Peer Comparison Feedback to Providers to Improve Hypertension Control

Hypertension (HTN) affects about 30% of US adults, and effective treatment that reduces long-term risk of subsequent cardiovascular disease is widely available; however, only about half of adults maintain good control. HTN control requires diagnosis, initiation of treatment, adherence to medications, and titration of medications. The investigators' prior work from Way2Text and SupportBP showed that there is significant clinical inertia in escalating medications for HTN through increasing dosage or adding new medications.

Prior studies have shown that providing feedback to providers with peer comparison data can leverage social norms to improve evidence-based practices in antibiotic and statin prescribing. Penn Medicine Lancaster General Primary Care is rolling out a Hypertension Control Implementation Plan (HCIP) as an initiative to improve hypertension control through creation of a clinic-based pathway to identify patients with hypertension, appropriately measure blood pressure, and prescribe medications to reduce blood pressure. Busy PCPs have competing demands of care, so there is an opportunity to leverage peer comparison to nudge providers to adhere to the HCIP and intensify medications.

The study design is a stratified parallel-group cluster-randomized trial. PCPs will be randomized in a 1:1 ratio, stratified by practice, to either: 1) Control: Usual Care- This will include the standard HCIP roll-out, and PCPs can access their HTN control rates using the existing EPIC dashboard.

Inclusion criteria

• Primary Care Providers who have at =>30 patients hypertension as determined by the HTN quality metric
• Patients aged 18-85 with hypertension in their encounter diagnosis within the last 2 years (office visits, ED/Urgent Care, Hospital, Hospital Encounter, and Prenatal Visit)
• Patients will be counted in the denominator of the quality metric if they have both systolic and diastolic BP measures from an encounter with their PCP department within the last year (including office visits, well child, prenatal visit, consult visit, confidential, e-visit, nursing only, home/offsite visit, and telemedicine) that is >140 for systolic BP and >90 diastolic BP

Exclusion criteria

• Primary Care Providers includes providers with <30 patients in the HTN quality metric
• Patients will be excluded if they are 66 and older with a frailty diagnosis and those with an advanced illness diagnosis within the past year; 81 and older with frailty diagnosis within the past year
• It also excludes patients with end stage renal disease (indicated by evaluation of the GFR, diagnosis of end stage renal disease in last year, dialysis received in last year, or renal transplant) and patients with a pregnancy diagnosis in the last 9 months
• It also excludes patients with an end of life indicator (comfort care encounter in last year, comfort care noted in problem list in last year, and comfort care/palliative care procedures in last year)