Improved Blood Pressure Control Associated With a Large-Scale Hypertension Program
Does the development of a large-scale hypertension program within a health care system improve the percentage of patients with blood pressure (BP) control on or below target?
The Kaiser Permanente Northern California (KPNC) hypertension program included a multifaceted approach to blood pressure control. Patients identified as having hypertension in KPNC from 2001-2009 were included. The comparison group was comprised of insured patients in California between 2006 and 2009, who were included in the Healthcare Effectiveness Data and Information Set (HEDIS) participating in the National Committee for Quality Assurance (NCQA). A secondary comparison group was included to obtain the reported national mean NCQA HEDIS commercial rates of hypertension control between 2001 and 2009, from health plans that participated in the NCQA HEDIS quality measure reporting process.
The KPNC hypertension registry included 349,937 patients when established in 2001, and increased to 652,763 by 2009. The NCQA HEDIS commercial measurement for hypertension control within KPNC increased from 43.6% (95% confidence interval [CI], 39.4%-48.6%) to 80.4% (95% CI, 75.6%-84.4%) during the study period (p < 0.001 for trend). In contrast, the national mean NCQA HEDIS commercial measurement increased from 55.4% to 64.1%. California mean NCQA HEDIS commercial rates of hypertension were similar to those reported nationally from 2006-2009 (63.4% to 69.4%).
Among adults diagnosed with hypertension, implementation of a large-scale hypertension program was associated with a significant increase in hypertension control compared with state and national control rates. Key elements of the program included a comprehensive hypertension registry, development and sharing of performance metrics, evidence-based guidelines, medical assistant visits for blood pressure measurement, and single-pill combination pharmacotherapy.
The study demonstrated that a no-copay visit with a medical assistant at 2- to 3-week follow-up visits to assess need for dose adjustment by the physician is safe and effective. To what degree the protocol would impact groups at high risk for noncompliance (black, lower socioeconomic level) needs to be evaluated.
Keywords: California, Hypertension
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