Download Petaluma Health Center Blood Pressure Control

Blood Pressure Control:
Path to the Million Hearts Award
Jessicca Moore, MSN, FNP Associate Clinical Director
Nurit Licht, MD, Chief Medical Officer
The Million Hearts Program
• Started in 2011, a national initiative to prevent
•
•
•
•
1 million heart attacks and strokes in 5 years
CDC co-leads Million Hearts with the US
Department of Health and Human Services,
Center for Medicare & Medicaid Services
The 2015 Hypertension Control Champions
used evidence-based strategies and patient
engagement to help their patients achieve
blood pressure control rates at or above the
Million Hearts target of 70 percent
The 18 Champions, ranging from small
practices to large health care systems
throughout the U.S., provide care to nearly 1.5
million adults, Petaluma Health Center was
named a 2015 Million Hearts Champion
To be eligible, entrants shared verifiable high
blood pressure control data and highlighted
successful strategies and best practices
adopted by the practice or system, such as the
use of health information technology and
team-based care
• All Champions achieved control rates of 70
percent or greater for their adult patients by
using a variety of approaches, including:
• Making high blood pressure control a
priority
• Using evidence-based treatment
guidelines and protocols
• Using health care teams to increase the
frequency of contact with patients
• Implementing consistent, strategic use of
electronic health records that include
clinical decision support tools, patient
reminders, and registry functionality
• Staying engaged with patients by offering
free blood pressure checks and
implementing the use of a patient navigator
or care coordinator
Understanding the Problem:
Education and Understanding
Patient’s Voice
Many patients with
hypertension and
uncontrolled blood
pressure do not
understand the
impact on their
health
• Advisory Council
• Informal Interviews
Staff/Provider Voice
• Workgroup
• Team Meetings
Understanding the Problem:
Team Approach
Patient’s Voice
Getting blood
pressure under
control requires
multiple
interventions and
visits
• Advisory Council
• Informal Interviews
Staff/Provider Voice
• Workgroup
• Team Meetings
Understanding the Problem:
Medication Adherence
Patient’s Voice
Many patients with
hypertension and
uncontrolled blood
pressure are not
taking their
medication as
directed.
• Advisory Council
• Informal Interviews
Staff/Provider Voice
• Workgroup
• Team Meetings
Barriers Identified
Systems
• No Standard Protocol for
•
•
•
•
Treatment
No Standard Protocol for
Medication Intensification
No Consistent System to
Address Adherence
Pharmacy
Refills
People
• Misunderstanding
Diagnosis
• Misunderstanding
Treatment Plan
• Fear of Side Effects
System Solutions
• Standard workflow with
templates to support
asking about issues
such as adherence
• Standard education for
patients
• Standard process for
team roles and visit
schedules
Template + Training
We had the template, but staff needed training on how
to best engage with patients to get meaningful and
accurate information?
“Many people with high blood pressure sometimes forget to
take their medication. How often do you forget or skip your
medications?”
“Tell me how you take your medications.”
“What’s your goal for your blood pressure?”
Standardization
• Standard HTN
protocols for providers
and RNs to follow
• Standardized patient
education
Refill Solutions: “Hassle Free”
• Standard 90 day supply for chronic medications with 3
•
•
•
•
refills
Add text to sig. “Lisinopril-HCTZ 10/25 one tablet daily for
blood pressure”
Stop using refills as the gate-keeper
Say “yes” AND follow regular recall calendar
In house pharmacy for more seamless communication
Results 2013-2016
12
CONTACT INFORMATION
Jessicca Moore, MSN, FNP
[email protected]
Nurit Licht, MD
[email protected]