1. Improving Diagnosis and Management of Hypertension: Implementation of Ambulatory Blood Pressure Monitoring in Primary Care* Scot B. Sternberg, MS; Kristine Sullivan, RN; Catherine Ivkovic, RN; Tarsha A. Soares,RN; Jennifer Beach, MD Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA A teaching hospital of Harvard Medical School The Results/Progress to Date:  BP measures during a 24-hour cycle provides valuable information for clinicians seeking to improve diagnosis and treatment of hypertension.  ABPM can assist providers in accurate diagnosis of hypertension and optimizing management of hypertension as well as identify those needing assessment for secondary causes.  Formalize referral process for ABPM within HCA including Hypertension Management consults.  Pending USPTF recommendations for use of ABPM¹, develop plan for further expansion of service.  Hypertension is a major risk factor for myocardial infarction, stroke and renal failure. Lowering blood pressure to target ranges prevents cardiovascular events and decreases mortality¹.  Ambulatory Blood Pressure Monitoring (ABPM) which records blood pressure measures during a 24 hour cycle provides a better indicator of actual BP and predictor of cardiovascular outcomes.  BIDMC’s HealthCare Associates (HCA) is a large academic adult primary care practice for almost 42,000 patients of whom approximately 30% have hypertension.  New Draft recommendations from the U. S. Preventive Services Task Force recommends considering ABPM to confirm all new diagnoses of hypertension prior to initiating drug therapy (Grade A recommendation)  Access to ABPM has historically been limited to a few specialty practices.  Implement a multidisciplinary ABPM clinic at HCA.  Improve diagnosis and management of hypertension.  Reviewed literature on ABPM and discussed with specialists using ABPM in BIDMC and externally.  Lead physician became certified as a hypertension specialist and received training in ABPM interpretation.  Purchased equipment and trained nursing staff on utilization.  Developed and fine-tuned referral process, patient education materials and activity log.  In collaboration with IS, developed process to integrate results and interpretation within webOMR.  Nurses educate patients on process of monitoring and logging activities. Aim/Goal: Problem: Description of the Intervention, including context Results/Findings to date: Key Lessons Learned Next Steps ¹James PA, et al. Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA Dec 18, 2014. ²Piper MA, et al. Screening for High Blood Pressure in Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 121. AHRQ Publication No. 13-05194-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2014. For More Information, Contact Jennifer L. Beach, MD: jlbeach@bidmc.harvard.edu 65.5% confirmed as sustained hypertension. Recommendations included increasing medication regimen, assessing for secondary causes, increasing lifestyle modifications and assessing adherence. 27.6% diagnosed as controlled hypertension. Recommended maintaining current treatment plan. 6.9% diagnosed as hypotensive. Recommended reducing medication regimen. 23.5% ABPM diagnosed as sustained hypertension. Recommendations include add medication, increase dose or assess for secondary causes *This work was supported by the Linde Fellowship in Primary Care Leadership. Special thanks to Jayne Carvelli-Sheehan, RN, VP Ambulatory/Emergency Services and System Integration, for support of this project and purchase of the Ambulatory Blood Pressure Monitors.