood pressure control in the United States, 2016.","volume":"33","author":"Shah","year":"2018","journal-title":"J Gen Intern Med"},{"issue":"2","key":"zoi250276r5","doi-asserted-by":"publisher","first-page":"110","DOI":"10.7326\/M17-1805","article-title":"Comparative effectiveness of implementation strategies for blood pressure control in hypertensive patients: a systematic review and meta-analysis.","volume":"168","author":"Mills","year":"2018","journal-title":"Ann Intern Med"},{"issue":"3","key":"zoi250276r8","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1097\/MLR.0b013e3182408812","article-title":"Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact.","volume":"50","author":"Curran","year":"2012","journal-title":"Med Care"},{"issue":"2","key":"zoi250276r16","doi-asserted-by":"publisher","DOI":"10.1002\/lrh2.10210","article-title":"The Stanford Lightning Report Method: a comparison of rapid qualitative synthesis results across four implementation evaluations.","volume":"4","author":"Brown-Johnson","year":"2019","journal-title":"Learn Health Syst"},{"issue":"1","key":"zoi250276r19","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s12875-021-01373-4","article-title":"Implementation outcomes of Humanwide: integrated precision health in team-based family practice primary care.","volume":"22","author":"Brown-Johnson","year":"2021","journal-title":"BMC Fam Pract"},{"issue":"6","key":"zoi250276r20","doi-asserted-by":"publisher","DOI":"10.2196\/32874","article-title":"Patient and health professional perceptions of telemonitoring for hypertension management: qualitative study.","volume":"6","author":"Baratta","year":"2022","journal-title":"JMIR Form Res"},{"issue":"5","key":"zoi250276r21","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1370\/afm.2714","article-title":"Primary care 2.0: a prospective evaluation of a novel model of advanced team care with expanded medical assistant support.","volume":"19","author":"Shaw","year":"2021","journal-title":"Ann Fam Med"},{"key":"zoi250276r22","doi-asserted-by":"publisher","DOI":"10.1177\/21501327211004285","article-title":"Transforming interprofessional roles during virtual health care: the evolving role of the medical assistant, in relationship to national health profession competency standards.","volume":"12","author":"Rokicki-Parashar","year":"2021","journal-title":"J Prim Care Community Health"},{"issue":"5","key":"zoi250276r24","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1007\/s11606-021-07246-x","article-title":"Implementation and qualitative evaluation of a primary care redesign model with expanded scope of work for medical assistants.","volume":"37","author":"Kwan","year":"2022","journal-title":"J Gen Intern Med"},{"key":"zoi250276r25","doi-asserted-by":"publisher","first-page":"S24","DOI":"10.1370\/afm.2424","article-title":"Practice transformation under the university of Colorado\u2019s primary care redesign model.","volume":"17","author":"Smith","year":"2019","journal-title":"Ann Fam Med"},{"issue":"4","key":"zoi250276r26","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1161\/CIRCOUTCOMES.112.966978","article-title":"Million hearts\u2013where population health and clinical practice intersect.","volume":"5","author":"Wright","year":"2012","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"1","key":"zoi250276r29","doi-asserted-by":"publisher","first-page":"175","DOI":"10.3122\/jabfm.2022.01.210226","article-title":"A clinician\u2019s guide to artificial intelligence (AI): why and how primary care should lead the health care AI revolution.","volume":"35","author":"Lin","year":"2022","journal-title":"J Am Board Fam Med"},{"issue":"8","key":"zoi250276r30","doi-asserted-by":"publisher","first-page":"1626","DOI":"10.1007\/s11606-019-05035-1","article-title":"Ten ways artificial intelligence will transform primary care.","volume":"34","author":"Lin","year":"2019","journal-title":"J Gen Intern Med"},{"key":"zoi250276r31","doi-asserted-by":"publisher","DOI":"10.2196\/43258","article-title":"A nurse-led care delivery app and telehealth system for patients requiring wound care: mixed methods implementation and evaluation study.","volume":"7","author":"Brown-Johnson","year":"2023","journal-title":"JMIR Form Res"},{"key":"zoi250276r32","doi-asserted-by":"publisher","DOI":"10.2196\/44732","article-title":"Physician- and patient-elicited barriers and facilitators to implementation of a machine learning\u2013based screening tool for peripheral arterial disease: preimplementation study with physician and patient stakeholders.","volume":"7","author":"Ho","year":"2023","journal-title":"JMIR Cardio"},{"issue":"5","key":"zoi250276r33","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.13178","article-title":"Perspectives on the intersection