National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Events (1)
- Ambulatory Care and Surgery (2)
- Behavioral Health (1)
- (-) Blood Pressure (29)
- Cardiovascular Conditions (9)
- Care Management (3)
- Case Study (2)
- Children/Adolescents (2)
- Chronic Conditions (3)
- Comparative Effectiveness (1)
- Depression (1)
- Diabetes (6)
- Diagnostic Safety and Quality (6)
- Disparities (1)
- Education: Continuing Medical Education (1)
- Education: Patient and Caregiver (1)
- Elderly (2)
- Electronic Health Records (EHRs) (3)
- Emergency Department (1)
- Evidence-Based Practice (4)
- Guidelines (3)
- Healthcare Delivery (1)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (4)
- Heart Disease and Health (2)
- Home Healthcare (1)
- Intensive Care Unit (ICU) (1)
- Kidney Disease and Health (1)
- Lifestyle Changes (1)
- Low-Income (1)
- Maternal Care (2)
- Medical Errors (1)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medication (6)
- Mortality (1)
- Nutrition (1)
- Obesity (2)
- Obesity: Weight Management (1)
- Outcomes (2)
- Patient-Centered Outcomes Research (2)
- Patient Safety (1)
- Patient Self-Management (1)
- Pregnancy (2)
- Prevention (4)
- Primary Care (4)
- Quality Improvement (1)
- Quality of Care (2)
- Racial and Ethnic Minorities (3)
- Risk (2)
- Screening (2)
- Social Determinants of Health (2)
- Stroke (2)
- Telehealth (1)
- Training (1)
- U.S. Preventive Services Task Force (USPSTF) (4)
- Urban Health (1)
- Women (2)
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 25 of 29 Research Studies DisplayedFink JT, Magnan EM, Johnson HM
Blood pressure control and other quality of care metrics for patients with obesity and diabetes: a population-based cohort study.
In this observational population-based cohort study, the investigators sought to examine the relationship between the extent of obesity and the achievement of guideline-recommended blood pressure goals and other quality of care metrics among patients with diabetes. The investigators suggest that although the cardiovascular risk for patients with obesity and diabetes is greater than for non-obese patients with diabetes, they found that patients with obesity are even further behind in achieving blood pressure control.
AHRQ-funded; HS021899.
Citation: Fink JT, Magnan EM, Johnson HM .
Blood pressure control and other quality of care metrics for patients with obesity and diabetes: a population-based cohort study.
High Blood Press Cardiovasc Prev 2018 Dec;25(4):391-99. doi: 10.1007/s40292-018-0284-x..
Keywords: Blood Pressure, Diabetes, Quality of Care, Obesity
Goldberg EM, Marks SJ, Merchant RC
National trends in the emergency department management of adult patients with elevated blood pressure from 2005 to 2015.
This study researched treatment trends for emergency department (ED) visits for hypertension from 2005 to 2015. The study found that there is still room for improvement, and disparities still exist for Blacks and uninsured patients.
AHRQ-funded; HS000011.
Citation: Goldberg EM, Marks SJ, Merchant RC .
National trends in the emergency department management of adult patients with elevated blood pressure from 2005 to 2015.
J Am Soc Hypertens 2018 Dec;12(12):858-66. doi: 10.1016/j.jash.2018.09.010..
Keywords: Blood Pressure, Emergency Department
Anstey DE, Muntner P, Bello NA
Diagnosing masked hypertension using ambulatory blood pressure monitoring, home blood pressure monitoring, or both?
The aim of this study was to determine the overlap between ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM) for the detection of masked hypertension (MHT). The investigators asserted that their data suggested that conducting ABPM will detect many individuals with MHT who have an increased cardiovascular disease risk.
AHRQ-funded; HS024262.
Citation: Anstey DE, Muntner P, Bello NA .
Diagnosing masked hypertension using ambulatory blood pressure monitoring, home blood pressure monitoring, or both?
Hypertension 2018 Nov;72(5):1200-07. doi: 10.1161/hypertensionaha.118.11319..
