UC Irvine

Background: Hypertension, or blood pressure (BP) ≥ 130/80 mmHg, affects one in four Americans. The 2025 American College of Cardiology (ACC)/ American Heart Association (AHA) guideline recommends incorporating home BP readings into primary care to improve diagnostic accuracy and hypertension management. While home BP monitoring (HBPM) is a cost-effective, validated method a gap analysis revealed underutilization at an academic FQHC due to a lack of an evidence-based implementation approach. Purpose: This project aimed to standardize the primary care provider (PCP) workflow for initiating HBPM in patients with new or chronic uncontrolled essential hypertension to enhance hypertension management. Methods: This quality improvement project used a pre-post design over an 8-week implementation period with two PCPs. PCPs received training on a standardized process for ordering home monitors and patient HBPM education materials (an AHA handout and Epic SmartPhrase with site-specific instructions and link to an American Medical Association HBPM demonstration video). Eligible patients were identified via direct PCP referral and in-office BP ≥ 140/90 mmHg, the Centers for Medicare and Medicaid Services’ hypertension threshold. Patients were instructed to perform HBPM prior to a 2-week nurse follow-up. An Epic review compared BP at nurse follow-up. PCP feedback was collected anonymously through a four-item Likert-scale QuestionPro survey. Results were analyzed using descriptive and inferential statistics. Results: There were six referrals during pre-implementation and 10 referrals during post-implementation. During pre-implementation, three of six patients attended nurse follow-up and two achieved BP control. During post-implementation, five of ten patients attended nurse follow-up and three reached BP control. Average systolic BP (SBP) reduction increased from 12.7 to 21.2 mmHg (unpaired t-test, t=0.57, p=0.59). Both PCPs shifted from disagreeing to agreeing on four survey items, including that same day HBPM education did not disrupt workflow and that the current HBPM workflow supported hypertension management. Conclusions: While nurse follow-up attendance remained at 50% pre-and-post, patient referrals, BP monitor access, and adherence to antihypertensives and HBPM increased. PCP survey results indicated improved sustainability of BP monitor ordering and same-day HBPM education. Consistent with existing literature, standardized PCP workflows for HBPM initiation improved access and adherence, supporting effective hypertension management.