Feasibility and Outcomes of an Electronic Health Record Intervention to Improve Hypertension Management in Immigrant-serving Primary Care Practices

Priscilla M. Lopez, Anna Divney, Keith Goldfeld, Jennifer Zanowiak, Radhika Gore, Rashi Kumar, Phoebe Laughlin, Ronald Sanchez, Susan Beane, Chau Trinh-Shevrin, Lorna Thorpe, Nadia Islam

Research output: Contribution to journalArticle

Abstract

Background: South Asians experience a disproportionate burden of high blood pressure (BP) in the United States, arguably the most preventable risk factor for cardiovascular disease. Objective: We report 12-month results of an electronic health record (EHR)-based intervention, as a component of a larger project, "Implementing Million Hearts for Provider and Community Transformation." The EHR intervention included launching hypertension patient registries and implementing culturally tailored alerts and order sets to improve hypertension control among patients treated in 14 New York City practices located in predominantly South Asian immigrant neighborhoods. Design: Using a modified stepped-wedge quasi-experimental study design, practice-level EHR data were extracted, and individual-level data were obtained on a subset of patients insured by a Medicaid insurer via their data warehouse. The primary aggregate outcome was change in proportion of hypertensive patients with controlled BP; individual-level outcomes included average systolic BP (SBP) and diastolic BP (DBP) at last clinic visit. Qualitative interviews were conducted to assess intervention feasibility. Measures: Hypertension was defined as having at least 1 hypertension ICD-9/10 code. Well-controlled hypertension was defined as SBP<140 and DBP<90 mm Hg. Results: Postintervention, we observed a significant improvement in hypertension control at the practice level, adjusting for age and sex patient composition (adjusted relative risk, 1.09; 95% confidence interval, 1.04-1.14). Among the subset of Medicaid patients, we observed a significant reduction in average SBP and DBP adjusting for time, age, and sex, by 1.71 and 1.13 mm Hg, respectively (P<0.05). Providers reported feeling supported and satisfied with EHR components. Conclusions: EHR initiatives in practices serving immigrants and minorities may enhance practice capabilities to improve hypertension control.

Original languageEnglish (US)
Pages (from-to)S164-S171
JournalMedical care
Volume57
DOIs
StatePublished - Jun 1 2019

Fingerprint

Electronic Health Records
Primary Health Care
Hypertension
Blood Pressure
Medicaid
International Classification of Diseases
Insurance Carriers
Ambulatory Care
Health Status
Registries
Emotions
Research Design
Cardiovascular Diseases
Confidence Intervals
Interviews

Keywords

  • community-clinical linkages
  • electronic health record (EHR)
  • health information technology (HIT)
  • hypertension
  • immigrant health
  • million hearts initiative
  • South Asians

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Feasibility and Outcomes of an Electronic Health Record Intervention to Improve Hypertension Management in Immigrant-serving Primary Care Practices. / Lopez, Priscilla M.; Divney, Anna; Goldfeld, Keith; Zanowiak, Jennifer; Gore, Radhika; Kumar, Rashi; Laughlin, Phoebe; Sanchez, Ronald; Beane, Susan; Trinh-Shevrin, Chau; Thorpe, Lorna; Islam, Nadia.

In: Medical care, Vol. 57, 01.06.2019, p. S164-S171.

Research output: Contribution to journalArticle

Lopez, PM, Divney, A, Goldfeld, K, Zanowiak, J, Gore, R, Kumar, R, Laughlin, P, Sanchez, R, Beane, S, Trinh-Shevrin, C, Thorpe, L & Islam, N 2019, 'Feasibility and Outcomes of an Electronic Health Record Intervention to Improve Hypertension Management in Immigrant-serving Primary Care Practices', Medical care, vol. 57, pp. S164-S171. https://doi.org/10.1097/MLR.0000000000000994
Lopez, Priscilla M. ; Divney, Anna ; Goldfeld, Keith ; Zanowiak, Jennifer ; Gore, Radhika ; Kumar, Rashi ; Laughlin, Phoebe ; Sanchez, Ronald ; Beane, Susan ; Trinh-Shevrin, Chau ; Thorpe, Lorna ; Islam, Nadia. / Feasibility and Outcomes of an Electronic Health Record Intervention to Improve Hypertension Management in Immigrant-serving Primary Care Practices. In: Medical care. 2019 ; Vol. 57. pp. S164-S171.
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AU - Zanowiak, Jennifer

AU - Gore, Radhika

AU - Kumar, Rashi

AU - Laughlin, Phoebe

AU - Sanchez, Ronald

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AU - Thorpe, Lorna

AU - Islam, Nadia

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