Success Story: FQHCs Remain Committed to Their Growing Populations
2014 Federally Qualified Health Centers (FQHCs)
In previous rounds of the Hypertension Control Challenge, Million Hearts® established a benchmark of 70% hypertension control for applicants’ adult populations. This 2014 success story reflects the earlier benchmark.
Million Hearts® has recognized 30 health care providers and organizations for their success in controlling the blood pressure of at least 70% of their hypertensive patients. In 2014, the following seven Federally Qualified Health Centers (FQHCs) were recognized as Hypertension Control Champions:
- Denver Health Community Health Services, Denver, CO
- East Jordan Family Health Center, Jordan, MI
- Family Health Centers of San Diego, San Diego, CA
- Peninsula Community Health Services, Bremerton, WA
- Roane County Family Health Care, Spencer, WV
- Southwest Montana Community Health Center, Butte, MT
- WinMed Health Services, Cincinnati, OH
FQHCs serve a unique role of providing preventive and primary care services in communities of need, regardless of an individual’s ability to pay. The Centers for Disease Control and Prevention spoke with some of the FQHC Champions to gather insights and best practices for hypertension control within their communities.
What They Did
Many of the patients served at Denver Health, Family Health Centers of San Diego, and WinMed are African American, a population at greater risk for high blood pressure. These health centers have taken steps to address populations at risk of high blood pressure through a variety of tactics. For example, Denver Health has partnered with the Center for African American Health’s Just Check It program to provide self-management support and health education to African Americans. Family Health Centers of San Diego and WinMed have maintained their vigilance to control blood pressure among African American patients through free blood pressure checks and patient appointment reminders.
“My advice to improve quality metrics is first to have data that providers understand and believe is valid.”
—Charles Smoot, MD, assistant medical director for clinical outcomes, Family Health Centers of San Diego
Trusted the data
Family Health Centers of San Diego increased its overall control rate for high blood pressure, also known as hypertension, by 3 percentage points in just 1 year. Staff achieved this milestone by building their own electronic health record (EHR) system that tracks multiple care quality indicators, contains 55 treatment reminders, and offers information and decision aids on demand. Providers can customize their own EHRs and see data in real time. Family Health Centers of San Diego also took the following steps:
- Establishing a clinical quality department to analyze data and drive improvements.
- Measuring 21 clinical outcomes and focusing more attention on those that fell below the national average.
- Sharing hypertension metrics with providers to encourage progress.
“The main thing is to always be vigilant.”
—Raymond Estacio, MD, associate medical director for quality and research, Denver Health Community Health Services
Supported a growing population
FQHCs nationwide have risen to the challenge of caring for more new patients as a result of wider health care coverage under the Patient Protection and Affordable Care Act (ACA). Denver Health has enrolled 15,000 new patients since the ACA took effect and anticipates adding 10,000 more in 2015. While going through tremendous growth, Denver staff continued to improve their hypertension control by taking the following steps:
- Establishing a hypertension clinic for patients with uncontrolled blood pressure, where patients can meet with a nurse practitioner or pharmacist.
- Promoting self-measured blood pressure monitoring and feedback for patients who have complex conditions.
- Forming partnerships with community groups, including the Center for African American Health, to engage them in preventive health programs.
“Our patients see us as their medical home.”
—Carroll Christiansen, MD, medical director, Roane County Family Health Care
Built a relationship
Roane increased its hypertension control rate by 4 percentage points in just 1 year by starting a data-driven program with clear provider goals. Staff know that medication adherence is key to blood pressure control, so they address unpleasant side effects and help patients find access to medicines at low or no cost. Roane’s rural location and comprehensive health service enable staff to form strong relationships with patients. Among the other steps that Roane has taken to achieve control are the following:
- Establishing clear protocols for treating patients with hypertension and training staff.
- Measuring blood pressure properly and repeating the measurement when the reading is high.
- Hiring a care coordinator to contact patients who are overdue for a checkup
“We make sure patients have their medications and come in regularly, even though it is labor intensive.”
—Yvette Casey-Hunter, MD, chief medical officer, WinMed Health Services
Tended the patient at the center
WinMed increased its hypertension control rate by 7 percentage points in just 1 year. WinMed notes one of the keys to controlling hypertension is to ensure patients come in for regular care and blood pressure screenings. The health center has implemented a team-based approach for treating patients composed of physicians, pharmacists, staff, and behavioral and dental experts to ensure the patient is cared for across the continuum of care.
WinMed also takes the following steps to achieve hypertension control:
- Reinforcing community ties, emphasizing patient education, and ensuring cultural competence to build trust with patients.
- Including specialists, such as pharmacists and patient assisters, on the health care team.
- Confirming regular appointments and sufficient medication for between visits.
These 2014 Million Hearts® Hypertension Control Champions know that blood pressure control is challenging, but it can be achieved by building trust, using health information technology, tracking quality, and working as a team. Together, these Champions have made control the goal to prevent heart attacks and strokes.