Blood Pressure Control

13th Annual Meeting - National Forum for Heart Disease and Stroke Prevention

October 21, 2015

Cindy Ferrara, RN, MS Essentia Health

Duluth, MN

• Strategies/Actions• Results over time• Successes and Challenges

1800 physicians/advanced practitioners67 clinics17 hospitals10,000 pt visits/day

Upper Midwest:Eastern ND, Northern and Central MN, Northwestern WI

Strategies and Actions to Improve BP Control

• Staff education– Accurate BP measurement– Importance of HTN management and target BP

• HTN registry• HTN protocol• Clinical Decision Supports• Transparency of data• Measure Up Pressure Down Campaign

• Accurate BP measurement• Lunch and Learn • Mandatory • Competency testing • HTN initiative and impact on pts• Train the trainer

• Common errors– Inappropriate cuff size– Placing cuff over clothing– Patient position– Readings too close together – Taking only one reading– Rounding– Failure to allow 5 min rest period

Staff Education

Last PCP and specialty visits and future PCP

visitLast BP and date

Diabetes, Vascular or CKD dx? On My

Health? (Pt portal)

PATIENT REGISTRYPopulated by EMR and Updated Weekly

Outreach to patients who miss scheduled appointments or are overdue for a follow-up visit.

HTN ProtocolScope

Patients managed by pharmacist or RN per protocol–Initial and follow-up visits–History/ Risk factors–Adherence–Medication management algorithms–Lab monitoring–Lifestyle modification and referral

Home BP monitoringDieticianTobacco cessationWeight management programs

Clinical Decision Support

• Best Practice AlertsCues provider:– If pt has HTN, diabetes, or vascular disease and

BP is > 140/90– If pt on medication that needs lab monitoring and lab is

due/overdue (e.g. K+) – If pt has BMI > 25– If pt uses tobacco

Data Feedback: How is the system performing?

Data Feedback: How is my region performing?

Data Feedback: How is my clinic performing?

Data Feedback: How am I performing?

Goals of Three-Year Campaign

Measurable improvements in high blood pressure prevention, detection, and control

80% of patients at goal 75% of AMGA membership adopt

(at least one) campaign planks that lead to measureable improvements in blood pressure control

Engage and empower patients to actively manage their health.

Minnesota: Land of Over-Achievers

• Mandated public reported data and ratings on health care quality, patient experience and cost

• 80 health care organizations reporting HTN metric • State average for BP control = 76%• Essentia is rated “average”

Successes and Challenges• Successes

– Reduced numbers of patients with adverse outcomes Increased quality of life• Reduced loss of function• Reduced medical costs

• Challenges – Adequate and effective communication– Provider engagement– Resource availability– Co-management with specialties– Accountability– Changing guidelines (JNC-8, SPRINT)

Selected Resources

Centers for Disease Control and Prevention. Hypertension Control Change Package for Clinicians. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2015. Available at: http://millionhearts.hhs.gov/Docs/HTN_Change_Package.pdf

James PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. doi:10.1001/jama.2013.284427.

Available at: http://jama.jamanetwork.com/article.aspx?articleid=1791497

Kenning I, Kerandi H, Luehr D, Margolis K, O’Connor P, Pereira C, Schlichte A, Woolley T. Institute for Clinical Systems Improvement. Hypertension Diagnosis and Treatment. Updated November 2014.

Measure Up Pressure Down Provider Toolkit: To Improve Hypertension Control http://www.measureuppressuredown.com/HCProf/Find/Toolkit/toolkit.pdf

Minnesota Health Scores. Available at: http://www.mnhealthscores.org/measuring-quality

National Heart, Lung, and Blood Institute. Landmark NIH study shows intensive blood pressure management may save lives. September 11, 2015. Available at: http://www.nhlbi.nih.gov/news/press-releases/2015/landmark-nih-study-shows-intensive-blood-pressure-management-may-save-lives#

Siu AL. Screening for High Blood Pressure in Adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. [Epub ahead of print 13 October 2015 doi:10.7326/M15-2223. Available at: http://annals.org/article.aspx?articleid=2456129