Hypertension Best Practice Session 6 Implicit Bias

1. Hypertension Best Practice Session 6 Implicit Bias

2. Hypertension best practice elements BP measurement: include 2 BP readings if first is high Timely follow-up: monthly visits until BP controlled Treatment algorithm: low cost once daily meds Communication: building trusting relationships Outreach: using a registry

3. Learning objectives Review process for obtaining a second blood pressure reading and sustaining efforts Review process for timely follow-up and sustaining efforts Finalize a plan for outreach using HTN registry Understand the importance of implicit bias as it relates to communicating with patients

4. Data Review

5. Uncontrolled blood pressure, by month Place your data/graph here.

6. TwoBP readings when first is elevated Place your data/graph here.

7. Repeat BP How could we increase the rates of repeat BP to 80% or higher?

8. Timely follow-up data Place your data/graph here.

9. Timely follow-up process How could we increase one-month follow-up rates to 70%?

10. Outreach

11. Outreach Outreach criteria Adults seen by the clinic within the past 2 years with the last BP recorded as elevated. Outreach methods E-mail Patient health portal Postal mail Telephone call and/or secure text messaging

12. Sampleprocessforoutreach Attempt to contact patient 3 times

13. Communication

14. Communication outline Implicit bias video and discussion Discuss implicit bias homework Strategies to reduce bias

15. Video Silent Beats

16. Homework Reactions to the homework

17. Implicit bias evidence Greater implicit pro-White bias associated with lower referral for thrombolysis in Black vs. Whites. (Green, 20071) Overweight/obese individuals more likely to report negative health care experiences and to avoid, cancel, or delay medical appointments than healthy weight peers. (McCauley, 20152) Despite being otherwise identical, male patients are referred for TKA more often than females. (Borkhoff, 20081) No association between implicit bias scores and medication intensification for blood pressure. (Blair, 20143) Likely due to use of best practice protocols 1. Physicians and Implicit Bias: How Doctors May Unwittingly Perpetuate Health Care Disparities. J Gen Intern Med 2013; 28(11):1504–10 2. McCauley J. An Examination of Weight, Weight Bias, and Health Care Utilization and Attitudes Among Emerging Adults. 2015. Available at: http://scholarscompass.vcu.edu/cgi/viewcontent.cgi?article=4988&context=etd 3. Blair IV, Steiner JF, Hanratty R et al. An investigation of associations between clinicians' ethnic or racial bias and hypertension treatment, medication adherence and blood pressure control. J Gen Intern Med. 2014 Jul;29(7):987-95.

18. Strategies to reduce implicit bias Best Practice Protocols For example, HTN best practice Environment to reduce negative experiences For obesity: chairs without armrests, scales that obese patients can use easily, BP cuffs of all sizes readily available, watch language and nonverbal expressions Individuation: detailed history Perspective taking: empathy Increased opportunity for positive contact Long-term reduction in implicit race bias: A prejudice habit breaking intervention. J ExpSoc Psychol. 2012 November; 48(6): 1267–1278.

19. Next steps Determine who will review data with the practice and at what times to sustain efforts.

20. Congratulations!Your have completed all six Hypertension Best Practice sessions.

21. Disclaimer Use of these slides alone will not improve blood pressure control within your practice. Blood pressure control will be achieved through active quality improvement efforts in conjunction with these slides. Practice coach consultation is available to assist you in improving outcomes.

22. Acknowledgements This work was made possible with funding from: The Mt. Sinai Healthcare Foundation Centers for Disease Control and Prevention Special thanks to: Better Health Partnership participating clinics Health Improvement Partnership-Cuyahoga (HIP-Cuyahoga)

23. Contact information For questions about the online toolkit or assistance with implementation, please contact our coaching team at info@betterhealthpartnership.org.

24. Thank you!