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VA Electronic Health Record Clinical Improvement in Hypertension

VA Electronic Health Record Clinical Improvement in Hypertension. Ross Fletcher, MD. VHA Doctor. 1. Reminders. Demo Patient 1. 000-00-0001. 001/01/1901 (00). 2. Select from Dialogs to Resolve the Reminder. 1. Select Reminder. Progress Note Text. Updates for PCE.

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VA Electronic Health Record Clinical Improvement in Hypertension

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  1. VA Electronic Health Record Clinical Improvement in Hypertension Ross Fletcher, MD

  2. VHA Doctor. 1 Reminders Demo Patient 1 000-00-0001 001/01/1901 (00) 2. Select from Dialogs to Resolvethe Reminder 1. SelectReminder ProgressNote Text Updatesfor PCE

  3. How VA Care Compares: Quality Measures

  4. Hypertension Treatment

  5. Analysis at 4 month Interval Baltimore Baltimore Washington Washington Martinsburg Martinsburg September 20, 2001 January 3, 2002 100 100 80 80 60 60 Percent of Patients 40 40 20 20 0 0 Normal Moderate High > (< 140 / 90 ) (140 - 159 / 90 - 99 ) ( 160 / 100 )

  6. Hypertensive Patients Returning to < 140 / < 90 0.6 0.55 0.5 Percent Patients 0.45 0.4 0.35 0.3 Jan 99 Jan 02 Jul 02 Jul 03 Jan 04 Jul 99 Jan 00 Jul 00 Jan 01 Jul 01 Jan 03 Months

  7. Hypertension Study – 15 Cities Anchorage, AK Portland, OR Minneapolis, MN Fargo, ND Boston, MS Philadelphia, PA New York, NY Chicago, IL Baltimore, MD Washington, DC Los Angeles, CA Houston, TX Miami, FL Honolulu, HI San Juan, PR

  8. Hypertensives Returned to Normal 80 582,881 Hypertensive Patients 75 70 Control rate 2000-2007 3.7%, 95% CI 3.1 – 4.3 P < 0.0001 65 Control rate 2007-2010 2.0%, 95% CI 1.9 – 2.2 P < 0.0001 Percent Normal 60 55 Summer – Winter Seasonal Variation 6.8 % 50 45 40 2000-09 2000-12 2001-03 2001-06 2001-09 2001-12 2002-03 2002-06 2002-09 2002-12 2003-03 2003-06 2003-09 2003-12 2004-03 2004-06 2004-09 2004-12 2005-03 2005-06 2005-09 2005-12 2006-03 2006-06 2006-09 2006-12 2007-03 2007-06 2007-09 2007-12 2008-03 2008-06 2008-09 2008-12 2009-03 2009-06 2009-09 2009-12 2010-03 2010-06 Month

  9. Hypertensives vs. Normotensives 150 Systolic – Patients with Hypertension 140 130 120 Systolic – Patients with Normal Blood Pressure 110 100 Blood Pressure 90 Diastolic – Patients with Hypertension 80 70 Diastolic – Patients with Normal Blood Pressure 60 50 2000-09 2000-12 2001-03 2001-06 2001-09 2001-12 2002-03 2002-06 2002-09 2002-12 2003-03 2003-06 2003-09 2003-12 2004-03 2004-06 2004-09 2004-12 2005-03 2005-06 2005-09 2005-12 2006-03 2006-06 2006-09 2006-12 2007-03 2007-06 2007-09 2007-12 2008-03 2008-06 2008-09 2008-12 2009-03 2009-06 2009-09 2009-12 2010-03 2010-06 Month

  10. Percent Hypertensives Controlled by Race 90 80 70 60 Percent Normal 50 Black 40 Hispanic Caucasian 30 Race not specified 2000-09 2000-12 2001-03 2001-06 2001-09 2001-12 2002-03 2002-06 2002-09 2002-12 2003-03 2003-06 2003-09 2003-12 2004-03 2004-06 2004-09 2004-12 2005-03 2005-06 2005-09 2005-12 2006-03 2006-06 2006-09 2006-12 2007-03 2007-06 2007-09 2007-12 2008-03 2008-06 2008-09 2008-12 2009-03 2009-06 2009-09 2009-12 2010-03 2010-06 Month

