Getting accurate blood pressure (BP) measurements in the clinical setting has long been a topic of discussion and debate, with some physicians and the American Medical Association calling for the reevaluation of existing measurement processes and the use of standardized principles. These principles are necessary for proper diagnosis and treatment of hypertension, as well as safe and effective self-management of the condition.

Both Lake Superior Quality Innovation Network (QIN)—the QIN-Quality Improvement Organization (QIO) serving Minnesota, Wisconsin and Michigan—and the Michigan Department of Health and Human Services (MDHHS) recognized the need for increased training of physician practices on BP measurement since this skill set is often omitted from other physician trainings. By comparing the prevalence of diagnosed hypertension among patients in recruited practices with expected prevalence of diagnosed hypertension in patients – using the Million Hearts Prevalence Estimator Tool – the QIN-QIO found in most cases the prevalence in recruited practices was much lower than the Estimator Tool expected rate. This led to the discussion on accuracy of measurements taken in the office and the development of the program.

In mid-2016, Lake Superior QIN began offering free, one-hour BP trainings to physicians, medical assistants, nurses, dental assistants and front office staff at clinical practices throughout Michigan. The QIN-QIO collaborated with MDHHS and used evidence-based practices from the American Medical Association and American Heart Association to develop the 10-step training to capture an accurate manual blood pressure reading and demonstrate skills in observation using a competency checklist.

During the on-site workshops, Lake Superior QIN provides a presentation, a BP management workbook and a measurement checklist for participants. The checklist gives providers a tool for ensuring they correctly follow all recommended steps when measuring BP, and the workbook provides resources regarding BP competency.

“It sounds simple, but you’d be surprised at how many mistakes are often made when taking blood pressures that result in a missed diagnosis.”

Following the training, attendees receive certificates of attendance and identify hypertension champions who lead annual trainings as refreshers and disseminate materials to new employees. This helps ensure that all clinicians within a care setting are taking blood pressure the same way. Providers who have completed the training are encouraged to teach patients the proper way to measure their BP levels at home. For instance, providers remind patients that they should not talk or have a full bladder when measuring their BP levels.  

As of December 2018, Lake Superior QIN has provided BP training to 363 clinicians. The QIN-QIO has measured success through pre- and post-training tests and has seen an 11.1 percent improvement in overall scores.

“It sounds simple, but you’d be surprised at how many mistakes are often made when taking blood pressures that result in a missed diagnosis,” said Andrea Boucher, senior clinical quality consultant and a blood pressure competency trainer with the Lake Superior QIN in Michigan. “Minor changes can be made that go a long way, such as adjusting the setup of exam rooms to better accommodate proper blood pressure measurement.”

In 2018, Lake Superior QIN examined the percentage of patients with a diagnosis of hypertension whose BP is in control and provided training in 33 clinician locations. QIN-QIO staff were able to collect results from 11 clinics and found an increased prevalence of hypertensive patients in those practices. This lends credence to the notion that as clinicians become more accurate in their BP readings, they are better able to identify and treat hypertensive patients.