Keywords: Blood Pressure, Diagnostic Safety and Quality
Sterling MR, Silva AF, Robbins L
Let's talk numbers: a qualitative study of community-dwelling US adults to understand the role of numeracy in the management of heart failure.
This qualitative study examined the role of numeracy (basic number skills) in the management of patients with heart failure (HF). Thirty men and women aged 47-89 years with a history of HF were recruited from an urban academic primary care practice. Participants all had a history of HF within the past year, were seen at the practice within the last year, and had been hospitalized for HF within the last 6 months. They were interviewed about their numeracy to help manage monitoring weight, maintaining a low-salt diet, and monitoring blood pressure. A wide range of knowledge and understanding was found and fear served as a barrier and facilitator to carrying out HF self-care tasks involving numbers. If the patient has a caregiver who also lacks those skills or does not have HF care training, patients may not be managing their HF as well as they should.
AHRQ-funded; HS000066.
Citation: Sterling MR, Silva AF, Robbins L .
Let's talk numbers: a qualitative study of community-dwelling US adults to understand the role of numeracy in the management of heart failure.
BMJ Open 2018 Sep 19;8(9):e023073. doi: 10.1136/bmjopen-2018-023073..
Keywords: Patient Self-Management, Education: Patient and Caregiver, Care Management, Heart Disease and Health, Nutrition, Lifestyle Changes, Obesity: Weight Management, Obesity, Blood Pressure, Cardiovascular Conditions
Rao G, Naureckas S, Datta A
Pediatric hypertension: diagnostic patterns derived from electronic health records.
This study examined the rates of diagnostic for pediatric hypertension using electronic health records (EHRs). The rates of diagnosis were very low (6.1%) among 1478 children identified as hypertensive. Rates of diagnosis improved in children aged 12 and above but was very low for children aged 6 and under. Underdiagnosis can lead to organ failure and increased risk for adult hypertension.
AHRQ-funded; HS024100.
Citation: Rao G, Naureckas S, Datta A .
Pediatric hypertension: diagnostic patterns derived from electronic health records.
Diagnosis 2018 Sep;5(3):157-60. doi: 10.1515/dx-2018-0010..
Keywords: Children/Adolescents, Blood Pressure, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT)
Ramirez M, Maranon R, Fu J
Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a "chart closure" hard stop.
The purpose of this study was to evaluate provider responses to a narrowly targeted Best Practice Advisory (BPA) alert regarding the intensification of blood pressure medications for persons with diabetes before and after implementation of a ‘chart closure’ hard stop. Researchers designed a BPA that sent alerts via an electronic health record system during outpatient encounters when patients with diabetes had elevated blood pressures and were not on angiotensin receptor blocking medications. These alerts were implemented in eight primary care practices within UCLA Health. Data on provider responses to the alerts was compared before and after implementing a ‘chart closure’ hard stop. Providers responded to alerts more often after the ‘chart closure’ hard stop was implemented. The researchers conclude that targeting specific omitted medication classes can produce specific alerts that may reduce alert fatigue, and that using a ‘chart closure’ hard stop may prompt providers to take action without major disruptions to their workflow.
AHRQ-funded; HS000046.
Citation: Ramirez M, Maranon R, Fu J .
Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a "chart closure" hard stop.
J Am Med Inform Assoc 2018 Sep;25(9):1167-74. doi: 10.1093/jamia/ocy073..
Keywords: Blood Pressure, Diabetes, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Care Management
Carter EJ, Moise N, Alcantara C
Patient barriers and facilitators to ambulatory and home blood pressure monitoring: a qualitative study.
Guidelines recommend that patients with newly elevated office blood pressure undergo ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) to rule-out white coat hypertension before being diagnosed with hypertension. This study explored patients' perspectives of the barriers and facilitators to undergoing ABPM or HBPM.
AHRQ-funded; HS024262.
Citation: Carter EJ, Moise N, Alcantara C .
Patient barriers and facilitators to ambulatory and home blood pressure monitoring: a qualitative study.
