Study Setting
The trial was conducted in primary care clinics that are part of the Ambulatory Care Network (ACN) of New York-Presbyterian (NYP), a health enterprise affiliated with 2 medical schools, CUIMC and WCM. The preimplementation period took place from October 1, 2016, to September 30, 2017; implementation from October 1, 2017, to March 31, 2018; and postimplementation from April 1, 2018, to March 31, 2019. The ACN serves a predominantly low-income, publicly insured population with substantial numbers of Hispanic and Black or African American patients. The 10 primary care practices in the ACN that serve adult patients, each in geographically distinct locations, are staffed by internal medicine physicians, family medicine physicians, nurse practitioners, and graduate medical education trainees. Office BP was taken by medical assistants using automated devices, with readings manually entered into the electronic health record (EHR). None of the practices had protocols for systematically repeating elevated office BP readings. The practices used 2 different EHR systems: Allscripts (Allscripts) at CUIMC-affiliated practices and Epic (Epic) at WCM-affiliated practices.