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A Collaborative Initiative to Improve the Care of Elderly Medicare Patients With Hypertension

Qualidigm, 100 Roscommon Drive, Middle-town, Conn, Department of Medicine, Yale University School of Medicine, New Haven, Conn, tmeehan{at}ctqio.sdps.org

Janet P. Tate, MPH

Qualidigm, 100 Roscommon Drive, Middle-town, Conn, Department of Community Medicine, University of Connecticut Medical School, Farmington, Conn

Eric S. Holmboe, MD

Qualidigm, 100 Roscommon Drive, Middle-town, Conn, Department of Medicine, Yale University School of Medicine, New Haven, Conn

Elizabeth A. Teeple, MS

Qualidigm, 100 Roscommon Drive, Middle-town, Conn

Anne Elwell, BS

Qualidigm, 100 Roscommon Drive, Middle-town, Conn

Rachel R. Meehan, MSN

Qualidigm, 100 Roscommon Drive, Middle-town, Conn

Marcia K. Petrillo, MA

Qualidigm, 100 Roscommon Drive, Middle-town, Conn

Stephen J. Huot, MD, PhD

Section of Nephrology, Yale University School of Medicine, New Ha-ven, Conn

Qualidigm, the Connecticut Quality Improvement Organization (QIO), collaborated with 17 primary care physicians (PCPs) in private practice to improve the care of elderly patients with hypertension. Patients were identified from Medicare billing data and care was assessed from medical records. Improvement interventions included feedback of baseline performance data and provision of a variety of practice enhancing materials. Care was assessed for 590 patients in 1997 (16-47 patients/PCP) and 547 patients in 1999 (7-51 patients/PCP). Patient characteristics were similar in both periods. Use of recommended therapies and blood pressure control, ie, percent < 140/90 mm Hg, was low and did not improve significantly between the 2 periods (aggregate 39% in 1997 versus 42% in 1999; P = .24). Care of elderly patients with hypertension was not improved with a multifaceted QIO intervention. Additional study is required to determine incentives, barriers, and facilitating factors for quality improvement in the private practice primary care setting.

Key Words: Hypertension • medicare • quality improvement

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