National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (1)
- (-) Blood Pressure (22)
- Cardiovascular Conditions (9)
- Children/Adolescents (2)
- Chronic Conditions (9)
- Clinical Decision Support (CDS) (1)
- Decision Making (2)
- Diabetes (6)
- Disparities (1)
- Elderly (1)
- Electronic Health Records (EHRs) (3)
- Evidence-Based Practice (2)
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- Health Information Technology (HIT) (6)
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- Heart Disease and Health (2)
- Labor and Delivery (1)
- Maternal Care (1)
- Medicaid (1)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medication (6)
- Outcomes (1)
- Patient-Centered Healthcare (1)
- Patient Adherence/Compliance (3)
- Practice Patterns (1)
- Pregnancy (3)
- Prevention (1)
- Primary Care (2)
- Quality Measures (1)
- Quality of Care (2)
- Racial and Ethnic Minorities (4)
- Risk (2)
- Screening (2)
- Telehealth (2)
- U.S. Preventive Services Task Force (USPSTF) (2)
- Women (3)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 22 of 22 Research Studies DisplayedDavoudi A, Lee NS, Chivers C
Patient interaction phenotypes with an automated remote hypertension monitoring program and their association with blood pressure control: observational study.
Researchers explored the unique phenotypes of patient interactions with an automated text messaging platform for blood pressure (BP) monitoring and to estimate associations between interaction phenotypes and BP control. Through a secondary analysis of data from a randomized controlled trial for adults with poorly controlled hypertension, they identified unique interaction phenotypes among patients engaging with an automated text message platform for remote BP monitoring; only the minimalist communication style was associated with achieving target BP. They recommended identifying and understanding interaction phenotypes to tailor future automated texting interactions and design future interventions to achieve better BP control.
AHRQ-funded; HS026372.
Citation: Davoudi A, Lee NS, Chivers C .
Patient interaction phenotypes with an automated remote hypertension monitoring program and their association with blood pressure control: observational study.
J Med Internet Res 2020 Dec 3;22(12):e22493. doi: 10.2196/22493..
Keywords: Telehealth, Blood Pressure, Health Information Technology (HIT)
Schesing KB, Chia R, Elwood B
Assessment of patient and provider attitudes towards therapeutic drug monitoring to improve medication adherence in low-income patients with hypertension: a qualitative study.
Previous studies have implicated therapeutic drug monitoring (TDM), by measuring serum or urine drug levels, as a highly reliable technique for detecting medication non-adherence but the attitudes of patients and physicians toward TDM have not been evaluated previously. In this study, the investigators solicited input from patients with uncontrolled hypertension and their physicians about their views on TDM.
AHRQ-funded; HS022418.
Citation: Schesing KB, Chia R, Elwood B .
Assessment of patient and provider attitudes towards therapeutic drug monitoring to improve medication adherence in low-income patients with hypertension: a qualitative study.
BMJ Open 2020 Nov 27;10(11):e039940. doi: 10.1136/bmjopen-2020-039940..
Keywords: Patient Adherence/Compliance, Medication, Blood Pressure
Gartlehner G, Vander Schaaf EB, Orr C
Gartlehner G, Vander Schaaf EB, Orr C, Kennedy SM, Clark R, Viswanathan M. Screening for hypertension in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
This paper is an evidence update that accompanies the final recommendation from the U.S. Preventive Services Task Force (USPSTF) on screening and treatment of hypertension in childhood and adolescence. The update confirmed the previous update that the evidence is inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care. Forty-two studies from 43 publications were included in the final review.
AHRQ-funded; 290201500011I.
Citation: Gartlehner G, Vander Schaaf EB, Orr C .
Gartlehner G, Vander Schaaf EB, Orr C, Kennedy SM, Clark R, Viswanathan M. Screening for hypertension in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2020 Nov 10;324(18):1884-95. doi: 10.1001/jama.2020.11119..
