1.  men Differences in Blood Pressure Documentation and Clinical Practice Variability: Implications for Population Management for Hypertension and Opportunities to Improve Rates of Control. Adaugo Amobi BA, Frederick Milgrim BA, Scot B. Sternberg MS, Jennifer L. Beach MD A teaching hospital of Harvard Medical School For More Information, Contact Jennifer L. Beach, MD: jlbeach@bidmc.harvard.edu Problem Hypertension affects over 65 million Americans and it is a major risk factor for myocardial infarction, renal failure, stroke and death. The percentage of patients 18 to 85 years of age with a diagnosis of hypertension (HTN) and adequately controlled blood pressure (BP) <140/90 is a key quality indicator. Population management of hypertensive patients depends on accurate measurement techniques and proper documentation of patient’s BP into structured data fields. In Healthcare Associates (HCA), a large academic primary care practice, there is practice variability in BP re-measurement and documentation during office visits. Aim To better understand the accuracy of BP measurements recorded into structured data fields. To describe the variation in clinical practice for hypertensive patients with blood pressure readings above goal. Intervention Randomly identified 75 patients with Stage 1 hypertension (initial reading between 140/90 and 160/100) and 75 patients with Stage 2 hypertension (initial readings of ≥ 160/100). Chart review performed to identify whether patients whose BP was remeasured by the clinician was documented in a note and/or in structured data fields. Results Out of the 150 encounters with an initial BP reading of >140/90, a BP recheck was documented in 101 patients (67.3%) in the notes. For 17.6% of those patients, the rechecked values were significantly lower (i.e. decreased enough to fall below the treatment threshold of 140/90), thus moving a patient’s status to in control. Only 10 (7%) of the rechecked readings were properly recorded into structured data fields in the online medical record. Initial ReadingMD recheck only Sheet + MD recheck No recheckTotal 911049150 60.67%6.67%32.67% Recheck ResultMD recheck onlySheet + MDNo RecheckTotal BP≥160/1002922152 31.9%20.0%42.9% 140/90≤BP≤160/1004682882 50.5%80.0%57.1% BP≤140/901600 17.6%0.0% MD recheck onlySheet + MDNo RecheckTotal Rationale / follow up / Intervention 911049 150 Referred to ED4004 4.4%0.0% New med rx142925 15.4%20.0%18.4% Increase dose81211 8.8%10.0%4.1% White coat HTN52411 5.5%20.0%8.2% Ambulatory rec.9009 9.9%0.0% Med Adherence73919 7.7%30.0%18.4% Diet/exercise131418 14.3%10.0%8.2% Follow up soon110819 12.1%0.0%16.3% Maintain treatment110112 12.1%0.0%2.0% No recommendation911222 9.9%10.0%24.5% Key Lessons Learned BP values rechecked were frequently not recorded in structured data fields and were often lower, thus the number of patients with hypertension who are out of control may be overstated. 32.7% patients who presented with a BP reading of greater than or equal to 140/90 had no BP recheck documented which suggest s the need for attention to BP re-measurement and documentation. Variability in care for patients whose BP is above goal suggest potential opportunities to standardize treatment recommendations based on the stage of hypertension which may translate into better rates of control. Table 1. Rates of Recheck by Hypertension Class Table 2. Summary of Physician Management Decisions Next Steps Standardize BP measurement and documentation