This article is more than 5 years old. Information may no longer be current.
Integrated care delivery system increased BP control rates in past decade
NEW YORK — BP control rates improved by more than 40% from 2001 to 2012 among Kaiser Permanente Northern California members after the implementation of a comprehensive program designed to address hypertension, according to results presented at the American Society of Hypertension Annual Scientific Meeting.
The Kaiser Permanente Northern California Hypertension Project was developed in 2001 as an evidence-based program to increase BP control for adult members with hypertension. Kaiser Permanente Northern California comprises approximately 2.3 million adult members, 21 hospitals and 45 medical facilities, and more than 7,000 physicians.
The Hypertension Project utilized physician-level and medical center metrics to measure performance over time, clinical practice guidelines that were developed and updated every 2 years, and infrastructure such as the creation of medical assistant BP checks and promotion of single-pill combination therapies with ACE inhibitors and hydrochlorothiazide. Clinicians were educated on the new guidelines and updated regularly on their control performance measurements, according to the study abstract.
From 2001 to 2012, BP control within the program increased from 43.6% to 85.7%. By comparison, the national rate of BP control was 55% in 2001 and 63% in 2012.
From 2009 to 2012, BP control increased from 80.4% to 85.7%. Rates of control were also higher within the Kaiser Permanente Northern California program compared with the average rate for the state of California at all evaluated time points.
As the drug treatment guideline within the network was updated every 2 years, therapy shifted from a focus on beta-blockers to more common treatment with ACE inhibitors and thiazide diuretics after the introduction of single-pill combination therapy in 2005. The use of this combination therapy increased from less than 0.1% to 30.5% during the study period.
Besides a comprehensive registry based on transparent performance metrics, Joseph D. Young, MD, of Kaiser Permanente Northern California in South San Francisco, said enabling feedback at the clinic level to facilitate change at the operational and system levels as needed is a key element of a large-scale hypertension control program such as this.
“We really focused on the team, on the functional unit ... as opposed to individual physician practices,” Young said. “By doing so, we were able to engage and energize the staff at the clinic, including medical assistants and pharmacists as well.”
Young said the medical assistant BP measurements played a vital role in the Kaiser Permanente Northern California program. The ability to have a patient undergo BP measurement during a primary care visit, with the information then routed to the appropriate clinician, helped to minimize the “white-coat effect” on BP — and, in turn, reduced overtreatment. He also stressed the importance of a simple, evidence-based treatment algorithm. These strategies, Young concluded, “… allow us to better leverage ancillary staff skills, as well as to reduce barriers to patients.” – by Adam Taliercio
For more information:
Jaffe M. LB-OR-02. Presented at: American Society of Hypertension 2014 Annual Scientific Meeting; May 16-20, 2014; New York.
Disclosure: Young reports no relevant financial disclosures.