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

▶

Apr 17, 2023 190 likes •355 views

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,

SLIDE 1

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

SLIDE 2

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

SLIDE 3

SLIDE 4

Results

SLIDE 5

33% 63%

67% 37%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

February, 2016 June, 2017

Anschutz Internal Medicine

Providers with 70% Control or Greater Providers with Less than 70% Control

27% 88%

73% 12% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% February, 2016 June, 2017

Lowry Internal Medicine

Providers with 70% Control or Greater Providers with Less than 70% Control

SLIDE 6

EDUCATION

Patient Education Materials Quarterly BP Measurement Technique Trainings

Medical Assistants (MAs)

participate in ongoing educational sessions

Includes:
Overview of BP
Cuff sizing
Patient positioning
Automatic BP machines
Manual readings

SLIDE 7

Previous outreach criteria:

Patients age 18-59
Last BP > 140/90
Average of the last 3 BP Readings > 150/90
Last PCP visit 6 months ago or longer

Expanded outreach criteria:

Patients age 18-59
Last BP >140/90
Average of the last 3 BP readings > 140/90
Last PCP visit 3 months ago or longer

269 504 280 95 100 200 300 400 500 600 700 Lowry (n=549) Anschutz (n=599)

Outreach Results

Attempted Resulted in Visit

OUTREACH

SLIDE 8

Anschutz

Pharmacy
Recheck & review
Encourage Self-monitoring

Lowry

Physician paired with a trained RN
Collaborate & manage complex hypertensive

patients

RN provides education & support via telephone

/ MHC

Recheck & review

AHA HBP Algorithm Including:

Patient education
Medication titration
Lifestyle modifications

TREATMENT & COUNSELING

SLIDE 9

SELF MONITORING

No Co-Pay BP Checks Home BP Checks

Encouraged self-monitoring as part of

treatment via the MD/ RN HTN clinic and the Pharmacy HTN clinic

Summary n % Total # no-charge BP Checks 94 # 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%

SLIDE 10

CURRENT FACULTY

# Patients age 18<=59 # with BP <= 140/90 # pts uncontrolled # additional controlled pts to meet goal % <= 140/90 Goal

Johnson, Michelle 20 16 4

80.00%

70.00% 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%

AUDIT & FEEDBACK

LOWRY IM OP TEST, DOCTOR NO TEST, PATIENT 888888 53 12/11/2015 06/16/2015 152 96 132 LOWRY IM OP TEST, DOCTOR YES JOHNSON, TEST 222222 62 6/24/2015 09/09/2014 133 80 144 LOWRY IM OP TEST, DOCTOR YES DOE, JANE 131313 68 6/17/2015 06/17/2015 138 75 143

# Patients with HTN: 3 # Patients with last BP <= 140/90 2 % Patients with last BP <= 140/90 66.67%

Last Practice Visit Last PCP Visit Last BP Systolic Last BP Diastolic Average BP Systolic Department Provider BP < 140/90 Patient Name MRN Age

SLIDE 11

AUDIT & FEEDBACK

54.55% 50.89% 51.72% 57.63% 56.14% 52.78% 57.02% 54.10% 61.11% 68.24% 71.71% 56.39% 60.33% 58.90% 57.96% 62.62% 56.02% 52.17% 53.61% 59.73% 61.75% 66.07% 40.00% 45.00% 50.00% 55.00% 60.00% 65.00% 70.00% 75.00% 80.00% Feb-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Oct-16 Dec-16 Feb-17 Apr-17 Jun '17

Resident Hypertension Control (Ages 18-59)

LOWRY RESIDENTS ANSCHUTZ RESIDENTS

SLIDE 12

Uncontrolled Patients: A Deep Dive

144, 83% 29, 17% Hypertensive Patients with Uncontrolled BP (N=173)

Uncontrolled patients who are NOT actionable Uncontrolled patients who are actionable and may benefit from an intervention

47, 33% 35, 24% 28, 19% 14, 10% 13, 9% 4, 3% 2, 1% 1, 1%

Reasons Patients Were Not Actionable (N = 144)

BP is adequately controlled in Primary Care/ home measurement Patient did not follow up Provider is actively intervening

n patient. (lifestyle

modifications or med titration) Following PCP's most recent intervention, BP is now controlled Medication non-adherence Other medical issues have taken priority No longer a patient with this provider/ clinic Patient refused intervention

SLIDE 13

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

SLIDE 14

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

SLIDE 15

Future Applications for Population Health

Providers receive actionable patient-level data Dashboard Automated process to push data

SLIDE 16