Abstract WP242: Using Systems Redesign in the Development, Implementation, and Evaluation of a Care Transitions and Hypertension (catch) Management Program for Veterans With Ischemic Stroke

Abstract

Introduction: Systems Redesign approaches have the potential to be used to develop, implement, and evaluate the implementation of post-ischemic stroke hypertension quality improvement initiatives. Methods: The CAre Transitions and Hypertension (CATcH) management program is a bundled, multi-faceted, provider- and healthcare-systems level pilot-intervention designed to enhance care coordination using infrastructure routinely available within a Veterans Health Administration (VHA) medical center delivering suboptimal post-stroke hypertension care. A rapid process improvement workshop with local personnel from internal medicine, neurology, clinical pharmacy, and facility leadership. The team process mapped out the current state of post-stroke blood pressure (BP) control from the hospitalization period to outpatient follow-up, and conceptualized a future state where there was enhanced care coordination between inpatient and outpatient providers, generalists and specialists, and increased engagement of underutilized talent within clinical pharmacy and telehealth. The CATcH bundle also included a Transition in Care note to improve communication between providers. The team decided to meet weekly to determine newly identified and ongoing needs for patients. Chart review was conducted to determine healthcare utilization. Results: In the six-months prior to the implementation of CATcH, facility-level pass rate for BP control (i.e., obtaining BP < 140/90 mmHg) was 50% (18/36). Stroke survivors were neither discharged with telehealth for BP monitoring nor received clinical pharmacy appointments. In the six-months after CATcH implementation, facility-level pass rate for BP control was 69% (22/32). Nineteen percent were enrolled in telehealth whereas all patients received and attended at least two clinical pharmacy appointments post-discharge. All patients discharged during the intervention period were recipients of the CATcH program. Conclusions: A Systems Redesign approach could be used to eliminate waste and minimize variability in the process of post-stroke hypertension management while using readily available hospital infrastructure to improve hypertension care for stroke survivors.