Am J Hypertens 2018 Jul 16;31(8):919-27. doi: 10.1093/ajh/hpy062..
Keywords: Blood Pressure, Diagnostic Safety and Quality
Lakshminarayan K, Westberg S, Northuis C
A mHealth-based care model for improving hypertension control in stroke survivors: pilot RCT.
Hypertension (HTN) is significantly under-treated in stroke survivors. The study authors examined usability and efficacy of a mHealth -based care model for improving post-stroke HTN control. They concluded that a mHealth-based HTN care model had excellent usability and provided better HTN control than usual care in stroke survivors.
AHRQ-funded; HS021794.
Citation: Lakshminarayan K, Westberg S, Northuis C .
A mHealth-based care model for improving hypertension control in stroke survivors: pilot RCT.
Contemp Clin Trials 2018 Jul;70:24-34. doi: 10.1016/j.cct.2018.05.005..
Keywords: Telehealth, Health Information Technology (HIT), Blood Pressure, Stroke, Cardiovascular Conditions
Egan BM, Li J, Davis RA
Differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States.
The US Preventive Services Task Force cholesterol guideline recommended statins for fewer adults than the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline by setting a higher 10-year atherosclerotic cardiovascular disease threshold and requiring concomitant diabetes mellitus, hypertension, dyslipidemia, or cigarette smoking. The 2017 ACC/AHA hypertension guideline lowered the hypertension threshold, increasing 2016 guideline statin-eligible adults. This article discusses differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States.
AHRQ-funded; P30 HS021667.
Citation: Egan BM, Li J, Davis RA .
Differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States.
J Clin Hypertens 2018 Jun;20(6):991-1000. doi: 10.1111/jch.13314..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Evidence-Based Practice, Guidelines, Blood Pressure, Medication, Prevention, Primary Care, U.S. Preventive Services Task Force (USPSTF)
Myerson RM, Colantonio LD, Safford MM
Does identification of previously undiagnosed conditions change care-seeking behavior?
The purpose of the study was to determine whether identification of previously undiagnosed high cholesterol, hypertension, and/or diabetes during an in-home assessment impacts care seeking among Medicare beneficiaries. The study concluded that in-home assessment of cholesterol, blood pressure, and blood glucose can increase doctor visits for individuals with previously undiagnosed conditions. However, biomarker assessment may have more limited impact among individuals with low access to care.
AHRQ-funded; HS000084.
Citation: Myerson RM, Colantonio LD, Safford MM .
Does identification of previously undiagnosed conditions change care-seeking behavior?
Health Serv Res 2018 Jun;53(3):1517-38. doi: 10.1111/1475-6773.12644..
Keywords: Blood Pressure, Diabetes, Home Healthcare, Cardiovascular Conditions
Chaddha A, Smith MA, Palta M
Hypertension control after an initial cardiac event among Medicare patients with diabetes mellitus: a multidisciplinary group practice observational study.
The objective of the study was to determine rates and predictors of achieving hypertension control among Medicare patients with diabetes and uncontrolled hypertension after hospital discharge for an initial cardiac event. A retrospective analysis of linked electronic health record and Medicare data was performed. The study findings demonstrated the importance of implementing guideline-directed multidisciplinary care in this population.
AHRQ-funded; HS018368; HS017646.
Citation: Chaddha A, Smith MA, Palta M .
Hypertension control after an initial cardiac event among Medicare patients with diabetes mellitus: a multidisciplinary group practice observational study.
J Clin Hypertens 2018 May;20(5):891-901. doi: 10.1111/jch.13282..
Keywords: Cardiovascular Conditions, Diabetes, Blood Pressure
Muldoon MF, Kronish IM, Shimbo D
Of signal and noise: overcoming challenges in blood pressure measurement to optimize hypertension care.
This paper reviews the manifestations and consequences of BP mismeasurement and misinterpretation in clinical practice and draw on recent research to propose a set of solutions that leverage available technologies to optimize hypertension care.
AHRQ-funded; HS024262.
