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Kaiser report shows large increase in high blood pressure control



Kaiser Permanente reports it used patient registries, data analytics, dissemination of evidence-based guidelines, sharing of performance metrics and the increased use of prescription drugs to achieve a near doubling of the rate of patients who got their high blood pressure under control. The report highlights the growing focus by healthcare providers and health plans on taking proactive measures to improve population health and management of chronic medical conditions.

Results of the long-term, large-scale and multifaceted effort were published online in the Journal of the American Medical Association. The lead author is Dr. Marc Jaffe, of the Kaiser Permanente South San Francisco Medical Center.

The report recaps the work of the Kaiser Permanente Northern California hypertension control program from 2001 through 2009. During that period, the number of patients in the division's hypertension registry increased from 349,937 to 652,763. The definition of blood pressure control used for the study was that of the National Committee for Quality Assurance's Healthcare Effectiveness Data and Information Set—a systolic blood pressure reading of less than 140 and a diastolic reading of less than 90.

During the study period, the HEDIS hypertension control rate in Kaiser's program rose from 43.6% in 2001 to 80.4% in 2009. In comparison, for the same period, the national mean NCQA HEDIS control rate increased from 55.4% to 64.1%, according to the study.

Since then, the division's control rates have kept climbing, to 83.7% in 2010 and 87.1% in 2011, according to a news release about the program.

“Key elements of the program include establishment of a comprehensive hypertension registry, development and sharing of performance metrics, evidence-based guidelines, medical assistant visits for blood pressure measurement, and single-pill combination pharmacotherapy,” the news release said.

For example, by leveraging the patient registry and data analytics technology, Kaiser could produce “customizable queries” to identify groups of patients with poorly controlled hypertension who were then “evaluated for appropriateness of treatment intensification,” the JAMA report said.

Every one to three months, the program generated hypertension control reports, which were distributed to the directors of each medical center in Kaiser's northern California region. “During the study period, a central hypertension management team identified successful practices and disseminated effective strategies to the medical centers,” the study article said. Regular reporting “facilitated identification of high-performing medical centers in which successful practices or innovations were identified and then disseminated program-wide. Although feedback at the individual clinician level has long been used to promote change, we focused on clinic-level feedback to facilitate operational and system-level change.”

Scheduling regular patient follow-up visits with medical assistants optimized workflow for clinicians, affording patients “greater access to the medical team by eliminating co-payments, allowing greater scheduling flexibility, and involving shorter visit times, all of which reduced patient barriers.”

The use of certain antihypertensive prescription drugs in single-pill combination was added to practice guidelines in 2005, “affording important advantages, including improved medication adherence and lower patient cost,” the article said. Meanwhile, the number of prescriptions per month for common medications such as ACE inhibitors and beta blockers, including some offered as SPCs, increased by 82%, the report said.

In addition, in 2001, “an evidence-based, four-step hypertension control algorithm was developed to aid clinicians. The guideline was updated every two years based on emerging randomized trial evidence and national guidelines. Clinicians were encouraged to follow the algorithm unless clinical discretion required otherwise. Dissemination of guidelines occurred through distribution of printed documents, e-mail, clinical tools (such as pocket cards), videoconferences, lectures, partnering with pharmacy managers, and use of the electronic medical record to optimize selection of medication,” the study report said.

Follow Joseph Conn on Twitter: @MHJConn

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