UCSF

Nearly half of all adults in the United States (U.S.) have high blood pressure (BP) and despite the availability of effective and affordable medications, it is often very challenging for people to achieve BP control this in turn raises the risk of stroke, myocardial infarction and heart failure. This dissertation examines the role that healthcare inequities can play for historically marginalized patient groups that experience persisting disparities in BP control. It is unclear how suboptimal care as it related to care processes involved in the treatment of hypertension (HTN), or healthcare inequities, may differentially impact observed disparities in BP control. Our goal for these analyses will be both descriptive and inferential. We will aim to conduct an in-depth examination of contributors to disparities in uncontrolled hypertension from the perspective of healthcare processes and clinical care management. We use electronic health record data from real-world health systems to examine, first, factors associated with high performing clinical sites for BP control among Black individuals. Next, we examine how different patients may engage with primary care and what that might mean for their BP control outcomes. Finally, we examine whether clinical engagement trajectories most closely resembling the established paradigm for sequential “diagnosis, treatment and control” more or less likely among historically marginalized patient groups, at 24-months post-diagnosis. While upstream societal and social inequities undoubtedly play a major role in healthcare inequities and health disparities, health care plays a crucial role in addressing disparities in BP control as it is a system that can be modified and optimized by leveraging existing quality improvement infrastructure within a healthcare system and the greater healthcare ecosystem.