Hea eart rt360 60 Fis ishb hbowl wl David J. Magid Insitute for Health Research Kaiser Permanente Colorado Scaling and Spreading Innovation Strategies to Improve Cardiovascular Health April 19, 2012
Rates es o of Hyper perten ension on Co Control l in in the U. U.S. S. are Lo Low • Benefits of hypertension therapy – 25% reduction in heart attack – 40% reduction in strokes – 50% reduction in heart failure • NHANES (2005-2008) – Treatment 70% – Control 46%
Foc Focus G Grou oups Ka Kais iser Co Colo lorado Clin Clinic ics • Controlling my BP is critical • Diet, exercise, and medications are important • Office visits are inconvenient and time-consuming • Using a home BP cuff is appealing
Pr Provider der Me Meetings gs Ka Kais iser Co Colo lorado Clin Clinic ics Providers Supportive Guideline driven Kept Informed
Home me B BP P Mo Moni nitor oring su suppo ported b ed by Ph Pharma macists a and nd Heart360 60
Res esea earch Q Ques estion For patients with hypertension, is a clinical pharmacy specialist-led Heart360 home BP monitoring program (HBPM) more effective than usual office-based care?
St Study Set Settin ing
Stu tudy dy P Popu opulati ation on Uncontrolled HTN Usual Care HBPM-Heart360 Initial visit Initial visit Referral Home BP To PCP monitoring six month follow-up visit
Moni Monitor oring ng P Prot otoc ocol
Re Result ults
HB HBPM Pat atien ents Had Had Superior 6 6-mo month th B BP P Contr Control 57% 37% Usual Care HBPM RR = 1.5 (1.2-1.9); p < 0.001
Heart360 H 0 HBPM PM G Group p Ha Had d a a Greater D Drop p in Blood ood P Pressure Usual Care HBPM HBPM Usual Care Mean BP drop (mm Hg) -5 -8 -11 -21 Systolic Diastolic P <0.001
Hea Heart360 HBP HBPM P Patien ients R Repo eported Gr Greate ter S Sati tisfaction w on with th Care 90% 61% Usual Care HBPM Very to Extremely Satisfied P <0.001
Wh What t are th the c cost st imp mplications fo for H Heart3 t360 60 HBPM? PM? • Intervention Costs • CV Events Prevented • Cost of Events Prevented
Co Cost st Ben Benefi efit o over er 10 0 Yea ears $35 $30 $ Invested $25 Millions of $ $ Saved $20 $15 $10 $5 $0 1 2 3 4 5 6 7 8 9 10 Year
Implementati tation B Bar arriers • Cost of BP cuffs • Need for computer and internet • Challenges of getting data into EHR • Capitation vs. Fee for Service • Patient Turnover
Trans nslation to on to Routi Routine ne Pract ctice: A A Ta Tale le of Tw Two R Reg egio ions Kaiser Colorado Kaiser Southern California
KP KP Co Colo lorado do • Enthusiastic response to presentations to health plan leaders and stakeholders • Little movement towards adoption in routine clinical practice – Turnover in clinical champion – Change in organizational priorities – Limited bandwidth – Lack of sponsorship
KP KP Souther hern Ca Califo lifornia • Enthusiastic response to presentations to health plan leaders and stakeholders • Rapid movement towards adoption – Stable clinical champion - > 20 years – Organizational priority – improve efficiency – Sponsorship by Associate Medical Director • Current Plans – Pilot 3 medical centers serving > 600K patients – Subsidize cost of cuff, consider BP cuff library – Existing infrastructure to support rollout
Lesson essons L Lea earned ed • Clinical champion • Organizational priorities • Bandwidth • Sponsorship
Disclaimer The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Agency for Healthcare Research and Quality.
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