Success Story: Rural Kansas Physicians Collaborate to Control Patients’ Blood Pressure
Jennifer Brull, MD, Plainville, Kansas (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.
Jennifer Brull, MD, is a family physician in rural northwest Kansas who serves nearly 600 adult patients each year, almost half of whom have been diagnosed with high blood pressure. Dr. Brull teamed up with four other medical practices to pool resources, forming a medical collaborative called Post Rock Family Medicine.
Dr. Brull’s unwavering commitment to quality improvement and exceptional patient care helped her achieve a hypertension control rate of 87% in 2013. Dr. Brull and Post Rock Family Medicine demonstrated how a small, rural practice can leverage limited resources to reach big goals by implementing health information technology (IT), taking action to improve medication adherence, and staying connected to patients.
What They Did
Implemented consistent, strategic use of electronic health records (EHRs)
- 575 adult patients annually in rural northwest Kansas are served
- 40% have high blood pressure
- 2% belong to a racial or ethnic minority
- 17% are eligible for Medicaid
“Our entire staff benefits when we show improvement in care for our patients. They are our community members and friends, so we know we are affecting this population personally.”
—Jennifer Brull, MD, family physician
Dr. Brull is a physician leader in EHR adoption, having been named an Office of the National Coordinator for Health Information Technology Health IT Fellow for the U.S. Department of Health and Human Services in 2013. At Post Rock Family Practice, clinicians used an EHR system to track patients’ blood pressure and accessed the data in user-friendly dashboards.
Took action to improve medication adherence
Given the often-large role that medications play in controlling high blood pressure, Dr. Brull worked closely with patients, local pharmacies, and insurers to make sure patients had the right prescriptions and were taking them as directed. She received alerts from health insurance companies when patients missed prescription refills. During each patient visit, Dr. Brull reviewed medication instructions and inquired about side effects, reinforcing how important it was to take medications as prescribed. Patients were more engaged in keeping up with their medications and refills with Dr. Brull’s increased awareness of their pharmacy history.
Stayed connected to patients
Realizing that no single channel meets everyone’s needs, patients were able to touch base with Dr. Brull and Post Rock Family Medicine in multiple ways, including via a patient portal, the company website, Facebook, and Twitter. For less tech-savvy patients, Dr. Brull sent printed appointment reminder cards.
What They Accomplished
Dr. Brull’s dedication to patient care led to an increase in the hypertension control rate within her patient population from 68% to 87% in 1 year (August 2012–August 2013). As a result, in 2013, of the original 230 adult patients with high blood pressure in her practice in 2012, more than 200 had their hypertension under control, reducing their risk for heart attack and stroke.
Advice for Others
For other private practitioners looking to improve their high blood pressure control rates, Dr. Brull recommends
- Finding the right tool to measure blood pressure, measuring it routinely, and using the data to identify the gap between current and target blood pressure control rates for the patient population.
- Starting with one small change to the practice’s overall hypertension treatment process, rather than trying to redesign the system all at once. Pick a change that is relatively easy to implement and will have quick benefits, such as confirming that blood pressure is being measured accurately.
- Involving the full health care team—including the patient—in achieving blood pressure control. Solicit input and ideas about how to achieve this goal from all team members and share progress throughout the process. For example, Dr. Brull uses the EHR system to generate printouts showing where patients could do better in regard to their health with a red “X” (e.g., elevated blood pressure) and areas where the patient is doing well with a green check mark. Dr. Brull shows the patient this printout, and together they build a shared mission to turn the red X’s into green checkmarks. Since implementing this tool, the hypertension control rate has grown to 89%.
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To help patients better understand the need to make what are often difficult changes in their lives, Dr. Brull emphasized the importance of controlling blood pressure for overall health and encouraged patients to make small manageable changes, such as taking daily walks or cutting out foods high in sodium.