Overview

This project at an academic medical center utilized a quality improvement program focused on medication intensification and serial measurement to improve hypertension management.

Organization Name

Cleveland Clinic

Organization Type

• Academic Medical Center
• Community health system
• Integrated healthcare system/network

National/Policy Context

• Even though health systems nationwide already provide high-quality hypertension care, there is still a need for higher levels of blood pressure control.
•  Hypertension caused or contributed to about half a million deaths in the United States in 2017 (CDC, 2020).
• About 76% of adults in the United States do not have their hypertension under control (CDC, 2020).

Local/Organizational Context

• There was the need for higher levels of blood pressure control at the Cleveland Clinic, a large integrated academic health system.

Patient Population Served and Payor Information

• Median patient age was 64.1 years. 
• 52% of patients were female and 77% of patients were male.

Leadership

• Elizabeth R. Pfoh, PhD spearheaded the project by creating the QI program, which includes two key components: blood pressure rechecks and medication intensification.
• Dr. Pfoh also provided leadership for the project during the implementation phase.

Research + Planning

• The implementation of this quality improvement program began June 2016.
  • The program includes two components: medication intensification and repeated measurement of blood pressure. 
• Primary care providers were trained to implement the quality improvement program when hypertensive patients showed up for their primary care visit.

Training

• MDs and NPs were trained to implement the quality improvement (QI) program by intensifying the medications prescribed and repeating blood pressure measurements when they saw patients with a diagnosis of hypertension at their primary care visit.

Tech Involved

• Electronic medical record

Team Members Involved

• NPs
• Physicians

Workflow Steps

• A patient with a diagnosis of hypertension walks in for their primary care appointment. 
• The primary care provider takes a blood pressure measurement or intensifies the medication regimen that the patient is prescribed during the appointment.
• At every subsequent appointment, the primary care provider repeats blood pressure measurement and intensifies the patient’s medication regimen. 
• Blood pressure control measures from 2016 are compared to those for each patient between 2016 and 2015.

Budget Details

• Labor costs associated with additional time spent by clinical staff members taking blood pressure measurements at every appointment. 
• Labor costs associated with additional time spent by clinical staff members implementing medication intensification.

Outcomes

• Mean systolic blood pressure measurement: The mean systolic blood pressure at last visit increased from 130.1mmHg in 2015 to 129.2mmHg in 2016. 
• Percentage of patients with controlled blood pressure reading: 79% of hypertensive patients had a controlled blood pressure measurement at their last visit in 2016 compared to 72% in 2015.

Benefits

• More patients having controlled blood pressure measurements between visits.

Sources

• Pfoh, E.R., Martinez, K., Vahaaria, N., Rothberg, M.B. (2019 June). Impact of a system-wide quality improvement initiative on blood pressure control. Poster session at the Academy Health Annual Research Meeting. Washington, D.C., United States.
• Facts about hypertension. (2020, February 25). Retrieved from https://www.cdc.gov/bloodpressure/facts.htm