Rising to the Top in Lowering Blood Pressure

Dr Hanak gives blood pressure exam to consented patient.By Michael Hanak, MD

Last year more than 23,000 patients were seen for high blood pressure as part of a visit with a doctor in one of Rush’s outpatient practices. By the end of the year, 75 percent of this group brought their blood pressure into a healthy range.

This great news was among data about various clinical measures just released this week. The turnaround puts Rush University Medical Group, known as RUMG*, in the top 10 percent of physicians who treat hypertension nationwide, according to the National Committee for Quality Assurance, a non-profit organization that promotes health care quality. More importantly, it means that more than 17,000 of Rush’s patients significantly have reduced their risk of heart attack and stroke, and of dying from these preventable conditions.

High blood pressure, or hypertension, is known to be a silent killer, because people often don’t notice they have high blood pressure. Far too many are at risk: According to the  Centers for Disease Control and Prevention, about one in three people in the United States (75 million) have high blood pressure, and only about half (54 percent) have their blood pressure under control.

This widespread danger contributes to heart disease being  the leading cause of death in the United States, accounting for more than 635,000 deaths in 2016 (the most recent figures available), according to CDC. Stroke ranks fifth, responsible for more than 142,000 deaths, and about half of all strokes can be attributed to hypertension.

On the other hand, studies have shown that aggressive blood pressure control reduces rates of cardiovascular disease by 30 percent and lowers the mortality risk in adults over 50 by 25 percent. We recognized a great opportunity at Rush to address heart disease through prevention, and in late 2015 launched an initiative to reduce rates of high blood pressure among patients in primary care practices.

We focused on clinical areas where blood pressure was directly related to the type of care being provided, such as primary care, cardiology, and endocrinology (and not on areas where blood pressure isn’t directly relevant). Patients diagnosed with high blood pressure were asked to return within a month for follow-up on the recommended therapies, often scheduling their appointment before even leaving the doctor’s office. In addition, patients received education in proper blood pressure technique, home monitoring strategies, and an introduction to digital tools to help keep them on track

It made a big difference. Among the patients who returned for a follow-up appointment, 90 percent improved their blood pressure, and half of them achieve a normal blood pressure.

To help doctors and other members of the health care team focus on reducing blood pressure, we created prompts and alerts in our electronic medical record system to remind them to schedule visits and escalate medication treatments as indicated. The system also made high blood pressure readings more prominently displayed in patients’ charts, helping care providers recognize hypertension and intervene more consistently.

In 2016, our first full year of the effort, 71 percent of our patients had blood pressure in the normal range, compared to 68 percent in 2015, the year before we launched the project.  Based on these results, the CDC recognized RUMG as a Million Hearts Hypertension Control Champion in 2017. The award honors organizations or providers who focused on proven strategies to help achieve blood pressure control at rates at or above the target of 70 percent of their patients.

RUMG’s ranking in the top 10 percent of blood pressure control for 2018 shows we’re continuing this success. In fact, we’ve been so successful that last summer we began using the same methods to try to increase diagnosis and prevention of diabetes, colon cancer and breast cancer.

Every physician goes into medicine to help people and improve the lives of others, but few get to experience improve the well-being of an entire community through ongoing quality efforts such as these. For me, that was the most fulfilling thing. We were sharing knowledge and helping patients engage in their care in a way that elevated the focus of an otherwise silent disease.  At the same time, were have been able to acknowledge disparities in closing gaps in care around these clinical topics, while showcasing the essential role that primary care plays in improving the health of our community.

Michael Hanak, MD, is an associate professor in Rush’s Department of Family Medicine and Rush’s associate chief medical informatics officer.

*Rush University Medical Group is the umbrella organization for all doctors employed by Rush University Medical Center, including physicians at the Medical Center’s satellite clinics.


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