Table 5.
Qualitative Excerpts Demonstrating Pathways Linked to a ≥10-Point Gain in BP Outcome
| Pathway | Excerpt |
|---|---|
| Measurement training: educated practice staff about how to take an accurate BP AND Solo practice |
We gave different tips on making sure that [the patient is] keeping both feet on the floor, [their] back is supported, they have an empty bladder, they’re not talking. Different tips like that to try to help patients lower their blood pressure. My biggest thing for all my providers that I recommended is to not talk to the patient while you’re doing it. Because I know most nurses or MAs are still trying to collect information while they’re taking blood pressure. (Facilitator interview; solo practice; clinician owned) [I] brought his nurse in, and the 3 of us [the facilitator, nurse, and clinician] went through proper blood pressure measurement. I printed out this PowerPoint that we had. ... We went, step by step, how to take the blood pressure. (Facilitator interview; solo practice; clinician owned) |
| Take second BP: took second BP during visit if first was elevated AND Documentation: practice developed method for documenting second or home BP as a discrete field in EHR AND Clinician ownership |
We’re on the third floor so some patients say, “Oh, great. I’ll take the stairs.” By the time they get here their blood pressure is high, or else they’re late and they’re frantic, or they’ve been fighting the ice and snow, traffic, whatever. So, we get a high blood pressure reading and the MAs didn’t know to retake it at the end of the visit. ... Also understanding which [blood pressure] to record in our EHR and which is counted. If they take 3 blood pressures during the course of the appointment, which one is the one that’s pulling or counting? We had to do some digging and ask some questions and figure all that out. (Practice interview; 2-5 clinicians; clinician owned) |
| Take second BP: took second BP during visit if first was elevated AND ≥50 facilitation hours |
We did workflow-mapping exercises, which [the practice] really liked. What I appreciated is they really spent time thinking about the workflow, and what worked and what didn’t. Whether the BP should be done again before—for example, before the patient sees the provider. (Facilitator interview; ≥11 clinicians; FQHC; facilitation duration 5 [≥50 hours with a facilitator]) |
| Measurement training: educated practice staff about how to take an accurate BP AND 10-24.9 facilitation hours |
They weren’t aware of the 5-minute rule, waiting, making sure the patient wasn’t talking, feet on the floor. We did some training, internal training, of how to take a blood pressure properly. That went over well. All of the MAs, all the providers, medical staff, went to the training. (Facilitator interview; 2-5 clinicians; system owned; facilitation duration 3 [10-24.9 hours with a facilitator]) |
BP = blood pressure; EHR = electronic health record; FQHC = Federally Qualified Health Center; MA = medical assistant.