Blood Pressure Management: An Improvement Story Annie Sy, PharmD, - PowerPoint PPT Presentation

Blood Pressure Management: An Improvement Story Annie Sy, PharmD, MHSA Director, SMF Integrated Quality Services Capital Region Right Care Initiative University of Best Practices Meeting October 8, 2018

Sutter Medical Foundation Theresa Frei CEO Years in Position: 3 Years with Sutter: 15 Physician Partners • Sutter Medical Group (SMG) • Sutter North Medical Group (SNMG) • Sutter Independent Physicians (SIP) • Aligned MDs: • Medical Groups: 1000+ • SIP: 541 Site Specifics • Sutter Surgical Hospital – North Valley • Care Centers: 84 locations • Surgery Centers: 2 locations • Diagnostic Imaging: 45 locations • Lab: 30 locations • Physical Therapy: 15 locations • Sutter Walk-In Care: 4 locations 2017 Quick Facts • Active Patients: 890k • 2017 Employees: 3,400 2 2

Where We Were • In 2016, among 36,626 Performance by Group (Data Through 12/31/2016) SMF patients with 100% hypertension and/or 80% diabetes, only 66% had 60% their blood pressure (BP) under control 40% • Top reason was failure to 20% review and act on results 0% – Only about 48% of patients SMG SNMG SIP Total Measure Rate 65.84% 71.88% 61.07% 65.97% with elevated BP were being P90 Benchmark 80.50% 80.50% 80.50% 80.50% addressed during clinic visits P50 Benchmark 68.50% 68.50% 68.50% 68.50% Denominator 29,113 3,755 3,758 36,626 Measure Definition: The percentage of members 18–85 years of age who had a diagnosis of hypertension, or 18-75 years of age with diabetes, and whose most recent BP within the past 12 months was adequately controlled according to the appropriate criteria based on their age and diabetic status. 3

What We Did • Monthly performance reports, with data at care center and physician levels • Hypertension guideline and measure FAQs • BP measurement training/education • Standard workflow to take second BP if first one is high • Improve documentation (Vitals, CPT-2 codes) 4

What We Did • Visual cues for PCPs for patients with elevated BP levels during clinic visits • Engage specialists • Telephonic Disease Management engagement • Outreach efforts (e.g., patients without follow up appointments) • Link it to patient wellbeing and decrease risk of cardiovascular events 5

Care Center Highlight: Davis Family Practice Group 6

Where We Are 100% • Since 12/31/2016: % of Patients with BP Under Control – Overall BP control rate increased 80% from 66% to 79% 60% – About 4,218 more SMF patients 40% have their BP under control • Number Needed to Treat (NNT) for 20% BP-lowering treatment to prevent 0% SMG SNMG SIP Total one CVD event in 5 years is 12/31/2016 65.84% 71.88% 61.07% 65.97% between 26 (highest risk group) 8/31/2018 79.47% 77.24% 75.27% 78.85% P90 Benchmark 80.50% 80.50% 80.50% 80.50% and 71 (lowest risk group) 1 P50 Benchmark 68.50% 68.50% 68.50% 68.50% 1 Estimated based on results from: Blood Pressure Lowering Treatment Trialists' Collaboration, Sundström J, Arima H, et al. Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data. Lancet 2014; 384:591. Measure Definition: The percentage of members 18–85 years of age who had a diagnosis of hypertension, or 18-75 years of age with diabetes, and whose most recent BP within the past 12 months was adequately controlled according to the appropriate criteria based on their age and diabetic status. 7

Blood Pressure Control in Patients with Hypertension and/or Diabetes (Rolling 12-Month Data) 90% % of Patients with BP Under Control 80% 78.85% 70% SMG 65.97% SNMG 60% SIP Total P90 Benchmark P50 Benchmark 50% Measure Definition: The percentage of members 18–85 years of age who had a diagnosis of hypertension, or 18-75 years of age with diabetes, and whose most recent BP within the past 12 months was adequately controlled according to the appropriate criteria based on their age and diabetic status. 8

Success Ingredients • Leadership champions • Clinician engagement • Care team support • Standard workflows • Visual management • Leverage friendly competitions • Recognize achievements 9

Questions / Comments / Feedback Annie Sy, PharmD, MHSA Director, SMF Integrated Quality Services Chair, SMF Quality & Patient Safety Committee (916) 731-7848 | Direct (916) 521-2591 | Mobile SyAZ@sutterhealth.org 10 10