Success Story: Wisconsin Team Leverages SMBP Monitoring to Improve Outcomes
Thedacare, Appleton, Wisconsin (2013)
In previous rounds of the Hypertension Control Challenge, Million Hearts® established a benchmark of 70% hypertension control for applicants’ adult populations. This 2013 success story reflects the earlier benchmark.
Hypertension, also called high blood pressure, is the leading clinical diagnosis at ThedaCare—a health care system located in Appleton, Wisconsin—meaning that far too many patients are living with an increased risk for heart attack and stroke. For years, ThedaCare clinicians have been working to lower the burden of high blood pressure for their patients. From 2012 to 2013, ThedaCare increased its hypertension control rate from 81.6% to 83%, earning recognition as a 2013 Million Hearts® Hypertension Control Champion. To achieve this improvement, ThedaCare used standardized processes throughout the patient care process, from measuring blood pressure to ensuring timely follow-up care.
What They Did
Implemented consistent, strategic use of electronic health records (EHRs)
ThedaCare’s EHR system generated worksheets that marked patients who were overdue for blood pressure checks, whose last reading was elevated, or both. All providers and staff could access this information, which is updated daily, and follow up with patients. Additionally, ThedaCare provided monthly, color-coded results, searchable by provider, location, and care group, to show goal progress.
- 100,357 adult patients in northeast Wisconsin are served
- 28% have high blood pressure
- 2% belong to a racial or ethnic minority
- 3% are eligible for Medicaid
Provided financial incentives for physicians
ThedaCare tied physician pay to performance on key quality measures, including hypertension control, meaning that physicians had clinical and financial motivation to lower their patients’ blood pressure using multiple strategies.
Promoted patient self-measured blood pressure monitoring
ThedaCare created and implemented a patient self-management program, Under Pressure, to help adults with hypertension age 60 and older learn new self-management skills. About 70% of the patients who enrolled in the program reached their target blood pressure, compared with 64% of patients who opted out.
What They Accomplished
ThedaCare’s strategies led to an improvement in its hypertension control rate from 81.6% in July 2012 to 83% in July 2013, meaning that in 2013, about 23,136 of ThedaCare’s 27,879 patients with high blood pressure had the condition under control.
Advice for Others
For others looking to improve practice-wide hypertension control rates, ThedaCare recommends
- Standardizing processes after carefully reviewing each step in the patient interaction process and identifying possible improvements. Use protocols to help providers measure and track blood pressure effectively for consistent follow-up.
- Getting buy-in from clinicians around a process for managing hypertension that aligns with their everyday challenges and routines.
- Emphasizing the importance of accuracy and consistency with staff members who measure blood pressure and explaining the importance of hypertension control.
Given the many competing priorities clinicians face each day, adherence to consistent procedures for taking blood pressure can be challenging. To address this barrier, ThedaCare provided clinician training on blood pressure measurement, and health care teams met regularly to discuss disease management and address barriers or concerns.