Citation: Muldoon MF, Kronish IM, Shimbo D .
Of signal and noise: overcoming challenges in blood pressure measurement to optimize hypertension care.
Circ Cardiovasc Qual Outcomes 2018 May;11(5):e004543. doi: 10.1161/circoutcomes.117.004543..
Keywords: Blood Pressure, Diagnostic Safety and Quality, Adverse Events, Medical Errors, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality of Care
Henderson KH, DeWalt DA, Halladay J
Organizational leadership and adaptive reserve in blood pressure control: the Heart Health NOW study.
The purpose of this study was to assess whether a practice's adaptive reserve and high leadership capability in quality improvement are associated with population blood pressure control. Its findings showed that adaptive reserve and leadership capability in quality improvement implementation are not statistically associated with achieving top quartile practice-level hypertension control at baseline in the Heart Health NOW project.
AHRQ-funded; HS023912.
Citation: Henderson KH, DeWalt DA, Halladay J .
Organizational leadership and adaptive reserve in blood pressure control: the Heart Health NOW study.
Ann Fam Med 2018 Apr;16(Suppl 1):S29-s34. doi: 10.1370/afm.2210.
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Keywords: Blood Pressure, Cardiovascular Conditions, Patient-Centered Outcomes Research, Primary Care, Quality Improvement
Tung EL, Wroblewski KE, Boyd K
Police-recorded crime and disparities in obesity and blood pressure status in Chicago.
The purpose of this study was to examine associations between several types of police-recorded crime (violent, nonviolent, and homicide) and cardiometabolic health (obesity and elevated blood pressure [BP]), and to determine if associations were modified by age and sex. It concluded that in a densely populated, high-poverty region in Chicago, recurrent exposure to high rates of violent crime was consistently associated with obesity and elevated BP, but rare exposure to homicide was not.
AHRQ-funded; HS023007.
Citation: Tung EL, Wroblewski KE, Boyd K .
Police-recorded crime and disparities in obesity and blood pressure status in Chicago.
J Am Heart Assoc 2018 Mar 24;7(7). doi: 10.1161/jaha.117.008030.
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Keywords: Blood Pressure, Disparities, Risk, Social Determinants of Health, Urban Health
Mabry-Hernandez I, Romano MJ
AHRQ Author: Mabry-Hernandez I
Screening for preeclampsia.
A 28-year-old white woman comes to your clinic for prenatal care reporting a new-onset severe headache. She is currently pregnant with twins at an estimated gestational age of 22 weeks. Her obstetric history is significant for one previous term singleton vaginal delivery at 24 years of age without complications. This case study poses three multiple choice questions together with the U.S. Preventive Services Task Force recommendations and related background information.
AHRQ-authored.
Citation: Mabry-Hernandez I, Romano MJ .
Screening for preeclampsia.
Am Fam Physician 2018 Jan 15;97(2):117-18.
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Keywords: Blood Pressure, Case Study, Maternal Care, Pregnancy, U.S. Preventive Services Task Force (USPSTF)
Darger B, Gonzales N, Banuelos RC
Outcomes of patients requiring blood pressure control before thrombolysis with tPA for acute ischemic stroke.
The purpose of this study was to assess safety and efficacy of thrombolysis in the setting of aggressive blood pressure (BP) control as it compares to standard BP control or no BP control prior to thrombolysis. The researchers observed no association between BP control and adverse outcomes in ischemic stroke patients undergoing thrombolysis.
AHRQ-funded; HS017586.
Citation: Darger B, Gonzales N, Banuelos RC .
Outcomes of patients requiring blood pressure control before thrombolysis with tPA for acute ischemic stroke.
West J Emerg Med 2015 Dec;16(7):1002-6. doi: 10.5811/westjem.2015.8.27859.
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Keywords: Blood Pressure, Stroke, Medication, Outcomes
Wolfe H, Maltese MR, Niles DE
Blood pressure directed booster trainings improve intensive care unit provider retention of excellent cardiopulmonary resuscitation skills.
