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Improving the quality of blood pressure measurements in an outpatient diabetes clinic
  1. Jennifer J Iyengar1,
  2. Matthew Johnson1,
  3. Shafaq Khairi1,
  4. Jessica E Fennelly2,
  5. Jennifer Wyckoff1
  1. 1Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
  2. 2Pharmacy Innovations and Partnerships, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Jennifer J Iyengar; jmacd{at}


Hypertension is an important modifiable risk factor for cardiovascular disease in patients with diabetes. Despite established guidelines, the percentage of patients meeting the target blood pressure (BP) of <140/90 mm Hg in clinic remains suboptimal. In this project, we sought to improve BP measurement in an outpatient diabetes clinic.

Two interventions were performed: (1) Changes were made to the timing of BP measurement during patient intake and (2) An electronic medical record (EMR) alert reminded staff to repeat BP if the initial reading was above target. Baseline data were collected on 4764 patients, with 72.5% meeting their BP target. After implementation of changes to the timing of BP measurement during patient intake, 73.3% of patients met the target (no significant change). However, after implementation of the EMR alert, there was a statistically significant improvement in patients meeting the target BP at 76.8% (p<0.01). This reduction was driven by the high percentage of patients with an initially elevated BP measurement that came down into goal range on repeat measurement. Those who remained above target despite multiple readings could be referred to a new pharmacist-led hypertension clinic to ensure adequate follow-up and medication adjustment.

It is important to ensure that in clinic BP measurements are taken correctly and adhere to best practices. Use of a single in-clinic BP measurement may result in overtreatment of hypertension. While timing of BP measurement during patient intake was not important, repeating high BP measurements did improve the number of patients in an outpatient diabetes clinic meeting their BP target.

  • continuous quality improvement
  • quality improvement
  • performance measures

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  • Contributors JW initiated the project and designed the interventions used in the PDSA cycles. MJ served as project manager. He oversaw the implementation of the PDSA cycles in the clinic and worked with clinic leadership to ensure staff had appropriate training in new protocols and workflows. MJ also worked with Quality Analytics to extract the data. JJI assisted with the implementation of the PDSA cycles, communicated results of each cycle with faculty to elicit feedback and performed the data analysis. JJI also took the lead in writing the manuscript. JEF worked with the project team to initiate the follow-up hypertension clinic and served as the PharmD of the clinic. She wrote sections of the manuscript pertaining to the hypertension clinic. SK was part of the project team and assisted with the design and implementation of the PDSA cycles and wrote the background portions of the manuscript. Each of the authors has revised and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The project was submitted to the Institutional Review Board of the University of Michigan and was deemed non-regulated as a clinical quality assurance activity (HUM00127059).

  • Data availability statement All data relevant to the study are included in the article.

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