Hea eart rt360 60 Fis ishb hbowl wl David J. Magid Insitute - - PowerPoint PPT Presentation

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

• f Hyper

perten ension

• n

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

• ups

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

• ring su

suppo ported b ed by Ph Pharma macists a and nd Heart360 60

For patients with hypertension, is a clinical pharmacy specialist-led Heart360 home BP monitoring program (HBPM) more effective than usual office-based care?

Res esea earch Q Ques estion

St Study Set Settin ing

Stu tudy dy P Popu

• pulati

ation

• n

Uncontrolled HTN HBPM-Heart360 Initial visit Usual Care six month follow-up visit Initial visit Referral To PCP Home BP monitoring

Moni Monitor

• ring

ng P Prot

• toc
• col

Re Result ults

HB HBPM Pat atien ents Had Had Superior 6 6-mo month th B BP P Contr Control

RR = 1.5 (1.2-1.9); p < 0.001

Usual Care HBPM

37% 57%

Systolic Diastolic P <0.001

• 8
• 5
• 21
• 11

Usual Care HBPM Usual Care

Mean BP drop (mm Hg)

Heart360 H 0 HBPM PM G Group p Ha Had d a a Greater D Drop p in Blood

• od P

Pressure

HBPM

Hea Heart360 HBP HBPM P Patien ients R Repo eported Gr Greate ter S Sati tisfaction w

• n with

th Care

61% 90% 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

• ver

er 10 0 Yea ears

$0 $5 $10 $15 $20 $25 $30 $35 1 2 3 4 5 6 7 8 9 10 Millions of $ Year

$ Invested $ Saved

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

• n 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.