Keywords: Children/Adolescents, U.S. Preventive Services Task Force (USPSTF), Blood Pressure, Screening, Evidence-Based Practice, Prevention, Cardiovascular Conditions
Odlum M, Moise N, Kronish IM
Trends in poor health indicators among Black and Hispanic middle-aged and older adults in the United States, 1999-2018.
This study used records extracted from the Behavioral Risk Factor Surveillance System to determine which health indicators have improved or became worse among Black and Hispanic middle-aged (45 and older) adults compared to Whites from 1999 to 2018. This data is required by the Minority Health and Health Disparities Research and Education Act of 2000. A sample included of 4,856,326 participants, of them 60.9% women, mean age 60.4. During the last 20 years, Black adults showed an overall decrease showing improvement in uninsured status and physical inactivity while showing an overall increase in hypertension, diabetes, asthma, and stroke, and also the same increases and decreases in the Black-White gap. Hispanic adults showed improvement in physical inactivity and perceived poor health, while they showed overall deterioration in hypertension and diabetes. The Hispanic-White gap improved in coronary heart disease, stroke, kidney disease, asthma, arthritis, depression and physical inactivity while it increased for diabetes, hypertension, and uninsured status.
AHRQ-funded; HS025198.
Citation: Odlum M, Moise N, Kronish IM .
Trends in poor health indicators among Black and Hispanic middle-aged and older adults in the United States, 1999-2018.
JAMA Netw Open 2020 Nov 2;3(11):e2025134. doi: 10.1001/jamanetworkopen.2020.25134..
Keywords: Elderly, Racial and Ethnic Minorities, Disparities, Health Status, Health Insurance, Diabetes, Blood Pressure, Chronic Conditions
Kaelber DC, Localio AR, Ross M
Persistent hypertension in children and adolescents: a 6-year cohort study.
The purpose of this study was to determine the natural history of pediatric hypertension. The study was conducted over a 72-month period among 165 primary care sites; blood pressure measurements from two consecutive 36-month periods were compared. Findings indicated that, in a primary care cohort, most children initially meeting criteria for hypertension or elevated blood pressure had subsequent normal blood pressure levels or did not receive recommended follow-up measurements. These results highlight the need for more nuanced initial blood pressure assessment and systems to promote follow-up of abnormal results.
AHRQ-funded; HS021645.
Citation: Kaelber DC, Localio AR, Ross M .
Persistent hypertension in children and adolescents: a 6-year cohort study.
Pediatrics 2020 Oct;146(4):Oct. doi: 10.1542/peds.2019-3778..
Keywords: Children/Adolescents, Blood Pressure, Cardiovascular Conditions, Chronic Conditions
Koopman RJ, Canfield SM, Belden JL
Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs.
This study examined whether using home blood pressure visualization tools helps management of hypertension for both patients and physicians. A multidisciplinary team used iterative user-centered design to create a blood pressure visualization EHR prototype that included patient-generated blood pressure data. The study included an attitude and behavior survey and 10 focus groups with 16 patients and 24 physicians. Most patients measured their blood pressure at home, but only half shared data with their physician. Data visualization helped patients and physicians have a fuller understanding of the blood pressure “story” and helped with patient-physician interactions to better control hypertension.
AHRQ-funded; HS023328.
Citation: Koopman RJ, Canfield SM, Belden JL .
Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs.
BMC Med Inform Decis Mak 2020 Aug 18;20(1):195. doi: 10.1186/s12911-020-01194-y..
Keywords: Blood Pressure, Electronic Health Records (EHRs), Health Information Technology (HIT), Chronic Conditions, Cardiovascular Conditions
Dorsch MP, Cornellier ML, Poggi AD
Effects of a novel contextual just-in-time mobile app intervention (LowSalt4Life) on sodium intake in adults with hypertension: pilot randomized controlled trial.
