{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T04:30:00Z","timestamp":1780374600136,"version":"3.54.1"},"reference-count":23,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2019,8,17]]},"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To assess the impact of a quality improvement programme on blood pressure (BP) control and determine whether medication intensification or repeated measurement improved control.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Retrospective cohort comparing visits in 2015 to visits in 2016 (when the programme started).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Subjects<\/jats:title>\n                  <jats:p>Adults with \u22651 primary care visit between January and June in 2015 and 2016 and a diagnosis of hypertension in a large integrated health system.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Measures<\/jats:title>\n                  <jats:p>Elevated BP was defined as a BP \u2265140\/90 mm Hg. Physician response was defined as: nothing; BP recheck within 30 days; or medication intensification within 30 days. Our outcome was BP control (&lt;140\/90\u2009mm Hg) at the last visit of the year. We used a multilevel logistic regression model (adjusted for demographic and clinical variables) to identify the effect of the programme on the odds of BP control.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Our cohort included 111\u2009867 adults. Control increased from 72% in 2015 to 79% in 2016 (p&lt;0.01). The average percentage of visits with elevated blood pressure was 31% in 2015 and 25% in 2016 (p&lt;0.01). During visits with an elevated BP, physicians were more likely to intensify medication in 2016 than in 2015 (43% vs 40%, p&lt;0.01) and slightly more likely to obtain a BP recheck (15% vs 14%, p&lt;0.01). Among patients with \u22651 elevated BP who attained control by the last visit in the year, there was 6% increase from 2015 to 2016 in the percentage of patients who received at least one medication intensification during the year and a 1% increase in BP rechecks. The adjusted odds of the last BP reading being categorised as controlled was 59% higher in 2016 than in 2015 (95% CI 1.54 to 1.64).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>A system-wide initiative can improve BP control, primarily through medication intensification.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjqs-2018-009032","type":"journal-article","created":{"date-parts":[[2019,8,31]],"date-time":"2019-08-31T17:15:16Z","timestamp":1567271716000},"page":"225-231","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Impact of a system-wide quality improvement initiative on blood pressure control: a cohort analysis"],"prefix":"10.1136","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3485-260X","authenticated-orcid":false,"given":"Elizabeth R","family":"Pfoh","sequence":"first","affiliation":[{"name":"Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Martinez","sequence":"additional","affiliation":[{"name":"Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nirav","family":"Vakharia","sequence":"additional","affiliation":[{"name":"Internal Medicine, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Rothberg","sequence":"additional","affiliation":[{"name":"Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,8,31]]},"reference":[{"key":"2025090411524776000_29.3.225.1","first-page":"703","article-title":"Vital signs: awareness and treatment of uncontrolled hypertension among adults-United states, 2003-2010","volume":"61","year":"2012","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025090411524776000_29.3.225.2","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.1016\/S0140-6736(14)60685-1","article-title":"Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1\u00b725 million people","volume":"383","author":"Rapsomaniki","year":"2014","journal-title":"The Lancet"},{"key":"2025090411524776000_29.3.225.3","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1001\/jama.2013.284427","article-title":"Evidence-Based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth joint National Committee (JNC 8)","volume":"2014","author":"James","year":"2014","journal-title":"JAMA"},{"key":"2025090411524776000_29.3.225.4","first-page":"e484","article-title":"ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology\/American heart association Task force on clinical practice guidelines","volume":"2018","author":"Whelton","year":"2017","journal-title":"Circulation"},{"key":"2025090411524776000_29.3.225.5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.15388"},{"key":"2025090411524776000_29.3.225.6","doi-asserted-by":"publisher","DOI":"10.1370\/afm.927"},{"key":"2025090411524776000_29.3.225.7","doi-asserted-by":"crossref","first-page":"983","DOI":"10.15585\/mmwr.mm6735a4","article-title":"Vital Signs : Prevalence of Key Cardiovascular Disease Risk Factors for Million Hearts 2022 \u2014 United States, 2011\u20132016","volume":"67","author":"Wall","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025090411524776000_29.3.225.8","first-page":"70885","article-title":"Medicare program; revisions to payment policies under the physician fee schedule and other revisions to part B for cy 2016. final rule with Comment period","volume":"80","year":"2015","journal-title":"Fed Regist"},{"key":"2025090411524776000_29.3.225.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.284430"},{"key":"2025090411524776000_29.3.225.10","doi-asserted-by":"crossref","unstructured":"Glynn LG , Murphy AW , Smith SM , et al . 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