At the American Medical Group Association’s 2013 Institute for Quality Leadership (IQL) conference in Scottsdale, AZ, Dr. Francis Colangelo approached the Foundation table to learn more about the national Measure Up / Pressure Down® hypertension campaign.
Since joining the campaign on the spot at the IQL conference, Premier Medical Associates has made hypertension control a priority through implementation of campaign planks (evidence-based care processes). This commitment has paid off for the largest multi-specialty physician practice in the Greater Pittsburgh area — Premier improved its hypertension control rates by 10 percent in a year, including a six percent increase in just two quarters. To date, a quarter of Premier’s providers have achieved the Measure Up / Pressure Down® campaign goal of 80 percent of patients in control of hypertension.
Premier achieved this remarkable and rapid improvement by:
- Highlighting room for improvement – At the time, Premier’s largest insurer introduced a value-based bonus program with a measure for blood pressure control rates among patients with diabetes. Premier saw room for improvement after reviewing its data and joined Measure Up / Pressure Down® to improve the health of its entire patient population, including those with diabetes.
- Motivating through best practices – Dissemination of the Journal of the American Medical Association article featuring the efforts of Kaiser Permanente Northern California showed physicians at Premier that high level of achievement is possible in hypertension control. The article, “Improved Blood Pressure Control Associated with a Large-Scale Hypertension Program,” describes the efforts of Kaiser Permanente Northern California that nearly doubled the percentage of its patients in control of hypertension (to 87%) through consistent execution of simple, standardized approaches.
- Achieving staff buy-in – In December 2013, Premier introduced the Measure Up / Pressure Down® campaign at an all-physician meeting with primary care providers and specialists. Providers quickly understood the importance of such an initiative and worked to implement various campaign planks. Premier demonstrated to staff that the initiative did not create additional work, but simply meant conducting existing processes in a more accurate way, which helped to expedite engagement. Throughout the campaign, staff have had positive responses to other campaign activities including distributing stress balls, water bottles, bookmarks, and a heart-healthy potluck in conjunction with the Measure Up / Pressure Down® National Day of Action in May 2014.
- Reminding staff of the “why” – During blood pressure measurement trainings, team members were more engaged because they realized the direct impact of these readings on patient care. Ultimately, those who weren’t checking blood pressure accurately prior to the training wanted to learn how to and start doing so because of its importance and benefits to patient care.
- Training direct care staff in accurate blood pressure measurement (Plank 1) – Premier developed a training video first featuring a staff member taking blood pressure readings incorrectly, followed by showing the correct technique along with explanations on proper form. All primary care and specialty offices were shown the video and new hires participated in a hypertension awareness class, which includes a viewing. Questions that arose from the training video resulted in the redesign of some exam rooms to allow patients to sit with their arm and back supported and feet flat on the floor.
- Training all team members in the importance of blood pressure goals and metrics (Plank 7) – Along with the blood pressure accuracy trainings, leadership also educated front and back office staff on the basics of blood pressure, health consequences and complications, goals, and treatment with a 20-minute PowerPoint presentation.
- Engaging patients in blood pressure measurement and management (Plank 5) – Premier’s team-based approach extends to patient engagement. Patients are educated about proper blood pressure technique by staff and exam room signage so that they understand the actions that will alter blood pressure reading accuracy (such as talking during readings or crossing of legs).
- Addressing blood pressure for every hypertension patient at every visit (Plank 3) – To ensure providers were addressing blood pressure for existing hypertensive patients or those with an initial escalated reading, Premier laminated red heart cutouts to place on exam room doors as a visual cue for the provider to retake blood pressure and address the reading.
- Seeing patients with hypertension within 30 days (Plank 4) – Premier created a work order, named “Measure Up / Pressure Down® Blood Pressure Follow-Up,” in its EHR that creates an overdue notice for patients who do not return for a follow-up visit within 30 days, which leads to patient outreach for blood pressure checks.
- Setting expectations for specialists (Plank 8) – The culture, expectations, and patient-centered focus at Premier resulted in specialists taking blood pressure readings at every visit without resistance. Since joining Measure Up / Pressure Down®, specialists now order 30-day follow-up visits for high blood pressure readings or directly call primary care providers to schedule immediate appointments for escalated readings (for both primary care providers at Premier or in the community).
- Disseminating transparent physician reports – Timely, transparent feedback is a key to increasing physician and staff engagement in performance improvement. Since April, Premier has disseminated unblinded data on hypertension control rates to all staff on a quarterly basis. This practice shows physicians where they are relative to their peers and motivates everyone on the care team to adopt the required changes in practice.
- Using hypertension registries to track patients (Plank 6) – In conjunction with the quarterly transparent reports, physicians also receive hypertension lists to allow for targeted patient outreach and follow up.