The authors incorporated arterial blood pressure (ABP) tracings into Booster Trainings, hypothesizing that ABP-directed CPR Booster Trainings would improve intensive care unit (ICU) provider 3-month retention of excellent CPR skills without need for interval retraining. They found that the ABP-directed CPR booster trainings improved ICU provider 3-month retention of excellent CPR skills without the need for interval retraining.
AHRQ-funded; HS022469; HS022464.
Citation: Wolfe H, Maltese MR, Niles DE .
Blood pressure directed booster trainings improve intensive care unit provider retention of excellent cardiopulmonary resuscitation skills.
Pediatr Emerg Care 2015 Nov;31(11):743-7. doi: 10.1097/pec.0000000000000394.
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Keywords: Blood Pressure, Education: Continuing Medical Education, Intensive Care Unit (ICU), Patient Safety, Training
Bangalore S, Ogedegbe G, Gyamfi J
Outcomes with angiotensin-converting enzyme inhibitors vs other antihypertensive agents in hypertensive blacks.
The study’s objective was to evaluate the effectiveness of angiotensin-converting enzyme inhibitors when compared with other antihypertensive agents in hypertensive blacks. It found that in a large cohort of hypertensive blacks, angiotensin-converting enzyme inhibitors were associated with less benefit when compared with calcium channel blockers or thiazide diuretics.
AHRQ-funded; HS018589.
Citation: Bangalore S, Ogedegbe G, Gyamfi J .
Outcomes with angiotensin-converting enzyme inhibitors vs other antihypertensive agents in hypertensive blacks.
Am J Med 2015 Nov;128(11):1195-203. doi: 10.1016/j.amjmed.2015.04.034..
Keywords: Blood Pressure, Racial and Ethnic Minorities, Medication, Outcomes, Cardiovascular Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice, Comparative Effectiveness
Weiss JW, Peters D, Yang X
Systolic BP and mortality in older adults with CKD.
This study sought to determine whether a nonlinear relationship between BP and mortality - as described for the broader chronic kidney disease (CKD) population and for older adults in the general population - is present for older adults with CKD. It found that in a cohort of older adults, a relationship between higher SBP and mortality was present only for younger members of this cohort and not for those older than 70.
AHRQ-funded; HS019456.
Citation: Weiss JW, Peters D, Yang X .
Systolic BP and mortality in older adults with CKD.
Clin J Am Soc Nephrol 2015 Sep 4;10(9):1553-9. doi: 10.2215/cjn.11391114.
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Keywords: Blood Pressure, Mortality, Elderly, Kidney Disease and Health
Buys DR, Howard VJ, McClure LA
Association between neighborhood disadvantage and hypertension prevalence, awareness, treatment, and control in older adults: results from the University of Alabama at Birmingham Study of Aging.
The investigators evaluated the effect of neighborhood disadvantage (ND) on older adults' prevalence, awareness, treatment, and control of hypertension. Using data from the University of Alabama at Birmingham Study of Aging along with US Census data, they created tertiles of ND and found that living in mid-ND and high-ND tertiles was associated with higher hypertension prevalence, and living in high-ND tertiles was further associated with lower odds of controlled hypertension.
AHRQ-funded; HS019465; HS013852.
Citation: Buys DR, Howard VJ, McClure LA .
Association between neighborhood disadvantage and hypertension prevalence, awareness, treatment, and control in older adults: results from the University of Alabama at Birmingham Study of Aging.
Am J Public Health 2015 Jun;105(6):1181-8. doi: 10.2105/ajph.2014.302048.
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Keywords: Elderly, Blood Pressure, Low-Income, Social Determinants of Health, Cardiovascular Conditions, Chronic Conditions
Wallace ML, Magnan EM, Thorpe CT
Diagnosis and treatment of incident hypertension among patients with diabetes: a U.S. multi-disciplinary group practice observational study.
