We know the facts: High blood pressure (or hypertension) can lead to cardiovascular events such as heart attacks and strokes. But what may be surprising is the number of people in the United States who have high blood pressure and are both unaware of it and untreated for it – 11.5 million. Most of these people have a regular source of care, and thus, are “hiding in plain sight” with undiagnosed hypertension. A group of 10 health centers involved in a Centers for Disease Control and Prevention (CDC)-funded project decided to test new population health approaches to find these patients hiding in plain sight – patients who, once diagnosed, could be treated so they could control their blood pressure.
Hypertension is the most common chronic condition diagnosed among patients served in the safety net in the United States. However, many safety-net patients with hypertension are not formally diagnosed and may remain untreated and at increased risk for cardiovascular events. CDC’s Million Hearts program worked with NACHC on a demonstration project involving 10 health centers in Arkansas, California, Kentucky, and Missouri. Identifying undiagnosed hypertension using algorithmic logic programmed into clinical decision support (CDS) approaches is a promising practice but has not been broadly tested in the safety-net setting.
As Heart Month draws to a close, we want to highlight “Improving Identification and Diagnosis of Hypertensive Patients Hiding in Plain Sight (HIPS) in Health Centers,” an article published online in the March issue of The Joint Commission Journal on Quality and Patient Safety. The article examines the use of algorithmic logic for identifying patients with possible undiagnosed hypertension to improve hypertension detection and diagnosis in health centers.
The results of the demonstration project were impressive:
- In 17 months, 1,785 patients who were previously undiagnosed for hypertension and “hiding in plain sight” were diagnosed with hypertension (based on 8 health centers’ data).
- 31.9% of patients identified by the HIPS algorithm who had a follow up blood pressure evaluation were diagnosed with hypertension.
Nearly all of the health centers involved said they were surprised that they had patients hiding in plain sight. Most thought since they took patients’ blood pressure as part of the standard vitals for each visit, they weren’t missing people who should be diagnosed. It was a real eye-opener. But using data-driven strategies coupled with patient engagement and a focus on accuracy of blood pressure measurement has made health centers leaders in providing the highest quality care to patients.