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Evaluation of a collaborative VA network initiative to reduce racial disparities in blood pressure control among veterans with severe hypertension.

Burkitt KH, Rodriguez KL, Mor MK, Fine MJ, Clark WJ, Macpherson DS, Mannozzi CM, Muldoon MF, Long JA, Hausmann LRM. Evaluation of a collaborative VA network initiative to reduce racial disparities in blood pressure control among veterans with severe hypertension. Healthcare (Amsterdam, Netherlands). 2021 Jun 1; 8 Suppl 1:100485.

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Abstract:

BACKGROUND: Compared to White patients in the United States, Black patients have a higher prevalence of hypertension and more severe forms of this condition. OBJECTIVE: To decrease racial disparities in blood pressure (BP) control among Black veterans with severe hypertension within a regional network of Veterans Affairs Medical Centers (VAMCs). METHODS: Health system leaders, clinicians, and health services researchers collaborated on a 12-month quality improvement (QI) project to: (1) examine project implementation and the QI strategies used to improve BP control and (2) assess the effect of the initiative on Black-White differences in BP control among veterans with severe hypertension. RESULTS: Within 9 participating VAMCs, the most frequently used QI strategies involved provider education (n = 9), provider audit and feedback (n = 8), and health care team change (n = 7). Among 141,124 veterans with a diagnosis of hypertension, 9,913 had severe hypertension [2,533 (25.6%) Black and 7380 (74.4%) White]. Over the course of the project, the proportion of Black veterans with severe hypertension decreased from 7.5% to 6.6% (p = .002) and the racial difference in proportions for this condition decreased 0.9 percentage points, from 2.9% to 2.0% (p = .01). CONCLUSIONS: A multicenter, equity-focused QI project in VA reduced the proportion of Black veterans with severe hypertension and ameliorated observed racial disparities for this condition. Embedding health services researchers within a QI team facilitated an evaluation of the processes and effectiveness of our initiative, providing a successful model for QI within a learning health care system.





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