Frequently Asked Question
1. How do I sign-up for webinars and/or workshops?Health Center NHCI program directors are invited via email from firstname.lastname@example.org. Please review curriculum dates listed in all presentations and contact email@example.com if invitation error occurs.
2. What is the timeline for NHCI?
The NHCI is a three-year project. The AHA has established key dates for the first year of the project.
|4/21/2021||Webinar||Use EHR Data for Patient & Performance Monitoring|
|5/21/2021||Webinar||Measure Accurately & Team-based care|
|6/16/2021||Webinar||Partner with Patients: SMBP I: Evidence & Patient Education|
|7/14/2021||Webinar||Partner with Patients: SMBP II: Work and Data Flow|
|8/18/2021||Webinar||Act Rapidly: Diagnosis & Treatment Algorithms (Rebroadcast on August 31 at 8 a.m. & 5 p.m.)|
|9/15/2021||Webinar||Act Rapidly: Treatment Intensification|
|10/13/2021||Webinar||Partner with Patients: Lifestyle Modification with Nutrition & Physical Activity|
|11/10/2021||Webinar||Partner with Communities: SHOD and Center-Community Linkages|
3. What topics will be covered in the Core Curriculum for the first year?
4. Will I be provided covered materials (slides, resources, webinars etc.)?Yes, after the webinar, the NHCI will provide an email with slide deck. All covered resources/materials are link embedded. You may watch past recordings at our NHCI website.
5. Are patient educational handouts available in other languages?
Yes, the AHA NHCI team is developing materials in English and Spanish. Additional languages may be added. Please check Find HBP Tools and Resources for the most updated resource list.
Self Measured Blood Pressure Devices
1. What SMBP device should my site use?
The guideline-recommended standard of care is to use devices validated for clinical accuracy. (1) Reference U.S. Blood Pressure Validated Device Listing (VDL™) for validated devices. Keep in mind the list updates.
However, if your device isn’t on the list, it may still be validated. Consult these lists to see if the model number has been validated in another country: Hypertension Canada, Stride BP, British and Irish Hypertension Society.
Review Choosing A Home Blood Pressure Monitor For Your Practice At-A-Glance comparison to help your organization decide which device to buy.
Visit Getting Started with SMBP for more.
Direct questions about the approved use of the HRSA supplemental grant funding for purchasing and other allowable costs to NHCI-Support@hrsa.gov .
2. Can wrist SMBP devices be used?
Although arguably more convenient, wrist SMBP devices make it harder to maintain the best wrist/arm position, which affects measurement precision.
For more on wrist precision, see 2019 Measurement of Blood Pressure in Humans: A Scientific Statement. Review Target: BP resource for how to use wrist blood pressure devices.
A common recommendation is that SMBP monitoring be based on two measurements taken at least one minute apart in the morning and evening (four readings per day) optimally for seven days (28 readings total) with a minimum of three days (12 readings total). Review Getting Started with SMBP as well as the patient education checklist.
For each monitoring period, the average of all SBP and DBP readings should be obtained to assess BP, and the “eyeball method” — visually scanning the readings to determine the presence of high BP or BP control — should be avoided.
Some guidelines and scientific statements recommend excluding the first day’s readings. If the first day’s readings are excluded, the preferred and minimum periods of monitoring should be eight and four days, respectively.
Several guidelines and scientific statements also recommend monitoring be conducted over consecutive days. However, readings taken on nonconsecutive days may also provide valid data.
4. Who should use SMBP?
In general, SMBP can be used to confirm a diagnosis of hypertension, help determine medications to reach control and/or as a long-term patient monitoring and activation strategy. Patient readiness remains a key consideration. Per 2017 AHA/ACC Hypertension Guideline recommendations
5. What factors should be considered for loaning versus giving patients a BP monitor?
The decision to loan versus give depends on the indications and expected duration of use. During diagnosis, the device might only be needed for 1-2 weeks, or a sufficient time to obtain a representative BP reading, including:
- Take two readings at least one minute apart in the morning before taking antihypertensive medications.
- Take two readings at least one minute apart in the evening before going to bed.
- Preferred monitoring period is seven days (28 readings or more scheduled readings).
- A minimum of three days (12 readings) may be sufficient, ideally in the period immediately before the next appointment with health care professional. Monitoring conducted over consecutive days is ideal; however, readings taken on nonconsecutive days may also provide valid data.
During treatment intensification, the device will be needed until a patient’s response to treatment can be assessed and BP control goal is achieved, which could take weeks to months, depending on prescribing practices, visit frequency, patient adherence and other variables. During management, the device will be needed longer while tracking lifestyle changes or to provide continuous monitoring of a chronic condition.