  11. Percent Hypertensives Controlled by Age 80 75 70 65 <55 60 55 < 70 Percent Normal 70 < 80 55 > 80 50 45 40 2000-09 2000-12 2001-03 2001-06 2001-09 2001-12 2002-03 2002-06 2002-09 2002-12 2003-03 2003-06 2003-09 2003-12 2004-03 2004-06 2004-09 2004-12 2005-03 2005-06 2005-09 2005-12 2006-03 2006-06 2006-09 2006-12 2007-03 2007-06 2007-09 2007-12 2008-03 2008-06 2008-09 2008-12 2009-03 2009-06 2009-09 2009-12 2010-03 2010-06 Month

  12. Systolic / Diastolic BP by Age Group 150 <55 55 - <70 70 - < 80 80+ 145 Systolic BP 140 135 85 Diastolic BP 75 65 2000-09 2000-12 2001-03 2001-06 2001-09 2001-12 2002-03 2002-06 2002-09 2002-12 2003-03 2003-06 2003-09 2003-12 2004-03 2004-06 2004-09 2004-12 2005-03 2005-06 2005-09 2005-12 2006-03 2006-06 2006-09 2006-12 2007-03 2007-06 2007-09 2007-12 2008-03 2008-06 2008-09 2008-12 2009-03 2009-06 2009-09 2009-12 2010-03 2010-06 Month

  13. Percent Hypertensives Controlled by Gender 80 75 70 65 Percent Normal 60 55 female 50 male 45 40 2000-09 2000-12 2001-03 2001-06 2001-09 2001-12 2002-03 2002-06 2002-09 2002-12 2003-03 2003-06 2003-09 2003-12 2004-03 2004-06 2004-09 2004-12 2005-03 2005-06 2005-09 2005-12 2006-03 2006-06 2006-09 2006-12 2007-03 2007-06 2007-09 2007-12 2008-03 2008-06 2008-09 2008-12 2009-03 2009-06 2009-09 2009-12 2010-03 2010-06 Month

  14. Percent Hypertensives Controlled by Climate 80 75 70 65 60 Percent Normal 55 50 Warm = Sja, Hon, Mia, Hou 45 Cold = Anc, Frg, Por, Min warm 40 cold 2000-09 2000-12 2001-03 2001-06 2001-09 2001-12 2002-03 2002-06 2002-09 2002-12 2003-03 2003-06 2003-09 2003-12 2004-03 2004-06 2004-09 2004-12 2005-03 2005-06 2005-09 2005-12 2006-03 2006-06 2006-09 2006-12 2007-03 2007-06 2007-09 2007-12 2008-03 2008-06 2008-09 2008-12 2009-03 2009-06 2009-09 2009-12 2010-03 2010-06 Month

  15. Seasonal Variation in Weight 202 100 15 Cities – 582,881Hypertensive Patients 99 200 98 198 97 Average BP Weight (lbs.) 196 96 95 194 94 192 93 Avg WT Avg BP 190 92 Jan-00 Jun-07 Jun-06 Jun-00 Dec-06 Dec-07 Jun-01 Jun-02 Jun-03 Jun-04 Jun-05 Dec-05 Dec-00 Dec-01 Dec-02 Dec-03 Dec-04 Month

  16. Hypertensive Rx 70 60 50 40 Patients Receiving Rx 30 20 10 0 BetaBlocker Calcium Channel Diuretic AceInhibitor Central Acting Sep - 03 Sep - 05 Sep - 07 Sep - 09

  17. Mortality 100 95 % Months Controlled Patients < 70 90 < 70 (75 – 100%) 85 < 70 (50 – 74%) 80 < 70 (25 – 49%) 75 < 70 (0 – 24%) Percent Survival Patients > 70 70 > 70 (75 – 100%) 65 > 70 (50 – 74%) 60 > 70 (25 – 49%) 55 > 70 (0 – 24%) 50 0 12 24 36 48 60 72 84 96 108 120 132 144 Months after 3rd elevated reading

  18. Control of Hypertension • Adopt reminders with EHR • Assess treatment rapidly – 2 weeks • Use diuretic medications • Improve compliance – Treat all patients • Decrease Winter Dip • Improve control in Black Patients • Reduce obesity

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