Researchers evaluated the effect of a just-in-time adaptive mobile application intervention, LowSalt4Life, on reducing sodium intake. They found that, in a randomized controlled pilot study in adults with hypertension, a contextual just-in-time mobile application intervention demonstrated a greater reduction in dietary sodium intake over 8 weeks compared to controls. There was not a statistically significant difference in self-confidence following a low sodium diet, 24-hour urinary sodium excretion, or dietary intake of sodium measured by 24-hour dietary recall compared to control over 8 weeks. They recommended a larger clinical trial is to elucidate further the effects of the LowSalt4Life intervention on sodium intake and blood pressure.
AHRQ-funded; HS024567.
Citation: Dorsch MP, Cornellier ML, Poggi AD .
Effects of a novel contextual just-in-time mobile app intervention (LowSalt4Life) on sodium intake in adults with hypertension: pilot randomized controlled trial.
JMIR Mhealth Uhealth 2020 Aug 10;8(8). doi: 10.2196/16696..
Keywords: Blood Pressure, Telehealth, Health Information Technology (HIT), Outcomes
Moise N, Phillips E, Carter E
Design and study protocol for a cluster randomized trial of a multi-faceted implementation strategy to increase the uptake of the USPSTF hypertension screening recommendations: the EMBRACE study.
The US Preventive Services Task Force (USPSTF) recommends out-of-office blood pressure (BP) testing to exclude white coat hypertension prior to hypertension diagnosis. Despite improved availability and coverage of home and 24-h ambulatory BP monitoring (HBPM, ABPM), both are infrequently used to confirm diagnoses. In this study, the investigators used the Behavior Change Wheel (BCW) framework, a multi-step process for mapping barriers to theory-informed behavior change techniques, to develop a multi-component implementation strategy for increasing out-of-office BP testing for hypertension diagnosis.
AHRQ-funded; HS025198; HS024262.
Citation: Moise N, Phillips E, Carter E .
Design and study protocol for a cluster randomized trial of a multi-faceted implementation strategy to increase the uptake of the USPSTF hypertension screening recommendations: the EMBRACE study.
Implement Sci 2020 Aug 8;15(1):63. doi: 10.1186/s13012-020-01017-8..
Keywords: U.S. Preventive Services Task Force (USPSTF), Blood Pressure, Screening, Guidelines, Evidence-Based Practice, Cardiovascular Conditions
Shaffer VA, Wegier P, Valentine KD
Use of enhanced data visualization to improve patient judgments about hypertension control.
Uncontrolled hypertension is driven by clinical uncertainty around blood pressure data. This research sought to determine whether decision support-in the form of enhanced data visualization-could improve judgments about hypertension control. The investigators concluded that enhancing data visualization with the use of a smoothing function to minimize the variability present in raw blood pressure data significantly improved judgments about hypertension control.
AHRQ-funded; HS023328.
Citation: Shaffer VA, Wegier P, Valentine KD .
Use of enhanced data visualization to improve patient judgments about hypertension control.
Med Decis Making 2020 Aug;40(6):785-96. doi: 10.1177/0272989x20940999..
Keywords: Blood Pressure, Decision Making, Chronic Conditions, Cardiovascular Conditions, Health Information Technology (HIT)
Rosenbloom JI, Stwalley D, Lindley KJ
Latency of preterm hypertensive disorders of pregnancy and subsequent cardiovascular complications.
The objective of this retrospective cohort study was to test the hypothesis that increasing latency from diagnosis to delivery in patients with preterm hypertensive disorders of pregnancy is associated with an increased maternal risk of cardiovascular admission after delivery. The investigators found that prolonging expectant management of preterm hypertensive disorders of pregnancy was associated with an increased risk of maternal cardiovascular disease after delivery.
AHRQ-funded; HS019455.
Citation: Rosenbloom JI, Stwalley D, Lindley KJ .
Latency of preterm hypertensive disorders of pregnancy and subsequent cardiovascular complications.
