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Marc Jaffe, MD

National Forum for Heart Disease and Stroke Prevention Improving Hypertension Control The Kaiser Permanente Hypertension Control Project: How a large health care organization improved blood pressure control from 44% to 80% in 8 years. Marc Jaffe, MD. Clinical Leader,

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Marc Jaffe, MD

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  1. National Forum for Heart Disease and Stroke PreventionImproving Hypertension ControlThe Kaiser Permanente Hypertension Control Project: How a large health care organization improved blood pressure control from 44% to 80% in 8 years Marc Jaffe, MD Clinical Leader, Kaiser Permanente Northern California Cardiovascular Risk Reduction Program Associate Clinical Professor of Medicine, UCSF October 17, 2012

  2. Kaiser Permanente Northern California (KPNC) 3.3 million members 2.7 million adults >5,000 MDs 17 medical centers 35 outpatient facilities Marc Jaffe, MD • The Permanente Medical Group, Inc. • Oakland, CA • 10/16/12

  3. KPNC Hypertension Implementation Timeline 2000 HTN Registry developed 2005 Single Pill Combination Promoted 2002 Performance Measures Distributed Successful practices disseminated 1995 Guideline Created, updated every 2 yrs 2007 Non-MDBP Visits 1995 1997 1999 2001 2003 2005 2007 2009 Marc Jaffe, MD • The Permanente Medical Group, Inc. • Oakland, CA • 10/16/12

  4. Evolution of the Hypertension Guideline TD=Thiazide Diuretic, BB=Beta Blocker, ACEI=Angiotensin Converting Enzyme Inhibitor, DCCB=Dihydropyridine Calcium Channel Blocker, Spir=Spironolactone *1995-2001 No Significant changes after step 2 Marc Jaffe, MD • The Permanente Medical Group, Inc. • Oakland, CA • 10/16/12

  5. Evolution of the Hypertension Guideline BB OK 1st BB OK 2nd BB 3rd BB OK 4th BB still 3rd BB not 1st SPC OK 1st ACEI 2nd ACEI or BB 2nd BB 3rd DCCB 3nd BB OK 4th TD=Thiazide Diuretic, BB=Beta Blocker, ACEI=Angiotensin Converting Enzyme Inhibitor, DCCB=Dihydropyridine Calcium Channel Blocker, Spir=Spironolactone. *1995-2001 No Significant changes after step 2 Marc Jaffe, MD • The Permanente Medical Group, Inc. • Oakland, CA • 10/16/12

  6. Hypertension Registry Development Hospital HTN Registry: Lab Results Medications Demographics Comorbid Conditions BP Measurements Visit Information Pharmacy Membership Data Outpatient Coding Outpatient EMR Clinical Laboratory Marc Jaffe, MD • The Permanente Medical Group, Inc. • Oakland, CA • 10/16/12

  7. Hypertension Registry Definition • Hypertension (HTN) Registry Population: • 2 visits for HTN in the past 2 yrs • No age limits • Designed to be very inclusive Marc Jaffe, MD • The Permanente Medical Group, Inc. • Oakland, CA • 10/16/12

  8. Hypertension Control Definition • Hypertension Control Rate • Age 18-85 yrs with an encounter diagnosis of Hypertension (46-85 before 2006) in the 1st 6 months of the reporting year • Blood Pressure at last clinic visit <140/90 (≤140/90 before 2006) • Exclusions: End Stage Renal Disease, Renal Transplant, pregnancy, or blood pressure measurements during hospitalization, Emergency Department visit, diagnostic test, or surgical procedure. Marc Jaffe, MD • The Permanente Medical Group, Inc. • Oakland, CA • 10/16/12

  9. Medical Center Hypertension Control 2001 Performance Reports Distributed to Medical Directors Quarterly Report 2001-2007, Monthly after 2007 High Performing sites identified and practices shared Marc Jaffe, MD • The Permanente Medical Group, Inc. • Oakland, CA • 10/16/12

  10. Evolution of Single Pill Combination Therapy in KPNC Optional Advised Not generally advised 1995 1997 1999 2001 2003 2005 2007 2009 Marc Jaffe, MD • The Permanente Medical Group, Inc. • Oakland, CA • 10/16/12

  11. 1/4 of ACEI Rx’s dispensedas Single Pill Combination Therapy Marc Jaffe, MD • The Permanente Medical Group, Inc. • Oakland, CA • 10/16/12

  12. Non-MD Blood Pressure Check Doctor clinic visit BP at goal BP over goal BP check • Advantages • Shorter visit for patient • No charge for visit • Scheduling flexibility • Improves access to MD Treatment intensification Follow up non-MD visit Marc Jaffe, MD • The Permanente Medical Group, Inc. • Oakland, CA • 10/16/12

  13. Hypertension Control Rates 2001-2009 80% 44% Commercial Rate as reported to HEDIS Marc Jaffe, MD • The Permanente Medical Group, Inc. • Oakland, CA • 10/16/12

  14. Hypertension Control Rates 2001-2010in Kaiser Permanent Northern California Commercial Rate as reported to HEDIS Marc Jaffe, MD • The Permanente Medical Group, Inc. • Oakland, CA • 10/16/12

  15. From 2001 to 2009 in KPNC HTN control rate nearly doubled from 44% to 80% HTN registry increased by 167% Controlled HTN tripled from 171,000 to 531,000 359,00 more people had controlled HTN 6 care processes implemented Evidence Based Guideline development HTN Registry creation Performance measure distribution Successful practice dissemination Single Pill Combination therapy promotion Non-physician BP visit creation Hypertension Results 2001-2009 Marc Jaffe, MD • The Permanente Medical Group, Inc. • Oakland, CA • 10/16/12

  16. Heart Attack Rates are declining in KPNC 16 Marc Jaffe, MD • The Permanente Medical Group, Inc. • Oakland, CA • 10/16/12

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