Measure Up, Pressure Down Together 2 Goal Ben Balatbat, M. D. FACP Chief Medical Officer
2018 Population Health Data • Total HTN patients: 31,343 • Total Diabetic patients: 11,897 • Diabetics with hypertension: 9,437 (79%) • Diabetics with CHF: 1,083 • Diabetics with hyperlipidemia: 1,047 • Current group BP control rate around 75% 2
BP Measurement (August v/s September 2015) Status # of count % Status # of count % Normal Normal 20,476 65 21,169 65 140-179/90- 6,246 20 140-179/90- 6,925 21 109 109 180-209/110- 226 1 180-209/110- 292 1 119 119 0 0 > 210/120 19 > 210/120 25 No Test 14 No Test 13 4,373 4,080 Total 31,340 100 Total 100 32,491
Measure Up, Pressure Down • BP measurement – meaningful use metric • MU attributable provider (PCP) – 85% • PCP Billing Provider – 99% 4
Campaign Planks • Direct Care Staff Trained in Accurate BP Measurement • Hypertension Guideline Used and Adherence Monitored • BP Addressed for Every Hypertension Patient at Every Primary Care or Cardiology Visit • All Patients Not at Goal or with New Hypertension Rx Seen within 30 Days • Prevention, Engagement and Self-Management Program in Place • Registry Used to Track Hypertension Patients
Campaign Planks (Specialty) • Direct Care Staff Trained in Accurate BP Measurement • All Team Members Trained in Importance of BP Goals and Metrics • All Specialties Intervene with Patients Not in Control
Guideline for RX of HTN in non – Primary Care Sites • If patient’s BP is elevated, please have patient sit for 5 minutes and repeat BP. If the BP remains elevated, please notify specialty physician, prior to implementing any of the following scenarios. 1. Systolic 140-179 or diastolic 90-109. Ask the patient to schedule a routine follow-up with their primary doctor. ALSO, send a task to the primary doctor including the BP. This can be completed by any level of clinical staff.
Guideline for RX of HTN in non – Primary Care Sites • If patient’s BP is elevated, please have patient sit for 5 minutes and repeat BP. If the BP remains elevated, please notify specialty physician, prior to implementing any of the following scenarios. 2. Systolic 180-209 or diastolic 110-119. Have the patient wait in the office and a licensed clinical staff will call the primary or doctor on call for advice.
Guideline for RX of HTN in non – Primary Care Sites • If patient’s BP is elevated, please have patient sit for 5 minutes and repeat BP. If the BP remains elevated, please notify specialty physician, prior to implementing any of the following scenarios. 3. Systolic over 210 or diastolic over 120. Have the patient wait in the office, and call the primary care physician. Treat as urgent. This communication will be physician to physician.
Dermatology Communication Template 10
MUPD Data (2015 – 2017) 11
Frequency Blood Pressure Not taken by Specialty 12
Hypertension Control Rate – Internal Medicine 13
Together 2 Goal Metrics (2016 – 2018) 14
Making an Impact “I think we just saved a life today.” Since we instituted doing vitals on everyone in the clinic at each visit, there have been numerous times in the eye dept. that we have found concerning problems such as hypertension, heart block, and other health problems. Yesterday was no different. We did vitals on a 92 year old who was here for his routine exam. Oxygen sat was 85. He said he was somewhat short of breath. After I evaluated him I decided to call 911 and have him taken to General Hospital. He was found to have a pneumothorax, was admitted, and had a chest tube placed. I continue to be grateful that these policies are in place not just for us, but for our patients. I think we just saved a life today. (Dr. Bellinoff, ophthalmology) 15
Next Steps: • Retraining and education of staff – high turnover • More intensive management when BP not at goal • Push data to specialists and re-engage • Decrease the variability in performance in primary care • Leverage care team – Advance clinic practitioners – Advance practice pharmacists – PCMH RN’s 16
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