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Open Access Research article

Prevalence and factors affecting home blood pressure documentation in routine clinical care: a retrospective study

Michael H Kramer1, Eugene Breydo23, Maria Shubina4, Kelly Babcock5, Jonathan S Einbinder236 and Alexander Turchin237*

Author Affiliations

1 Department of Computer Science, Harvard College, Cambridge, MA, USA

2 Clinical Informatics Research and Development, Partners HealthCare System, Boston, MA, USA

3 Harvard Medical School, Boston, MA, USA

4 Center for Clinical Investigation, Brigham and Women's Hospital, Boston, MA, USA

5 Bouvé College of Health Sciences, Northeastern University, Boston, MA

6 Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA

7 Division of Endocrinology, Brigham and Women's Hospital, Boston, MA, USA

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BMC Health Services Research 2010, 10:139  doi:10.1186/1472-6963-10-139

Published: 27 May 2010

Abstract

Background

Home blood pressure (BP) is closely linked to patient outcomes. However, the prevalence of its documentation has not been examined. The objective of this study was to analyze the prevalence and factors affecting documentation of home BP in routine clinical care.

Methods

A retrospective study of 142,973 encounters of 9,840 hypertensive patients with diabetes from 2000 to 2005 was performed. The prevalence of recorded home BP and the factors associated with its documentation were analyzed. We assessed validity of home BP information by comparing the difference between home and office BP to previously published prospective studies.

Results

Home BP was documented in narrative notes for 2.08% of encounters where any blood pressure was recorded and negligibly in structured data (EMR flowsheets). Systolic and diastolic home BP in narrative notes were lower than office BP readings by 9.6 and 2.5 mm Hg, respectively (p < 0.0001 for both), consistent with prospective data. Probability of home BP documentation increased by 23.0% for each 10 mm Hg of office systolic BP (p < 0.0001), by 6.2% for each $10,000 in median income of zip code (p = 0.0055), and by 17.7% for each decade in the patient's age (p < 0.0001).

Conclusions

Home BP readings provide a valid representation of the patient's condition, yet are seldom documented despite their potential utility in both patient care and research. Strong association between higher patient income and home BP documentation suggests that the cost of the monitors may be a limiting factor; reimbursement of home BP monitoring expenses should be pursued.