Quality improvement program narrows systemwide racial disparities in BP control
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A Kaiser Permanente Southern California quality improvement program reduced but did not entirely eliminate racial disparities in BP control between Black and white patients, researchers reported.
The largest reductions in BP control disparity were observed between Black and white women aged 50 to 64 years and Black and white men aged 18 to 49 years, according to a study published in JAMA Network Open.
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“This study looked at more than 600,000 Kaiser Permanente Southern California patients with hypertension and compared the time before the program was implemented to after implementation,” Kristi Reynolds, PhD, MPH, director of the division of epidemiologic research at Kaiser Permanente Southern California, told Healio. “We found that between 2008 and 2019, the racial disparities in BP control were nearly halved, with the largest reductions in disparities among: Black and white women aged 50 to 64 years, with a reduction of 61%, and Black and white men aged 18 to 49 years, with a reduction of 45%. Despite these large reductions, the disparity in BP control between Black and white individuals persisted, particularly in the younger age groups, which also has been reported in other U.S. populations.”
Implementation of the quality improvement program
In 2004, KPSC launched its multifaceted quality improvement hypertension program, including a population care management registry, to improve the identification and treatment of patients with hypertension, according to the study.
The program included the following:
- monthly performance feedback for physicians with physician-specific performance data on BP control rates;
- tailored outreach to Black patients with uncontrolled BP via letters with physician photos and voice recordings by their primary care physician;
- panel management programs for Black patients who have not previously used thiazides or are not on optimal lisinopril-hydrochlorothiazide doses;
- African American storytelling videos with Kaiser Permanente patients distributed to all regional medical centers for viewing in waiting rooms and provided to patients with uncontrolled BP;
- large group appointments;
- clinician and staff education programs around building trust and integrating culturally tailored communication tools; and
- patient education emphasizing a low-sodium diet, DASH diet, smoking cessation, exercise, weight reduction and medication adherence.
A study published in The Permanente Journal showed that although BP control increased after implementation of the quality improvement program in the KPSC population, racial and ethnic disparities persisted.
For the present study, researchers conducted a difference-in-difference analysis to assess change in BP control among Black and white patients from before (2008-2009) and after (2016-2019) the implementation of the quality improvement initiative.
Changes in BP control
Researchers reported that the total number of patients with hypertension increased from 624,094 in 2008 (mean age, 62 years; 53% women; 14.3% Black; 45.5% white) to 855,257 in 2019 (mean age, 65 years; 52% women; 12.5% Black; 38.8% white).
From before to after implementation of the quality improvement program, BP control increased 4.6% among Black patients compared with 2.1% among white patients (difference-in-difference, 2.5 percentage points; 95% CI, 2.2-2.8).
Researchers observed the largest reduction in BP control disparity between Black and white women aged 50 to 64 years (difference-in-difference, 3.8 percentage points; 95% CI, 3.2-4.4) and between Black and white men aged 18 to 49 years (difference-in-difference, 4.2 percentage points; 95% CI, 3-5.5).
Moreover, BP control among Black men aged 18 to 49 years between 2008 and 2019 was lower compared with men and women in other age and racial and ethnic groups, according to the study.
“Our work in reducing and eliminating disparities with BP control will continue. This study has shown us quality improvement programs can have an impact on BP control,” Reynolds told Healio. “That gives us reassurance we are on the right path, and hope that as other health care organizations step up their quality improvement in this area, that they, too, will see those disparities be reduced or eliminated.”
For more information:
Kristi Reynolds, PhD, MPH, can be reached at kristi.reynolds@kp.org.
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