Abstract: PUB427
A System-Based Initiative to Improve Screening for Primary Aldosteronism (PA) in Patients with Resistant Hypertension
Session Information
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Airy, Medha, Baylor College of Medicine, Houston, Texas, United States
- Fordis, Michael, Baylor College of Medicine, Houston, Texas, United States
- Mcneal, Tresa, Baylor Scott & White Medical Center Temple, Temple, Texas, United States
- Meeks, Derek, Baylor College of Medicine, Houston, Texas, United States
- Minor, Jacob Steven, Baylor Scott & White Medical Center Temple, Temple, Texas, United States
- Murphy, Daniel R., Baylor College of Medicine, Houston, Texas, United States
- Mcneal, Michael J., Baylor Scott & White Medical Center Temple, Temple, Texas, United States
- King, Jason E., Baylor College of Medicine, Houston, Texas, United States
- O'Connor, Michael, Baylor College of Medicine, Houston, Texas, United States
- Mendoza, Abraham, Baylor College of Medicine, Houston, Texas, United States
- Narayanan, Mohanram, Baylor Scott & White Medical Center Temple, Temple, Texas, United States
- Bedrose, Sara, Baylor College of Medicine, Houston, Texas, United States
- Sarkar, Arindam, Baylor College of Medicine, Houston, Texas, United States
- Ramm, Jason D., Baylor College of Medicine, Houston, Texas, United States
- Laubscher, Rory R., Baylor College of Medicine, Houston, Texas, United States
- Coots, Penny M., Baylor Scott & White Medical Center Temple, Temple, Texas, United States
- Janek, Hania, Baylor Scott & White Medical Center Temple, Temple, Texas, United States
- Balasubramanyam, Ashok, Baylor College of Medicine, Houston, Texas, United States
- Winter, F David D., Baylor Scott & White Medical Center Temple, Temple, Texas, United States
Background
PA is increasingly recognized as an under-screened etiology of resistant hypertension for all patients including those with chronic kidney disease. The specific aim was to increase the screening rates for PA by 25% over baseline.
Methods
The study aimed to change PA screening and referral practices of primary care clinicians operating in two diverse health systems: a health science university [HSU] and a large health system [HS]. Customized interventions, adapted to each system’s workflow, included live meetings; online modules in an indexed library to support just-in-time education, and point-of care education delivered via the EHR using a best practice advisory (BPA) to identify patients at risk for PA. Each health system collected data on three targeted metrics measured pre- and post-intervention: overall screening rates for PA [primary metric], referrals of patients with positive screening results to appropriate subspecialty department (i.e., nephrology, endocrinology, cardiology), and total diagnoses of PA after controlling for patient populations [secondary metrics].
Results
For the primary metric, baseline screening rates of 1.4% (HSU) and 0.015% (HS) of patients improved at post intervention to 7.1% (~5-fold increase) and 0.117% (~8-fold increase), respectively. A z test for independent proportions applied to each dataset indicated statistical significance (p < 0.001 for each analysis). Use of statistical control charts with special cause analysis allowed us to track for each of the three metrics whether intervention effects emerged, and if so, whether higher levels of performance continued and stabilized over time or degraded. Enhanced screening rates following the intervention were evident in the control charts, which continued during the 16-month post period. Regarding secondary metrics, rates of referral and diagnosis evidenced similar trends in meeting the conditions for detecting special cause, with elevated gains sustained longitudinally.
Conclusion
PA is an important cause of resistant hypertension. Increasing awareness of this diagnosis amongst clinicians can improve diagnosis and outcomes in patients.