Factors Associated With Evidence of Self‐Measured Blood Pressure Adoption in an Urban Safety‐Net Health System

Uncontrolled hypertension is a leading cause of preventable cardiovascular mortality. Although self‐measured blood pressure (SMBP) monitoring is recommended by evidence‐based guidelines, adoption remains uneven in safety‐net health systems. We conducted a cross‐sectional analysis in an urban safety‐net health system to assess factors associated with documented SMBP adoption. Using electronic health record (EHR) data from patients included in a safety‐net health system's hypertension registry, we defined documented SMBP adoption as documentation of at least one patient‐reported value in the EHR. We evaluated factors associated with documented SMBP adoption using sequential multivariable logistic regression and hierarchical modeling to estimate patient‐, provider‐, and clinic‐level variation. We analyzed 15 937 patients cared for by 283 providers across 12 clinics. Twenty‐six percent (4186) of patients had documented SMBP adoption. In the full model, patients aged 75 years and older [vs. 18–34 years old] (aOR 2.37, 95% CI 1.62–3.55) and those with an activated patient portal (aOR 1.36, 95% CI 1.25–1.49) were more likely to have documented SMBP adoption, while patients experiencing homelessness (aOR 0.72, 95% CI 0.60–0.87) were less likely. Substantial variation in documented SMBP adoption was observed across clinics. In the hierarchical model, 75% of the variance in documented SMBP adoption was attributable to patient‐level factors, 19% to clinics, and 6% to providers. Given that nearly one‐quarter of the variation in documented SMBP adoption was attributable to nonpatient factors, clinic‐ and provider‐level workflows may be modifiable targets to improve equitable uptake and documentation of SMBP monitoring in safety‐net health systems.