Adapting and Evaluating a Health System Intervention From Kaiser Permanente to Improve Hypertension Management and Control in a Large Network of Safety-Net Clinics

Fontil, Valy; Gupta, Reena; Moise, Nathalie; Chen, Ellen; Guzman, David; McCulloch, Charles E.; Bibbins‐Domingo, Kirsten

doi:10.1161/circoutcomes.117.004386

Cited by 47 publications

(67 citation statements)

References 16 publications

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“…2,3 While the Million Hearts blood pressure control goal is ambitious, it aligns with blood pressure control quality benchmarks and comprehensive hypertension control programs demonstrate attaining it is feasible. [4][5][6][7] However, it remains unclear which components of these comprehensive programs had the largest impact on improved blood pressure control rates.…”

Section: Introductionmentioning

confidence: 99%

Clinic-Based Strategies to Reach United States Million Hearts 2022 Blood Pressure Control Goals

Bellows

Ruiz‐Negrón

Bibbins‐Domingo

et al. 2019

Circ: Cardiovascular Quality and Outcomes

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Background-The Centers for Disease Control and Prevention's Million Hearts initiative includes an ambitious ≥80% blood pressure control goal in U.S. adults with hypertension by 2022. We used the validated Blood Pressure Control Model (BPCM) to quantify changes in clinic-based hypertension management processes needed to attain ≥80% blood pressure control.Methods and Results-The BPCM simulates patient blood pressures weekly using three key modifiable hypertension management processes: office visit frequency, clinician treatment intensification given an uncontrolled blood pressure, and continued antihypertensive medication use (medication adherence rate). We compared blood pressure control rates (using the Seventh Joint National Committee on hypertension targets) achieved over four years between usual care and the best observed values for management processes identified from the literature (1-week return visit interval, 20%−44% intensification rate, and 76% adherence rate). We determined the management process values needed to achieve ≥80% blood pressure control in U.S. adults. In adults with uncontrolled blood pressure, usual care achieved 45.6% control (95% uncertainty interval [UI] 39.6%−52.5%) and literature-based best observed values achieved 79.7% control (95% UI 79.3%−80.1%) over four years. Increasing treatment intensification rates to 62% of office visits with an uncontrolled blood pressure resulted in ≥80% blood pressure control, even when the return visit interval and adherence remained at usual care values. Improving to best observed values for all three management processes would achieve 78.1% blood pressure control in the overall U.S. population with hypertension, approaching the ≥80% Million Hearts 2022 goal.Conclusions-Achieving the Million Hearts blood pressure control goal by 2022 will require simultaneously increasing visit frequency, overcoming therapeutic inertia, and improving patient

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Section: Introductionmentioning

confidence: 99%

Clinic-Based Strategies to Reach United States Million Hearts 2022 Blood Pressure Control Goals

Bellows

Ruiz‐Negrón

Bibbins‐Domingo

et al. 2019

Circ: Cardiovascular Quality and Outcomes

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“…9,11 Treatment algorithms can be adapted in consultation with local experts and modified based on common formularies. 8 Primary care providers can still give individualized care, particularly for patients with compelling indications for alternative therapy or a history of adverse effects, but standardized management protocols are effective and safe for most people. 8,10 Finally, registries with regular performance reporting at the provider, clinic and regional level should be used to maintain best practices, to provide audit data and feedback for learning, to offer incentives and to close important care gaps.…”

Section: Refocusing On Hypertension Control In Canadamentioning

confidence: 99%

“…Specifically, a combination of health system, provider-level and patient-level approaches has proven highly effective in closing care gaps and is generalizable to many settings. 8 The World Health Organization and its partners developed the HEARTS program that outlines best practices for improving hypertension management to reduce cardiovascular disease. 9 These include screening all adults, identifying associated health risks, promoting team-based care, using a treat-to-target approach with simple directive algorithms and monitoring performance using registries with reporting functions.…”

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Refocusing on hypertension control in Canada

Leung

Bell

Tsuyuki

et al. 2021

CMAJ

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“…One population health-related approach used by clinical pharmacists includes review of patients’ charts to identify patients with metrics indicative of uncontrolled chronic conditions. 7,8 For identified patients, referrals from PCPs may be obtained if needed, given that the scope pharmacists practice under varies across states. Patients are then contacted to schedule a face-to-face appointment.…”

Section: Introductionmentioning

confidence: 99%

Patient Outreaches for Clinical Pharmacy Services: A Population Health Management Program Assessment

Bhat

Kroehl

Maniga

et al. 2019

Journal of Pharmacy Practice

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Background: Pharmacists in ambulatory care can utilize population health approaches to identify patients needing disease management and improve outcomes. However, population health is only effective when identified patients are successfully outreached and show to appointments. Objective: Describe a population health approach utilized by pharmacists in primary care, report outcomes of outreach attempts and scheduled appointments, and determine whether patient and referral characteristics predict no-show appointments. Methods: Retrospective cohort study of patients referred for pharmacist management of hypertension or chronic pain through population health between 2013-2016. Outreach attempt and appointments outcomes were collected. Patient and referral characteristics were analyzed to determine whether predictive of no-show appointments using logistic regression. Results: Of 450 outreach attempts, 250 (56%) patients were not reached, 164 (36%) scheduled appointments, and 36 (8%) were reached but declined an appointment. Of 164 patients with appointments, 71 (43%) no-showed. Patients with higher systolic blood pressure were more likely to no-show (OR: 1.02, 95% CI: 1.00-1.04). Other characteristics were not predictive of no-show appointments. Conclusion: Successful outreach and showed appointments are essential components of successful population health programs. Using multiple outreach modalities and further identifying factors predictive of no-show appointments to refine the current approach may lead to increased efficiency.

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Adapting and Evaluating a Health System Intervention From Kaiser Permanente to Improve Hypertension Management and Control in a Large Network of Safety-Net Clinics

Abstract: Evidence-based system approaches to improving BP control can be implemented in safety-net settings and could play a pivotal role in achieving improved population BP control and reducing hypertension disparities.

Cited by 47 publications

References 16 publications

Clinic-Based Strategies to Reach United States Million Hearts 2022 Blood Pressure Control Goals

Clinic-Based Strategies to Reach United States Million Hearts 2022 Blood Pressure Control Goals

Refocusing on hypertension control in Canada

Patient Outreaches for Clinical Pharmacy Services: A Population Health Management Program Assessment

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