Success Story: Large Health Systems Use Multiple Strategies to Achieve Control
Presbyterian Healthcare Services (Albuquerque, New Mexico); Kaiser Permanente Southern California; and Essentia Health (Duluth, Minnesota) (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.
For their success in keeping patients’ blood pressure under control, Million Hearts® has recognized 30 health care providers, practices, and systems as 2014 Hypertension Control Champions. Among them are three large health care organizations: Presbyterian Healthcare Services in Albuquerque, New Mexico; Kaiser Permanente Southern California; and Essentia Health in Duluth, Minnesota. These large health systems, which together serve more than 4 million patients, have helped at least 70% of their hypertensive patients achieve a safe blood pressure level of 120/80 mmHg or below.
Rapid Improvement in Hypertension Control
In 2012, Presbyterian Healthcare decided to take action and revamp its hypertension protocols to further help patients with blood pressure control. The health system staff created a step-by-step, evidence-based “care pathway” to outline patient-specific interventions and the role of each care team member in hypertension control.
By September 2014, Presbyterian increased its hypertension control rate by 18 percentage points. The rapid improvement brought many more people’s blood pressure into control, preventing heart attacks, strokes, and kidney and heart failure. Buoyed by their own success, the medical and nursing directors who help guide the new program set a new goal to achieve an additional control rate by 5 percentage points by the end of 2015.
To get there, Presbyterian will use proven strategies that include the following:
- Engaging all staff, from appointment schedulers to providers, as part of the care team, including a registered nurse who specializes in population health as the team manager to educate patients and staff.
- Creating opportunities for conversations between patients and care team members about hypertension and the importance of managing the condition, including easy appointment scheduling and no-cost walk-in blood pressure checks.
“Preventive care is a mantra at Kaiser.”
—Joel Handler, MD, Hypertension Lead Physician, Kaiser Permanente Southern California
Prevention for All
African Americans develop high blood pressure more often and at earlier ages than white Americans. Over the past couple of years, Kaiser has improved the hypertension control rate of all its patients while also reducing the gap between blood pressure control rates of African Americans and white Americans from 6% to 3.8%.
To help achieve its success, Kaiser focused on the following methods:
- Harnessing the power of electronic health records to create a hypertension registry, based on diagnosis and procedure codes, with treatment and testing reminders and patient reports.
- Tapping medical assistants to take walk-in, 10-minute blood pressure checks, of which there are about 30,000 every month.
- Prescribing a simple drug regimen that patients can follow, with automated reminders for prescription refills and checkups.
- Using an evidence-based protocol to guide treatment.
We make quality performance data available to all 13,000 employees.”
—Patrick Twomey, MD, chief medical officer and chief quality officer, Essentia Health
Incentives for Control
Transparency has been a powerful tool for blood pressure control at Essentia, where 3% of physicians’ compensation is tied to performance across 28 quality measures, including hypertension control. In 2013, the organization began sharing these performance data, broken down by region, clinic, and individual provider. This transparency encouraged friendly competition and prompted discussions among providers about how to help more patients control their blood pressure.
Essentia also expanded hypertension monitoring to specialty areas such as orthopedics. Staff in these specialties alert patients’ primary care providers to elevated blood pressure readings and encourage patients to schedule a follow-up primary care appointment before they leave the specialists’ office. Essentia has also taken the following evidence-based steps:
- Training all care team members to use proper technique to measure blood pressure accurately.
- Providing designated nurses to manage patients with complex health issues who need additional support to achieve blood pressure control.
- Encouraging select patients to meet with a pharmacist to help manage their medications and improve adherence.
These 2014 Million Hearts® Hypertension Control Champions know that blood pressure control is challenging, but it can be achieved through the use of team-based care, health information technology, performance tracking, and even friendly competition. These strategies take time and dedication to put into action but lead to fewer heart attacks and strokes and healthier patients.