Pregnancy Hypertens 2020 Jul;21:139-44. doi: 10.1016/j.preghy.2020.05.015..
Keywords: Blood Pressure, Pregnancy, Cardiovascular Conditions, Women, Maternal Care, Risk
Cuffee YL, Rosal M, Hargraves JL
Does home remedy use contribute to medication nonadherence among Blacks with hypertension?
The objective of this study was to examine home remedy (HR) use among Blacks with hypertension and to determine if home remedy use is correlated with blood pressure and medication adherence. Data was obtained from the TRUST study conducted 2006-2008. Findings showed that the use of HR and the number of HRs used may be associated with medication nonadherence and with higher systolic and diastolic blood pressure among Blacks with hypertension. Recommendations included that health care providers need to be aware of health behaviors that may serve as barriers to medication adherence, such as the use of home remedies.
AHRQ-funded; HS020755.
Citation: Cuffee YL, Rosal M, Hargraves JL .
Does home remedy use contribute to medication nonadherence among Blacks with hypertension?
Ethn Dis 2020 Summer;30(3):451-58. doi: 10.18865/ed.30.3.451..
Keywords: Patient Adherence/Compliance, Medication, Blood Pressure, Racial and Ethnic Minorities, Cardiovascular Conditions
Huguet N, Kaufmann J, O'Malley J
Using electronic health records in longitudinal studies: estimating patient attrition.
This study’s objective was to estimate overall and among adults with diabetes or hypertension: 1) patient attrition over a 3-year period at community health centers; and 2) the likelihood that patients with Medicaid switched their primary care source. Data was collected from the retrospective cohort study of 2012-2017 claims data Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Data Research Network of community health centers. This study focused on Oregon Medicaid enrollees with a total of 232,891 patients aged 19-64 with a gap of 6 months or more following a claim for a visit billed to a primary care source. The authors theorized the reason was due to patients with Medicaid permanently changing their primary care source. They found that attrition over 3 years averaged 33.5% but patients with diabetes or hypertension was lower (25% or less). Among Medicaid patients the attrition rate 12% for community health center patients compared with 39% for single-provider practice patients.
AHRQ-funded; HS025962.
Citation: Huguet N, Kaufmann J, O'Malley J .
Using electronic health records in longitudinal studies: estimating patient attrition.
Med Care 2020 Jun;58(Suppl 1):S46-S52. doi: 10.1097/mlr.0000000000001298...
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diabetes, Blood Pressure, Chronic Conditions, Primary Care, Medicaid
Mefford MT, Goyal P, Howard G
The association of hypertension, hypertension duration, and control with incident heart failure in black and white adults.
Associations between hypertension and some cardiovascular diseases are stronger in black vs white adults. In this study, the investigators examined associations of hypertension, hypertension duration, and control with incident heart failure (HF) in black and white REasons for Geographic And Racial Differences in Stroke study participants (n = 25 770) who were followed for incident HF hospitalization (n = 947) from enrollment in 2003-2007 through 2015.
AHRQ-funded; HS013852.
Citation: Mefford MT, Goyal P, Howard G .
The association of hypertension, hypertension duration, and control with incident heart failure in black and white adults.
J Clin Hypertens 2020 May;22(5):857-66. doi: 10.1111/jch.13856..
Keywords: Blood Pressure, Heart Disease and Health, Cardiovascular Conditions, Racial and Ethnic Minorities
Ramirez M, Chen K, Follett RW
Impact of a "chart closure" hard stop alert on prescribing for elevated blood pressures among patients with diabetes: quasi-experimental study.
The aim of the study was to evaluate whether the implementation of the Best Practice Advisory (BPA) was associated with changes in angiotensin-converting enzyme inhibitor (ACEI) and angiotensin-receptor blocker (ARB) prescribing during primary care encounters for patients with diabetes. The investigators concluded that a BPA with a "chart closure" hard stop is a promising tool for the treatment of patients with comorbid diabetes and hypertension with an ACEI or ARB, especially when implemented within the context of team-based care, wherein clinical pharmacists support the work of primary care providers.