The researchers aimed to evaluate rates and associations of hypertension diagnosis and treatment among patients with diabetes mellitus and incident hypertension. They found that among patients with diabetes mellitus, even using a cut-point of 140/90 mmHg, approximately 50 percent remained undiagnosed and untreated for hypertension.
AHRQ-funded; HS018368.
Citation: Wallace ML, Magnan EM, Thorpe CT .
Diagnosis and treatment of incident hypertension among patients with diabetes: a U.S. multi-disciplinary group practice observational study.
J Gen Intern Med 2015 Jun;30(6):768-76. doi: 10.1007/s11606-015-3202-0..
Keywords: Blood Pressure, Diabetes, Diagnostic Safety and Quality, Chronic Conditions
Zhao B, Jose PO, Pu J
Racial/ethnic differences in hypertension prevalence, treatment, and control for outpatients in Northern California 2010-2012.
The purpose of this paper is to study the prevalence, treatment, and control of hypertension among rapidly--growing minority groups. The authors found substantial racial/ethnic variation in hypertension prevalence, treatment, and control in the study population in northern California. Filipino and non-Hispanic black women and men are at especially high risk for hypertension and may have more difficulty in achieving adequate blood pressure control.
AHRQ-funded; HS019815.
Citation: Zhao B, Jose PO, Pu J .
Racial/ethnic differences in hypertension prevalence, treatment, and control for outpatients in Northern California 2010-2012.
Am J Hypertens 2015 May;28(5):631-9. doi: 10.1093/ajh/hpu189.
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Keywords: Blood Pressure, Racial and Ethnic Minorities, Cardiovascular Conditions, Medication, Ambulatory Care and Surgery
Zhou M, Daubresse M, Stafford RS
National trends in the ambulatory treatment of hypertension in the United States, 1997-2012.
The researchers examined trends in the use of antihypertensive therapies in the United States between 1997 and 2012. They found that annual hypertension treatment visits increased from 56.9 million treatment visits in 1997 to 83.3 million visits in 2008, then declined steadily to 70.9 million visits in 2012.
AHRQ-funded; HS018960.
Citation: Zhou M, Daubresse M, Stafford RS .
National trends in the ambulatory treatment of hypertension in the United States, 1997-2012.
PLoS One 2015 Mar 4;10(3):e0119292. doi: 10.1371/journal.pone.0119292..
Keywords: Blood Pressure, Ambulatory Care and Surgery, Medication
Bateman BT, Huybrechts KF, Fischer MA
Chronic hypertension in pregnancy and the risk of congenital malformations: a cohort study.
The researchers sought to examine the effect of chronic hypertension on the risk of congenital malformations in a large cohort of pregnancies in Medicaid beneficiaries. In a cohort of 878,126 pregnancies, they found that both treated and untreated maternal chronic hypertension were associated with a similar 20-30 percent increase in the risk of congenital malformations in the infant after adjusting for confounding factors as compared with normotensive controls.
AHRQ-funded; HS018533.
Citation: Bateman BT, Huybrechts KF, Fischer MA .
Chronic hypertension in pregnancy and the risk of congenital malformations: a cohort study.
Am J Obstet Gynecol 2015 Mar;212(3):337.e1-14. doi: 10.1016/j.ajog.2014.09.031..
Keywords: Blood Pressure, Chronic Conditions, Pregnancy, Risk, Maternal Care, Women
Mabry-Hernandez I, Chu K
AHRQ Author: Mabry-Hernandez I
Screening for primary hypertension in children and adolescents.
This article presents a case study about a 14-year-old black adolescent who presents for a routine school physical examination. Her mother tells you that she and her husband have hypertension, and they worry about their daughter’s blood pressure. She asks you whether her child should be periodically checked for high blood pressure. The case study was coordinated with the AHRQ-administered US Preventive Services Task Force and published online on the American Academy of Family Practice website.
Citation: Mabry-Hernandez I, Chu K .
Screening for primary hypertension in children and adolescents.
Am Fam Physician 2015 Feb 15;91(4):257-8..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Blood Pressure, Screening, Evidence-Based Practice, Guidelines, Prevention, Case Study