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Health See other Health Articles Title: System-Wide Effort Improves Hypertension in 80% of Patients Medscape Medical News Editors' Recommendations Treatment-Resistant HTN and Suboptimal Therapy Controlling BP and Cholesterol Online Tool Helps Control Blood Pressure Long Term When Kaiser Permanente Northern California (KPNC) initiated a program to control hypertension in its patient population in 2001, less than half of patients diagnosed with hypertension had their blood pressure under control. Nine years later, 80% of KPNC hypertensive patients had blood pressures lower than 140/90 mm Hg, an improvement rate that exceeded both state and national trends. Marc G. Jaffe, MD, from the Department of Endocrinology, Kaiser Permanente South San Francisco Medical Center, California, and colleagues tracked data from KPNC, 1 of 8 divisions of the integrated managed care organization, Kaiser Permanente, as it adopted a system-wide program employing several strategies to improve blood pressure control. They published the results of the program in the August 21 issue of JAMA. In the quality improvement program, patients were identified each quarter for inclusion in a hypertension registry based on diagnostic codes, pharmacy data, and hospital records. Hypertension control rates were generated every 1 to 3 months for each KPNC medical center and distributed to center directors. The group used those data to identify practices associated with higher control rates, which they disseminated to other centers. A hypertension control algorithm, based on emerging evidence, was updated every 2 years, suggesting a step-wise approach to hypertension medications for blood pressure control. In addition, in 2005, single-pill combination therapy of lisinopril-hydrochlorothiazide was incorporated into the regional guideline as first-line medication. In 2007, KNPC added patient follow-up visits with medical assistants 2 to 4 weeks after a medication adjustment to monitor medication control success. Between 2001 and 2009, the KPNC hypertension registry population grew from 349,937 patients (15.4% of the adults in KPNC) to 652,763 patients (27.5% of the adults in the system). By 2009, the hypertension control rate for KPNC was 80.4% (95% confidence interval [CI], 75.6% - 84.4%) compared with the initial control rate of 43.6% (95% CI, 39.4% - 48.6%) in 2001 (P < .001 for trend). In comparison, the Healthcare Effectiveness Data and Information Set national mean hypertension control rate improvement failed to meet statistical significance, rising from 55.4% to 64.1% (P = .24 for trend) during the same period. The increase across California, available only since 2006, also failed to reach statistical significance, rising from 63.4% to 69.4% (P = .37 for trend). Moreover, the KPNC hypertension control rate has continued to rise in years after the study, climbing to 83.7% in 2010 and 87.1% in 2011, the authors report. Abhinaval Goyal, MD, MHS, assistant professor of medicine, Division of Cardiology, Emory School of Medicine, Atlanta, Georgia, and William A. Bornstein, MD, PhD, chief quality and medical officer, Emory Healthcare, Atlanta, authors of an accompanying editorial, call the KPNC study "an important contribution to the science of improving systems of care to detect and treat community-based hypertension." Dr. Goyal and Dr. Bornstein write that fee-for-service environments are less likely to implement approaches such as those used in the KNPC study because of the dual risks of increased costs and decreased reimbursements. "Fully integrated health systems (such as KPNC) that assume full responsibility by both insuring and delivering health care are particularly invested in managing risk factors to reduce downstream costs," they write. However, a transition to value-based models in all health sectors and the growth of accountable care organizations and shared savings models could ultimately make this kind of approach more widespread. Dr. Bornstein reported serving on an advisory panel for Cigna. The authors and Dr. Goyal have disclosed no relevant financial relationships. JAMA. 2013;310:695-696, 699-705. Post Comment Private Reply Ignore Thread
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