Measure Components	The CDU relies on various available components of team-based care in clinical settings for patients with HBP, which may include:
	• Pharmacists
	• RNs/APRNs
	• Physician assistants
	• Medical assistants
	• Community health workers
	• Integrated care managers
	• Social workers
	• Behavioral interventionists
	• Trainees
	• Algorithms to support clinicians
	• EHR support (BP recording, actionable prompts for clinicians, population health management)
	• Remote HBPM (EHR integration)
	• Monitoring performance metrics
	• Population health management
	• Telephone-based follow-up
	• Regular team meetings (best practice updates, workflow evaluation)
	• Assigned roles and responsibilities (patient and clinicians, clarity about team member roles)
	• *Optional: SM-4: EHR to diagnose and assess, SM-8: use of telehealth, SM-10: performance measurement
	Goals of team-based care:
	• Improve clinical workflow
	• Patient education
	• Closer follow-up of BP after initiation
	• Medication titration
	• Laboratory follow-up
	• Improved adherence
	• Lower clinician burn-out193
	Checklist
	Goal: To optimize outpatient hypertension management (to be specifically stated as team’s purpose/responsibility).
	Team Members:
	• Lead clinician (at least 1): APRN or physician
	• Clinical support (at least 1): pharmacist, nurse, physician assistant, medical assistant, community health worker, care manager, or EHR support modules specific to hypertension
	• Administrative support (at least 1): scheduler, receptionist
	• Expert referral (onsite or external): designated referral system for refractory patients: cardiologist, nephrologist, endocrinologist
	Team meetings: regular meetings on at least a quarterly basis to evaluate delivery of care for patients with hypertension.
	Performance monitoring: Use of PM 1–5 and QM 1–6 for feedback on performance and quality of care.
	Program elements (at least 2):
	1. Patient educational materials or sessions on hypertension.
	2. Availability of BP-specific follow-up in 1 mo (telephone based, with HBPM, telehealth, or clinical support or clinician follow-up).
	3. Ability of patients to contact team-based care team in a timely fashion about hypertension concerns (telephone, secure EHR messaging, email, urgent appointments).
	4. Algorithm for medication titration led by clinical support team member and lead clinician supervision.
	5. Timely follow-up and monitoring of laboratory results, with titration of relevant drug classes.
	6. Monitoring adherence by using pharmacy fill data.
	7. Provider-specific performance reports with hypertension metrics.
Rationale
RCTs and meta-analyses of RCTs of team-based hypertension care involving nurse or pharmacist intervention demonstrated reductions in SBP and DBP and/or greater achievement of BP goals when compared with usual care.194–197
Similarly, systematic reviews of team-based care for patients with primary hypertension, including a review of studies that included community health workers, showed reductions in SBP and DBP and improvements in BP control, appointment keeping, and hypertension medication adherence as compared with usual care.198,199
Team-based care can be defined by numerous structures that are functional and improve care in various settings and patient populations. Inherently, they try to provide a division of labor and improved workflows so that the delivery of quality care is maximized/optimized. Disease-management-specific programs and protocols help identify areas to improve workflow and patient-centered care.
AHRQ summary statement of team-based care: “the primary goal of medical teamwork is to optimize the timely and effective use of information, skills, and resources by teams of health care professionals for the purpose of enhancing the quality and safety of patient care.”200
Clinical Recommendations
2017 Hypertension Clinical Practice Guidelines4
Recommendation for Structured, Team-Based Care Interventions for Hypertension Control (Guideline Sections 8.3.2 and 12.2)
1. A team-based care approach is recommended for adults with hypertension.194–197,199,201,202 (Class 1, Level of Evidence: A)
2. For older adults (≥65 y of age) with hypertension and a high burden of comorbidity and limited life expectancy, clinical judgment, patient preference, and a team-based approach to assess risk/benefit are reasonable for decisions regarding intensity of BP lowering and choice of antihypertensive drugs. (Class 2a, Level of Evidence: C-EO)
3. Follow-up and monitoring after initiation of drug therapy for hypertension control should include systematic strategies to help improve BP, including use of HBPM, team-based care, and telehealth strategies.47,203–207 (Class 1, Level of Evidence: A)

ACC indicates American College of Cardiology; AHA, American Heart Association; AHRQ, Agency for Healthcare Research and Quality; APRN, advanced practice registered nurse; BP, blood pressure; CDU, care delivery unit; DBP, diastolic blood pressure; EHR, electronic health record; HBP, high blood pressure; HBPM, home blood pressure monitoring; NAM, National Academy of Medicine; PM, performance measure; QM, quality measure; RCTs, randomized controlled trials; RN, registered nurse; SM, structural measure; and SBP, systolic blood pressure.