Division of General Internal Medicine Hypertension Impact Project - PowerPoint PPT Presentation

Division of General Internal Medicine Hypertension Impact Project September 21, 2017 Integrated Network Summit Presented by: Mark Earnest, MD, PhD Lauren Drake, Wagner Schorr-Ratzlaff MD, Huong Lam MD, Laurence Williams MD, Mary McCord MD, Hillary Chrastil MHA, Mary Kozloski, Carmen L. Lewis MD, MPH

Background • Goal: To achieve 70% hypertension control across both our General Internal Medicine practices. • Strategy: Five evidence-based domains with 1-3 strategies each • Setting • Anschutz Internal Medicine ~ 4,700 • Lowry Internal Medicine ~ 2,400

Results

Anschutz Internal Medicine Lowry Internal Medicine 100% 100% 12% 90% 90% 37% 80% 80% 70% 70% 67% 73% 60% 60% 50% 50% 88% 40% 40% 63% 30% 30% 20% 20% 33% 27% 10% 10% 0% 0% February, 2016 June, 2017 February, 2016 June, 2017 Providers with 70% Control or Greater Providers with 70% Control or Greater Providers with Less than 70% Control Providers with Less than 70% Control

EDUCATION Quarterly BP Measurement Technique Patient Education Materials Trainings • Medical Assistants (MAs) participate in ongoing educational sessions • Includes: • Overview of BP • Cuff sizing • Patient positioning • Automatic BP machines • Manual readings

Outreach Results 700 OUTREACH 600 95 Previous outreach criteria: 500 • Patients age 18-59 280 400 • Last BP > 140/90 • Average of the last 3 BP Readings > 150/90 300 • Last PCP visit 6 months ago or longer 504 Expanded outreach criteria: 200 • Patients age 18-59 269 100 • Last BP >140/90 • Average of the last 3 BP readings > 140/90 0 • Last PCP visit 3 months ago or longer Lowry (n=549) Anschutz (n=599) Attempted Resulted in Visit

TREATMENT & COUNSELING AHA HBP Algorithm Including: • Patient education • Medication titration • Lifestyle modifications Lowry Anschutz • Physician paired with a trained RN • Pharmacy • Collaborate & manage complex hypertensive • Recheck & review patients • Encourage Self-monitoring • RN provides education & support via telephone / MHC • Recheck & review

SELF MONITORING Home BP Checks No Co-Pay BP Checks • Encouraged self-monitoring as part of Summary n % treatment via the MD/ RN HTN clinic and the Total # no-charge BP Checks 94 Pharmacy HTN clinic # Unique patients 84 BP =< 140/90 57 60.6% Escalated to RN 32 34.0% Escalated to MD 2 2.1% Sent to ED 1 1.1%

AUDIT & FEEDBACK # additional controlled pts to meet goal Last Last Last Average BP < Patient MRN Age PCP BP BP BP Last Practice Visit Department Provider 140/90 Name Visit Systolic Diastolic Systolic LOWRY IM OP TEST, DOCTOR NO TEST, PATIENT 888888 53 12/11/2015 06/16/2015 152 96 132 # Patients age 18<=59 # with BP <= 140/90 LOWRY IM OP TEST, DOCTOR YES JOHNSON, TEST 222222 62 6/24/2015 09/09/2014 133 80 144 # pts uncontrolled LOWRY IM OP TEST, DOCTOR YES DOE, JANE 131313 68 6/17/2015 06/17/2015 138 75 143 % <= 140/90 Goal CURRENT FACULTY # Patients with HTN: 3 Johnson, Michelle 20 16 4 - 80.00% 70.00% # Patients with last BP <= 140/90 2 % Patients with last BP <= 140/90 66.67% Jordan, Michael 87 69 18 - 79.31% 70.00% Doe, Jane 12 9 3 - 75.00% 70.00% Test, Doctor 33 24 9 - 72.73% 70.00% Lee, NP 11 8 3 - 72.73% 70.00% Green, Mario 57 41 16 - 71.93% 70.00% Red, Allison 14 10 4 - 71.43% 70.00% ALL 796 538 258 20 67.59% 70.00% Diaz, Director 77 52 25 2 67.53% 70.00% Day, Dean 91 61 30 3 67.03% 70.00% Physician, Miss 24 15 9 2 62.50% 70.00% RESIDENTS 144 88 56 13 61.11% 70.00% Last, First 61 37 24 6 60.66% 70.00% Name, Name 12 6 6 3 50.00% 70.00%

Resident Hypertension Control (Ages 18-59) AUDIT & 80.00% FEEDBACK 75.00% 71.71% 70.00% 68.24% 65.00% 66.07% 62.62% 60.33% 61.11% 61.75% 58.90% 60.00% 57.96% 59.73% 56.02% 56.39% 54.10% 57.63% 56.14% 57.02% 55.00% 54.55% 53.61% 52.78% 52.17% 50.00% 51.72% 50.89% 45.00% 40.00% Feb-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Oct-16 Dec-16 Feb-17 Apr-17 Jun '17 LOWRY RESIDENTS ANSCHUTZ RESIDENTS

Uncontrolled Patients: A Deep Dive Hypertensive Patients with Uncontrolled BP Reasons Patients Were Not Actionable (N=173) (N = 144) BP is adequately controlled in Primary Care/ home 2, 1% 1, 1% measurement 4, 3% Patient did not follow up 29, 17% 13, 9% Provider is actively intervening on patient. (lifestyle 47, 33% modifications or med titration) 14, 10% Following PCP's most recent intervention, BP is now controlled 144, 83% Medication non-adherence 28, 19% Other medical issues have taken priority Uncontrolled patients who are NOT actionable No longer a patient with this Uncontrolled patients who are actionable and may benefit from an 35, 24% provider/ clinic intervention Patient refused intervention

In In Summary ry • Push individualized bi-monthly data to providers • Focused work with residents • Patient education materials • Training for MAs • Outreach • AHA HBP Algorithm • No co-pay BP checks • Home BP monitoring

Lessons Learned • Pursue improvement in multiple domains • Monitoring the multiple data streams used to support hypertension improvement is key for improvement work • Accurate panel attribution is imperative • Pushing actionable patient-level data is a meaningful exercise

Future Applications for Population Health Providers receive Automated process Dashboard actionable to push data patient-level data

Discussion