AHRQ-funded; HS00046.
Citation: Ramirez M, Chen K, Follett RW .
Impact of a "chart closure" hard stop alert on prescribing for elevated blood pressures among patients with diabetes: quasi-experimental study.
JMIR Med Inform 2020 Apr 17;8(4):e16421. doi: 10.2196/16421..
Keywords: Blood Pressure, Medication, Diabetes, Clinical Decision Support (CDS), Decision Making, Chronic Conditions
Rosenbloom JI, Lewkowitz AK, Lindley KJ
Expectant management of hypertensive disorders of pregnancy and future cardiovascular morbidity.
The purpose of this study was to test the hypothesis that a longer length of time between diagnosis of hypertensive disorders of pregnancy and delivery is associated with increased risk of cardiovascular morbidity in the years after delivery. The investigators concluded that prolonged expectant management of preterm hypertensive disorders of pregnancy was associated with an increased risk of maternal cardiac disease in the ensuing years.
AHRQ-funded; HS019455.
Citation: Rosenbloom JI, Lewkowitz AK, Lindley KJ .
Expectant management of hypertensive disorders of pregnancy and future cardiovascular morbidity.
Obstet Gynecol 2020 Jan;135(1):27-35. doi: 10.1097/aog.0000000000003567..
Keywords: Blood Pressure, Pregnancy, Cardiovascular Conditions, Labor and Delivery, Risk, Women
Voils CI, Sleath B, Maciejewski ML
Patient perspectives on having multiple versus single prescribers of chronic disease medications: results of a qualitative study in a veteran population.
The researchers sought to understand the reasons why patients have increasing numbers of prescribers of medications and to understand patient perspectives on advantages and disadvantages of having multiple prescribers, including effects on medication supply. They found that, with patients from a Veterans Affairs (VA) Medical Center, multiple prescribers arose through referrals and patients actively seeking non-VA prescribers to maximize timeliness and access to medications, to provide access to medications not on the VA formulary, and to minimize out-of-pocket costs.
AHRQ-funded; HS019445.
Citation: Voils CI, Sleath B, Maciejewski ML .
Patient perspectives on having multiple versus single prescribers of chronic disease medications: results of a qualitative study in a veteran population.
BMC Health Serv Res 2014 Oct 25;14:490. doi: 10.1186/s12913-014-0490-8.
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Keywords: Chronic Conditions, Medication, Diabetes, Blood Pressure, Heart Disease and Health
Cea Soriano L, Bateman BT, Garcia Rodriguez LA
Prescription of antihypertensive medications during pregnancy in the UK.
The authors aimed to describe the management of antihypertensive medications in pregnancy by general practitioners in the UK and compare it with current guidelines. Using electronic medical records from The Health Improvement Network database, they found that, in this population of UK pregnant women, prescription patterns of antihypertensive medications were dominated by recommended treatments, although some patients continued on contraindicated drugs throughout pregnancy or switched to preferred agents in a delayed fashion.
AHRQ-funded; HS018533.
Citation: Cea Soriano L, Bateman BT, Garcia Rodriguez LA .
Prescription of antihypertensive medications during pregnancy in the UK.
Pharmacoepidemiol Drug Saf 2014 Oct;23(10):1051-8. doi: 10.1002/pds.3641.
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Keywords: Blood Pressure, Pregnancy, Medication, Women, Practice Patterns
Benkert R, Dennehy P, White J
Diabetes and hypertension quality measurement in four safety-net sites: lessons learned after implementation of the same commercial electronic health record.
The authors described what implementation of a commercially available EHR with built-in quality query algorithms showed us about our care for diabetes and hypertension populations in four safety net clinics. They found that utilizing a shared EHR, a Regional Extension Center-like partnership model, and similar quality query algorithms allowed safety-net clinics to benchmark and improve the quality of care across differing patient populations and health care delivery models.
