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An Implementation Model To Enhance Post Discharge Blood Pressure Management
Abdullah Khan, MD, Fachreza Aryo Damara, MD, Scott Cameron, MD, Francis Caputo, MD, Sean Lyden, MD, Lee Kirksey, MD.
Cleveland Clinic, Cleveland, OH, USA.
OBJECTIVE: This study aimed to optimize the management of postoperative hypertension in high-risk vascular surgery patients by implementing an interdepartmental quality improvement (QI) program between Vascular Surgery (VS) and Vascular Medicine (VM). The pilot program utilized digital and telehealth services to facilitate early patient engagement following hospital discharge for patients at high risk for hospital readmission. METHODS: A retrospective analysis of a single-center implementation model for enhanced transitional phase management of hypertension following hospital inpatient discharge was conducted between 2020 and 2022. Patients had undergone either carotid endarterectomy or treatment of aortic pathology. The QI program fostered collaboration with VS managing antiplatelets and anticoagulants, and VM managing hypertension in both the inpatient and care transition period. The interventions included prescription of a home BP cuff, pre-discharge patient/family education, medication adherence strategies, utilization of a digital health platform, and continuous feedback loops between providers. RESULTS: A total of 22 patients were included in the analysis. The mean age of the cohort was 68.6 years, with 22.7% female. Most patients (54.5%) had one visit with VM for blood pressure control, with remaining patients requiring visits ranging up to five at a mean follow-up duration of 1.8 months. The mean systolic blood pressure on the last visit was 134.5 ± 19.3 / 75.3 ± 7.4 mmHg. Significant decreases were noted in both systolic blood pressure (mean difference of 18.3 ± 11.2 mmHg, P = .048) and diastolic blood pressure (mean difference of 9.2 ± 16.2 mmHg, P = .024). No patient required hospital readmission or an Emergency Department visit over the study interval, and all were successfully transitioned to the care of their Primary provider. CONCLUSIONS: The QI program, which integrated VS & VM care, successfully lowered BP in VS patients in the immediate hospital discharge period. The program demonstrated the feasibility of reducing hospital readmission and ED visits in a high-risk population utilizing widely available tools. These findings underscore the value of an interdisciplinary and coordinated approach in postoperative hypertension management. Future strategies should continue to focus on collaborative care models leveraging existing technology to optimize hypertension control in this vulnerable population.
Blood pressure outcomes for patients managed under the QI program| Outcomes | Number | Statistics | P value |
| Final systolic blood pressure | 22 | 134.5 ± 19.3 | |
| Final diastolic blood pressure | 22 | 75.3 ± 7.4 | |
| SBP Change: Visit 1 | 20 | -0.10 ± 21.8 | 0.98 |
| DBP Change: Visit 1 | 19 | 9.2 ± 16.2 | 0.024 |
| SBP Change: Visit 2 | 10 | 6.5 ± 24.1 | 0.42 |
| DBP Change: Visit 2 | 9 | 7.0 ± 15.7 | 0.22 |
| SBP Change: Visit 3 | 4 | 18.3 ± 11.2 | 0.048 |
| DBP Change: Visit 3 | 4 | 13.8 ± 15.7 | 0.18 |
| Follow-up Duration, month | 22 | 1.8 (0.26, 11.7) | |
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