Professional Data Analysts, Minneapolis, Minnesota.
J Public Health Manag Pract. 2024;30:S107-S115. doi: 10.1097/PHH.0000000000001894. Epub 2024 Jul 22.
Self-measured blood pressure monitoring (SMBP) with clinical support is effective at reducing blood pressure for people with hypertension. Although strengths and challenges around SMBP are well-documented, few studies describe the complexities of real-world implementation of SMBP with clinical support in the Federally Qualified Health Center (FQHC) setting.
Between 2019 and 2023, the Ohio Department of Health funded the Ohio Association of Community Health Centers to manage a multiyear quality improvement (QI) project with 21 FQHCs. The project aimed to improve the identification and management of patients with hypertension, diabetes, and prediabetes. This study focuses on the activities implemented to provide SMBP support to patients with hypertension.
FQHCs implemented clinical SMBP support using multiple roles, approaches, and resources. FQHCs established a process to identify patients eligible for SMBP support, provide blood pressure monitors, train patients on SMBP, track blood pressure readings, follow up with patients, and connect patients to resources.
External evaluators interviewed 13 staff members within seven FQHCs from the QI project. Interviewed FQHCs were located across Ohio and represented urban, rural, suburban, and Appalachian areas. Clinical activities to support SMBP, facilitators, and barriers were identified with thematic analysis. The National Association of Community Health Centers SMBP Implementation Toolkit was used as a framework to assess SMBP activities. Facilitators included team-based care, health information technology capacity, funding for blood pressure monitors and staff time, leadership and staff support, and external support. Barriers included technology challenges, staffing shortages, low patient engagement, sustainability, and the COVID-19 pandemic.
This study demonstrates how FQHCs can use a variety of staff, processes, and resources to implement clinical SMBP support across a range of geographic regions. To facilitate this, FQHCs and patients may need more comprehensive insurance coverage of blood pressure monitors, reimbursement for staff time, and technology support.
自我监测血压（SMBP）结合临床支持可有效降低高血压患者的血压。尽管 SMBP 的优势和挑战已得到充分记录，但很少有研究描述在联邦合格的健康中心（FQHC）环境中结合临床支持实施 SMBP 的复杂性。
2019 年至 2023 年期间，俄亥俄州卫生署资助俄亥俄州社区卫生中心协会管理一个由 21 个 FQHC 参与的多年质量改进（QI）项目。该项目旨在改善高血压、糖尿病和前期糖尿病患者的识别和管理。本研究重点关注为高血压患者提供 SMBP 支持所实施的活动。
FQHC 采用多种角色、方法和资源实施临床 SMBP 支持。FQHC 确定了识别有资格接受 SMBP 支持的患者、提供血压监测仪、培训患者进行 SMBP、跟踪血压读数、与患者跟进以及为患者提供资源的流程。
外部评估员采访了 QI 项目中来自七个 FQHC 的 13 名员工。接受采访的 FQHC 分布在俄亥俄州各地，代表了城市、农村、郊区和阿巴拉契亚地区。采用主题分析确定了支持 SMBP 的临床活动、促进因素和障碍。国家社区卫生中心 SMBP 实施工具包被用作评估 SMBP 活动的框架。促进因素包括团队合作、健康信息技术能力、血压监测仪和员工时间的资金、领导力和员工支持以及外部支持。障碍包括技术挑战、人员短缺、患者参与度低、可持续性和 COVID-19 大流行。
本研究展示了 FQHC 如何在各种地理区域使用各种员工、流程和资源实施临床 SMBP 支持。为了促进这一点，FQHC 和患者可能需要更全面的血压监测仪保险覆盖、员工时间报销和技术支持。