AHRQ-funded; HS017191.
Citation: Benkert R, Dennehy P, White J .
Diabetes and hypertension quality measurement in four safety-net sites: lessons learned after implementation of the same commercial electronic health record.
Appl Clin Inform 2014 Aug 20;5(3):757-72. doi: 10.4338/aci-2014-03-ra-0019.
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Keywords: Diabetes, Blood Pressure, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality of Care, Chronic Conditions
Bernard DM, Johansson P, Fang Z
AHRQ Author: Bernard DM
Out-of-pocket healthcare expenditure burdens among nonelderly adults with hypertension.
The investigators examined the prevalence of high out-of-pocket burdens and self-perceived financial barriers to care among patients receiving hypertension treatment. They found that the prevalence of high total burdens was significantly greater for persons receiving treatment for hypertension compared with other chronically ill and well patients. Among hypertension patients with high total burdens, 15.7% said they were unable to get care and 13.6% said they delayed care due to financial reasons.
AHRQ-authored.
Citation: Bernard DM, Johansson P, Fang Z .
Out-of-pocket healthcare expenditure burdens among nonelderly adults with hypertension.
Am J Manag Care 2014 May;20(5):406-13.
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Keywords: Medical Expenditure Panel Survey (MEPS), Blood Pressure, Healthcare Costs, Health Insurance
Liss DT, Fishman PA, Rutter CM
Specialty use among patients with treated hypertension in a patient-centered medical home.
The researchers described changes in outpatient specialty use among patients with treated hypertension during and after patient-centered medical home (PCMH) practice transformation. Their results suggest that more comprehensive primary care in this PCMH redesign enabled primary care teams to deliver more hypertension care, and that many needs of low morbidity patients were within the scope of primary care practice.
AHRQ-funded; HS019129.
Citation: Liss DT, Fishman PA, Rutter CM .
Specialty use among patients with treated hypertension in a patient-centered medical home.
J Gen Intern Med 2014 May;29(5):732-40. doi: 10.1007/s11606-014-2776-2..
Keywords: Blood Pressure, Patient-Centered Healthcare, Primary Care, Healthcare Delivery
Navar-Boggan AM, Fanaroff A, Swaminathan A
The impact of a measurement and feedback intervention on blood pressure control in ambulatory cardiology practice.
This study evaluated the impact of a targeted provider feedback intervention on rates of blood pressure control. Providers received quarterly provider-specific reports over a period of one year for a group of 300 patients treated in outpatient cardiology clinic practices. These reports as a stand-alone intervention did not affect overall BP control rates in cardiology clinics.
AHRQ-funded; HS021092
Citation: Navar-Boggan AM, Fanaroff A, Swaminathan A .
The impact of a measurement and feedback intervention on blood pressure control in ambulatory cardiology practice.
Am Heart J. 2014 Apr;167(4):466-71. doi: 10.1016/j.ahj.2013.12.015..
Keywords: Blood Pressure, Ambulatory Care and Surgery, Diabetes, Chronic Conditions, Quality Measures, Quality of Care
Schoenthaler A, Montague E, Baier Manwell L
Patient-physician racial/ethnic concordance and blood pressure control: the role of trust and medication adherence.
The researchers examined the associations between racial/ethnic concordance and blood pressure (BP) control to determine whether patient trust and medication adherence mediate these associations. They found that higher levels of trust were associated with better medication adherence and a tendency toward better BP control, irrespective of patient–physician racial/ethnic concordance.
AHRQ-funded; HS011955.
Citation: Schoenthaler A, Montague E, Baier Manwell L .
Patient-physician racial/ethnic concordance and blood pressure control: the role of trust and medication adherence.
Ethn Health 2014;19(5):565-78. doi: 10.1080/13557858.2013.857764..
Keywords: Blood Pressure, Racial and Ethnic Minorities, Medication, Patient Adherence/Compliance