Academic journal article Journal of Healthcare Management

Practice Level Costs of Office-Based Hypertension Performance Improvement: The Heart Healthy Lenoir Study

Academic journal article Journal of Healthcare Management

Practice Level Costs of Office-Based Hypertension Performance Improvement: The Heart Healthy Lenoir Study

Article excerpt


Nearly one third of U.S. adults have hypertension (HTN), increasing their risk for cardiovascular morbidity and mortality (National Center for Health Statistics, 2013). The costs of HTN in the United states have been estimated to be $93.5 billion, including costs of healthcare services, medications, and missed work days (Heidenreich et al., 2011). Patients who adhere to therapeutic regimens can reduce their cardiovascularrelated risk (Estruch et al., 2006, 2013; Keyserling et al., 2014) and use of hospitals and emergency departments, thus positively affecting lives and better controlling these healthcare costs (Pittman, Tao, Chen, & Stettin, 2010). Identifying feasible and fiscally sound interventions to improve blood pressure (BP) control is a key objective for patients, physicians, and payers (Barton, Andronis, Briggs, McPherson, & Capewell, 2011; Keyserling et al., 2014; Kilpatrick et al., 2005) and may be of heightened importance in communities and medical practices with limited financial resources.

As primary care practices shift their focus toward managing patient populations and ongoing performance improvement, data-driven quality improvement (QI) approaches to optimize BP control are attractive options to help guide the change process. Practice leaders can review the practice-based QI activities that are effective in improving BP metrics and adapt relevant strategies for their unique settings (Mueller, Purnell, Mensah, & Cooper, 2015; Shojania, McDonald, Wachter, & Owens, 2004; Walsh et al., 2006). However, providers and practice administrators also need to understand the costs their practices may incur in taking on these new endeavors.

A limited number of publications describe the costs incurred by practices to implement practice improvement activities. Some authors calculate societal level costs, including patient, health system, and nonmedical costs (Allen, Dennison Himmelfarb, Szanton, & Frick, 2014; Brunenberg et al., 2007; Chung et al., 2014; Reed et al., 2010), whereas others describe practice level costs to finance individual programs such as a self-management support program (Hollenback, Weiner, & Turner, 2014; Schroeder, Fahey, Hollinghurst, & Peters, 2005).

With this article, we add to the growing literature by detailing the practice level costs of participating in the National Heart, Lung, and Blood Institute-funded Heart Healthy Lenoir (HHL) HTN multilevel intervention cohort trial that took place in an economically distressed and rural region of North Carolina from 2010 to 2015 (North Carolina Department of Commerce, 2015). As part of the larger study, we performed an activity-based costing analysis for each of the four most engaged practices. We present information about how we engaged with various stakeholders to develop and implement the HHL intervention and describe the practice level costs incurred to cover staff time to perform key tasks.

our objectives are twofold: (a) to describe the cost estimates such that primary care practice stakeholders have insights into potential expenses incurred when investing staff time and other resources in HTN QI initiatives and (b) to gain insights into the nature of the key Qi tasks staff members may need to perform.



The HHL study is a practice-based multilevel QI effort designed to improve HTN control and to narrow racial disparities in HTN control in rural North carolina. We focused on this region because of the elevated rates of HTN, cardiovascular morbidity and mortality, noted racial disparities in HTN prevalence, relative economic distress, and existing collaborative community and healthcare infrastructure. Six primary care practices without experience in HTN QI work participated in the trial.

Development of the HHL QI Intervention

We engaged with practice stakeholders and patients to develop the QI intervention. Our approach is based on our team's extensive experience in developing QI methods, processes, and tools (DeWalt et al. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed


An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.