of electronic health records and health care team communication, function, and well-being.","volume":"6","author":"Amano","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"4","key":"zoi250276r34","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1136\/bmjsrh-2023-201814","article-title":"You\u2019re invited: welcome to the dynamic world of quality improvement and implementation science.","volume":"49","author":"Goldthwaite","year":"2023","journal-title":"BMJ Sex Reprod Health"},{"issue":"5","key":"zoi250276r35","doi-asserted-by":"publisher","first-page":"e35","DOI":"10.1161\/HYP.0000000000000087","article-title":"Measurement of blood pressure in humans: a scientific statement from the American Heart Association.","volume":"73","author":"Muntner","year":"2019","journal-title":"Hypertension"},{"issue":"4","key":"zoi250276r36","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1370\/afm.2422","article-title":"Powering-up primary care teams: advanced team care with in-room support.","volume":"17","author":"Sinsky","year":"2019","journal-title":"Ann Fam Med"},{"issue":"Suppl 1","key":"zoi250276r37","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1111\/1475-6773.12602","article-title":"New roles for medical assistants in innovative primary care practices.","volume":"52","author":"Chapman","year":"2017","journal-title":"Health Serv Res"},{"key":"zoi250276r17","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen","year":"1988","edition":"2nd ed"},{"key":"zoi250276r23","volume-title":"SGIM Forum","author":"Levine","year":"2018"},{"key":"zoi250276r4","unstructured":"Quality? ID. Controlling blood pressure. Accessed November 29, 2022. https:\/\/qpp.cms.gov\/docs\/QPP_quality_measure_specifications\/CQM-Measures\/2019_Measure_236_MIPSCQM.pdf"},{"key":"zoi250276r6","unstructured":"Hypertension Management Program (HMP) Toolkit | cdc.gov. March 22, 2021. Accessed March 10, 2024. https:\/\/www.cdc.gov\/dhdsp\/pubs\/toolkits\/hmp-toolkit\/index.htm"},{"key":"zoi250276r7","unstructured":"Hypertension Control Change Package. July 2023. Accessed March 10, 2024. https:\/\/millionhearts.hhs.gov\/files\/HTN_Change_Package.pdf"},{"key":"zoi250276r9","unstructured":"Stanford Medicine Center for Improvement Guidelines for Oversight of Quality Improvement Projects. Accessed March 10, 2024. https:\/\/smci.stanford.edu\/s\/SMCIimprovementoversightguidelinesrevised202104.pdf"},{"key":"zoi250276r10","unstructured":"SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process EQUATOR Network. Accessed January 23, 2025. https:\/\/www.equator-network.org\/reporting-guidelines\/squire\/"},{"key":"zoi250276r11","unstructured":"7 Simple tips to getting an accurate blood pressure. Accessed November 29, 2022. https:\/\/targetbp.org\/wp-content\/uploads\/2017\/02\/Measuring-blood-pressure-new.pdf"},{"key":"zoi250276r12","unstructured":"Stanford Research Repository (STARR) Tools. Accessed October 20, 2022. https:\/\/med.stanford.edu\/starr-tools.html"},{"key":"zoi250276r13","doi-asserted-by":"crossref","unstructured":"Wasserstein? RL, Lazar? NA. The ASA statement on P values: context, process, and purpose.? Am Stat. 2016;70(2):129-133. doi:10.1080\/00031305.2016.1154108?","DOI":"10.1080\/00031305.2016.1154108"},{"key":"zoi250276r14","unstructured":"Using standardized mean differences. Accessed June 27, 2024. https:\/\/cran.r-project.org\/web\/packages\/tableone\/vignettes\/smd.html"},{"key":"zoi250276r15","unstructured":"R Core Team. R: a language and environment for statistical computing. 2020. Accessed March 10, 2024. https:\/\/www.R-project.org\/"},{"key":"zoi250276r18","unstructured":"Measuring blood pressure in office third. Accessed March 10, 2024. https:\/\/targetbp.org\/measuring_blood_pressure_in-office-third-2\/"},{"key":"zoi250276r27","unstructured":"Rethinking Clinical Trials. Definitions and uses. Accessed March 10, 2024. https:\/\/rethinkingclinicaltrials.org\/chapters\/conduct\/real-world-evidence-clinical-decision-support\/definitions-and-uses-for-cds\/"},{"key":"zoi250276r28","unstructured":"National Public Radio. Eating disorder helpline takes down chatbot after it gave weight loss advice. June 8, 2023. Accessed March 10, 2024. https:\/\/www.npr.org\/2023\/06\/08\/1181131532\/eating-disorder-helpline-takes-down-chatbot-after-it-gave-weight-loss-advice"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2833283\/phadke_2025_oi_250276_1744992044.25523.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T15:30:49Z","timestamp":1745595049000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2833283"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,25]]},"references-count":37,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.7313","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,25]]}}}