Disparities in Hypertension Control Across and Within Three Health Systems Participating in a Data-Sharing Collaborative.
- Selby K From the Kaiser Permanente Division of Research, Oakland, CA (KS); Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland (KS); Department of Family and Community Medicine, University of California-San Francisco, San Francisco (MM, GG, RP, MBP); Division of General Internal Medicine, Multiethnic Health Equity Research Center, University of California-San Francisco, San Francisco (LK, VF); UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco (VF).
- Michel M From the Kaiser Permanente Division of Research, Oakland, CA (KS); Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland (KS); Department of Family and Community Medicine, University of California-San Francisco, San Francisco (MM, GG, RP, MBP); Division of General Internal Medicine, Multiethnic Health Equity Research Center, University of California-San Francisco, San Francisco (LK, VF); UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco (VF).
- Gildengorin G From the Kaiser Permanente Division of Research, Oakland, CA (KS); Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland (KS); Department of Family and Community Medicine, University of California-San Francisco, San Francisco (MM, GG, RP, MBP); Division of General Internal Medicine, Multiethnic Health Equity Research Center, University of California-San Francisco, San Francisco (LK, VF); UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco (VF).
- Karliner L From the Kaiser Permanente Division of Research, Oakland, CA (KS); Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland (KS); Department of Family and Community Medicine, University of California-San Francisco, San Francisco (MM, GG, RP, MBP); Division of General Internal Medicine, Multiethnic Health Equity Research Center, University of California-San Francisco, San Francisco (LK, VF); UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco (VF).
- Pramanik R From the Kaiser Permanente Division of Research, Oakland, CA (KS); Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland (KS); Department of Family and Community Medicine, University of California-San Francisco, San Francisco (MM, GG, RP, MBP); Division of General Internal Medicine, Multiethnic Health Equity Research Center, University of California-San Francisco, San Francisco (LK, VF); UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco (VF).
- Fontil V From the Kaiser Permanente Division of Research, Oakland, CA (KS); Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland (KS); Department of Family and Community Medicine, University of California-San Francisco, San Francisco (MM, GG, RP, MBP); Division of General Internal Medicine, Multiethnic Health Equity Research Center, University of California-San Francisco, San Francisco (LK, VF); UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco (VF).
- Potter MB From the Kaiser Permanente Division of Research, Oakland, CA (KS); Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland (KS); Department of Family and Community Medicine, University of California-San Francisco, San Francisco (MM, GG, RP, MBP); Division of General Internal Medicine, Multiethnic Health Equity Research Center, University of California-San Francisco, San Francisco (LK, VF); UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco (VF). Michael.potter@ucsf.edu.
- 2018-11-11
Published in:
- Journal of the American Board of Family Medicine : JABFM. - 2018
Blood Pressure
Hypertension
Multivariate Analysis
Primary Health Care
Retrospective Studies Quality Improvement
Adult
Aged
Aged, 80 and over
Antihypertensive Agents
Blood Pressure
Blood Pressure Determination
Female
Healthcare Disparities
Humans
Hypertension
Male
Medically Uninsured
Middle Aged
Practice Guidelines as Topic
Practice Patterns, Physicians'
Primary Health Care
Quality Improvement
Retrospective Studies
San Francisco
Treatment Outcome
Young Adult
English
INTRODUCTION
We aimed to standardize data collection from 3 health systems (HS1, HS2, HS3) participating in the San Francisco Bay Collaborative Research Network, and compare rates and predictors of uncontrolled blood pressure among hypertensive adults to identify opportunities for regional collaboration in quality improvement.
METHODS
Retrospective cohort study using deidentified electronic health record data from all primary care patients with at least 1 visit in a 2-year period, using standard data definitions in a common data repository. Primary outcome was uncontrolled blood pressure at the most recent primary care visit.
RESULTS
Of 169,793 adults aged 18 to 85 years, 53,133 (31.3%) had a diagnosis of hypertension. Of these, 18,751 (35%) had uncontrolled blood pressure at their last visit, with the proportion varying by system (29%, HS1; 31%, HS2; and 44%, HS3) and by clinical site within each system. In multivariate analyses, differences between health systems persisted, with HS2 and HS3 patients having a 1.15 times (95% CI, 1.11 to 1.19) and 1.46 times (95% CI, 1.42 to 1.50) greater relative risk of uncontrolled blood pressure compared with HS1. Across health systems, hypertensive patients were more likely to have uncontrolled blood pressure if they were uninsured, African Americans, current smokers, obese, or had fewer than 2 primary care visits during the 2-year measurement period.
CONCLUSIONS
After controlling for standard individual predictors of hypertension control, significant and substantial differences in hypertension control persisted between health systems, possibly due to local quality improvement programs among other factors. There may be opportunities to share best practices and address common disparities across health systems.
We aimed to standardize data collection from 3 health systems (HS1, HS2, HS3) participating in the San Francisco Bay Collaborative Research Network, and compare rates and predictors of uncontrolled blood pressure among hypertensive adults to identify opportunities for regional collaboration in quality improvement.
METHODS
Retrospective cohort study using deidentified electronic health record data from all primary care patients with at least 1 visit in a 2-year period, using standard data definitions in a common data repository. Primary outcome was uncontrolled blood pressure at the most recent primary care visit.
RESULTS
Of 169,793 adults aged 18 to 85 years, 53,133 (31.3%) had a diagnosis of hypertension. Of these, 18,751 (35%) had uncontrolled blood pressure at their last visit, with the proportion varying by system (29%, HS1; 31%, HS2; and 44%, HS3) and by clinical site within each system. In multivariate analyses, differences between health systems persisted, with HS2 and HS3 patients having a 1.15 times (95% CI, 1.11 to 1.19) and 1.46 times (95% CI, 1.42 to 1.50) greater relative risk of uncontrolled blood pressure compared with HS1. Across health systems, hypertensive patients were more likely to have uncontrolled blood pressure if they were uninsured, African Americans, current smokers, obese, or had fewer than 2 primary care visits during the 2-year measurement period.
CONCLUSIONS
After controlling for standard individual predictors of hypertension control, significant and substantial differences in hypertension control persisted between health systems, possibly due to local quality improvement programs among other factors. There may be opportunities to share best practices and address common disparities across health systems.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.3122/jabfm.2018.06.180166
- PMID 30413545
- Persistent URL
- https://sonar.ch/global/documents/186127
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