6. Which validated BP device has an extra-large cuff?
As of July 25, 2021 Hillrom-Welch Allyn’s Welch Allyn Home® Blood Pressure Monitor, 1700 Series H-BP100SBP is validated for use with sizes: XS (15-24 cm), Standard (22-42 cm), XL (40-54 cm). Refer to U.S. Blood Pressure Validated Device Listing (VDL™) for update list of devices and their accompanying cuff sizes.
7. What should be considered when evaluating different methods (manual, cellular, Bluetooth) for transferring measurement data from patient to the health care professional?
In general, electronic transfer is preferred over manual transfer for timely, accurate data and to best align with UDS reporting (see below) and some reimbursement requirements. However, some don’t have access to the internet or cellular service required to electronically transfer data. Devices that store data and can be brought back to the clinic to download may be more feasible. Manual recording and reporting on paper logs might be necessary.
For UDS reporting and per the 2021 UDS Manual, only blood pressure readings performed by a health care professional or a remote monitoring device are acceptable for the numerator criteria with this measure. To be a valid remote blood pressure reading, the remote monitoring device must capture and store the reading seen by the health care professional or care team member, and the reading must be recorded in the patient’s health record at the Health Center (see pages 120-121 of the 2021 UDS Manual). Patient-reported readings aren’t considered valid and can’t be used for UDS reporting.
The AHA will provide guidance on RPM programs/platforms, including use of validated devices, concordance with guideline recommendations, data transmission (Bluetooth, cellular, manual), internet/Wi-Fi requirements, user interface, EHR integration, user interface/alerts/dashboard/coaching, languages and cultural adaptation, training/maintenance support, product fees/business model, etc.
4.2. Out-of-Office and Self-Monitoring of BP
Recommendation for Out-of-Office and Self-Monitoring of BP References that support the recommendation are summarized in Online Data Supplement 3 and Systematic Review Report.
|I||ASR||1. Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension (Table 11) and for titration of BP-lowering medication, in conjunction with telehealth counseling or clinical interventions S4.2-1, S4.2-2, S4.2-3, S4.2-4.|
SR indicates systematic review.
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Whelton and colleagues.
8.3.2. Monitoring Strategies to Improve Control of BP in Patients on Drug Therapy for High BP
Recommendation for Monitoring Strategies to Improve Control of BP in Patients on Drug Therapy for High BP
References that support the recommendation are summarized in Online Data Supplement 29.
|I||A||1. Follow-up and monitoring after initiation of drug therapy for hypertension control should include systematic strategies to help improve BP, including use of HBPM, team-based care, and telehealth strategies S8.3.2-1, S8.3.2-2, S8.3.2-3, S8.3.2-4, S8.3.2-5, S8.3.2-6.|
NHCI Training and Technical Assistance - Core Curriculum
The AHA has designed the NHCI Core Curriculum for HRSA-funded Health Centers to help improve blood pressure control among patients.
This plan is:
- Grounded in science such as the 2017 AHA/ACC Hypertension Guidelines and 2019 AHA Scientific Statement on BP Measurement in Humans and evidence-based approaches such as the AMA’s MAP framework (see figure)
- Designed to provide a progression of support through:
- National webinars laying a common foundation of knowledge
- Associated workshops providing tools to translate evidence into practice
- Office hours answering frequently asked questions
- Taught with the diverse learning needs of the Health Center team in mind:
- Health care professionals (physicians, nurse practitioners, physician's assistants)
- Clinical staff (nurses, pharmacists, medical assistants)
- Quality improvement professionals Administrative experts (operations, information technology)
- Recordings from all events can be found on the Health Center Hub.
- We encourage Health Centers to use these records and other recorded content in the Quick Start Guide to inform and improve the skills of their teams. In many cases, CME/CE credit is available.
- The following resources will be introduced in their respective webinar, recommended as preparation for the associated workshop and then discussed further during office hours to address FAQ for the Core Curriculum.
In each workshop, volunteers from Health Centers will be invited to serve as panelists to share their pre-assessment findings, reflect on best practices, and identify opportunities for improvement.
NHCI Training Technical Assistance Core Curriculum
Use EHR Data for Patient & Performance Monitoring
Measure Accurately & Team-Based Care
06/29/2021 Office Hours
Partner with Patients: SMBP I: Evidence & Patient Education
Partner with Patients: SMBP II: Work and Data Flow
08/10 & 08/11 Office Hours
Act Rapidly: Diagnosis & Treatment Intensification
TBD Office Hours
Act Rapidly: Treatment Algorithms
TBD Office Hours
Partner with Patients: Lifestyle Modification with Nutrition
TBD Office Hours
Partner with Communities: SDOH and Center-Community Linkages
TBD Office Hours
Preparing Your Team
- The SMBP Quick Start Guide is a great launch point that begins with an SMBP Pre-Assessment to evaluate your Health Center’s readiness to incorporate SMBP into clinical practice and systems of care.
- The SMBP Podcast provides a brief overview of key principles
- The Using SMBP to Diagnose and Manage HBP webinar provides a more detailed overview and offers CME/CE credit