Population health management for hypertension - building it into the system

Abstract

Purpose of the study: Hypertension is prevalent, expensive and a major contributor to cardiovascular mortality. There are numerous recommended hypertension practice guidelines and algorithms. However, population management is the key and can be achieved at all levels in health care through a systems approach. Statement of the methods used: InterMed a multispecialty group practice in Portland Maine with 75,000 patients integrates a population health management approach at the clinical level. Using Clinical Microsystems (front-line units comprised of a small group of people that provide health care) and ‘‘Working from the ground up’’ we have a structured approach to organizational improvement and a ‘‘laboratory’’ for finding and refining successful practices for hypertension management that can be adopted across the organization. Summary of results: InterMed has implemented full utilization of data at all levels of care including: Terminal digit bias data for accurate BP measurement and assessment of staff training Hypertension patient panel data Population management and performance metrics tied to public reporting InterMed’s systems approach has allowed us to adopt, test and modify an algorithm/practice guidelines for hypertension management. Components which include: Established a prescription refill protocol which reduces delays in BP medication refills NP/PA hypertension experts to see patients in follow up for medication titration Provide 24 hour blood pressure monitor as appropriate Home BP monitoring and patient engagement in self-management Establish Hypertension Specialty Practice for resistant hypertension and challenging cases (InterMed is the first health system in Maine to have a primary care physician certified as hypertension specialist) Conclusions reached: Hypertension is associated with increased risk of cardiovascular events, particularlystroke, heart failure, and kidney disease. Improved control of blood pressure leads to a proven reduction in cardiac events. Evidence supports an organized, comprehensive system of regular population review and intervention to improve the management of hypertension.