Despite their helpfulness to guiding care, home blood pressure readings are rarely documented in routine clinical care
Research Activities, December 2010, No. 364
Anything that can be done to help patients manage their high blood pressure is a welcome part of treatment planning. Just like people with diabetes monitor their glucose levels, patients with hypertension can use home blood pressure measurements to give a more accurate, ongoing picture of their situation. While patients may embrace such monitoring, providers do not always document such data in their clinical notes, according to findings from a recent study.
Researchers went back and looked at 142,973 encounters of 9,840 patients with high blood pressure and diabetes. All providers of these patients used electronic medical records (EMRs) to document blood pressure readings. The researchers first determined the source of the reading (provider or patient) and then where it was located in the medical record (flowsheets or narrative notes).
Home blood pressure readings were found to be rarely documented in routine clinical care. There was documentation for home blood pressure in the narrative notes for only 2.08 percent of encounters where any blood pressure was recorded. The values of home blood pressure readings found in the narrative notes tended to be lower when compared with office-based readings (-9.6 mm Hg for systolic and -2.5 mm Hg for diastolic). For each 10 mm Hg increase in office systolic blood pressure, the probability of home blood pressure monitoring being recorded increased by 23 percent. Home blood pressure documentation was 53.9 percent lower, however, for Hispanic patients compared with whites.
The researchers also point out that the rate of home blood pressure documentation increases 6.2 percent for every $10,000 increase in the median income for the patient's Zip code. Such findings may be related to the fact that home blood pressure monitoring is currently not reimbursed by insurance carriers. The study was supported in part by the Agency for Healthcare Research and Quality (HS17030).
See "Prevalence and factors affecting home blood pressure documentation in routine clinical care: A retrospective study," by Michael H. Kramer, A.B., Eugene Breydo, Ph.D., Maria Shubina, Sc.D., and others in the BMC Health Services Research 10(139), pp. 1-10, 2010.