Success Story: Small Practices Make Big Impacts on Patients’ Lives Using Health IT
Holly R. Dahlman, MD, of Green Spring Internal Medicine (Lutherville, Maryland), and Mark Backus, MD, of Cascade Internal Medicine Specialists (Bend, Oregon) (2014)
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® recognizes 30 health care providers and organizations as 2014 Hypertension Control Champions for their success in controlling the blood pressure of at least 70% of their hypertensive patients. Two of these Champions are private practice providers: Holly R. Dahlman, MD, of Green Spring Internal Medicine, Lutherville, Maryland, and Mark Backus, MD, of Cascade Internal Medicine Specialists, Bend, Oregon. Dr. Dahlman is a solo practitioner, and Dr. Backus is part of a two-physician office.
What They Did
Providers in small or solo physician practices are pulled in many directions. These Champions successfully implemented processes to monitor and track patients’ blood pressure while simultaneously forming partnerships with patients to help them keep their blood pressure at a healthy level.
Trusted the data
In 2011, Dr. Dahlman looked at how many of her patients had high blood pressure and was surprised to learn that many did not have their blood pressure under control.
“Clearly, that was something we needed to improve,” said Dr. Dahlman. To efficiently and effectively treat patients, Dr. Dahlman uses the registry feature in her electronic health record (EHR) to identify and monitor high-risk patients. The feature allows her to sort patients at risk for high blood pressure and monitor when they are due for a follow-up appointment. Patients can also self-monitor their blood pressure and record the results in a daily log.
Dr. Dahlman and the nurse practitioner at Green Spring work with patients to identify barriers to controlling blood pressure and strategies to overcome those barriers. She individualizes her approach for each patient to ensure the blood pressure management plan matches the patient’s cultural attitudes toward their disease and aligns with the individual’s goals.
Encouraging a healthy lifestyle is a priority. Dr. Dahlman recommends the DASH (Dietary Approaches to Stop Hypertension) eating plan. DASH encourages patients to eat heart-healthy foods low in sodium and trans and saturated fat. Many of Dr. Dahlman’s patients follow the diet because they want to control their blood pressure without medication.
When each patient leaves the office, Dr. Dahlman gives the patient the notes generated by the EHR, as well as additional resources, such as information about DASH, so patients can refer back to the resources later.
Provided team effort
At Cascade Internal Medicine Specialists, a medical assistant takes the patient’s blood pressure. If the blood pressure is high, the assistant waits 5 minutes before retaking it. If the blood pressure continues to be high, the assistant informs Dr. Backus.
“All of that happens without me having to think about it, which is really nice,” Dr. Backus said. He credits his hypertension control rate to a system that has internal checks to prevent patients from falling through the cracks, as well as a team that follows the system closely. Those internal checks ensure all patients will be monitored, even on unusually busy days or when the serious illness of another patient is occupying the doctor’s time.
“The demands on providers in small practice settings make it hard to focus on blood pressure over time, so you need a system to get it done,” Dr. Backus said. He continues staff training by reviewing procedures or teaching staff new skills, such as how to take pressure in elderly patients who have only a faint pulse.
“You can’t achieve blood pressure control right away, but the longer you work on it, the better control you get,” Dr. Backus said. Many of his patients have been with him for 15 years, giving him and his patients time to find the strategies that work best for each individual. His patients are happy when they get their blood pressure down.
Dr. Dahlman and Dr. Backus have engaged their patients and staff, put time-saving system changes in place, and focused on patient relationships, all of which have helped these small practices become Million Hearts® Hypertension Control Champions—one heart at a time.