Using various system-based improvement methods over the past two years, the Division of Nephrology and Hypertension at Cincinnati Children’s achieved better office-visit blood pressure (BP) values for chronic kidney disease (CKD) patients. Good blood pressure control is crucial to avoid future cardiovascular complications and slow loss of kidney function in this population. We wanted to be more aggressive about BP control, division-wide.

In this project, blood pressures were measured from a cross section of the patient population in February 2014 and again in March 2016. After two years of system-wide intervention, the percentage of patients with BP below the 75th percentile — when controlled for age, gender and height — rose from 59 to 73 percent.

To effect this change, our team created the “BP Trendformer” to supplement pre-visit planning for our CKD population. The BP Trendformer is a visual display of the previous three nephrology visit systolic blood pressure percentiles or values. A green area defines the goal office systolic BP for each patient, and allows both provider and patient to quickly see the systolic BP trend over time, including the effects of any treatment or lack thereof.

In response to this added information, providers prescribed more therapy for patients whose BP was elevated. Our hope is that patients — being more aware of their BP status — would adhere more strictly to medication regimens as well. Future work addressing barriers to blood pressure adherence is planned.