For the largest health system in Illinois, the typical patient with hypertension is a white female in her 60s who is a Medicare beneficiary. With that description in mind, Amita Health—a faith-based health system in Lisle, Illinois with more than 230 outpatient locations and 900 primary and specialty care physicians—began addressing blood pressure control rates in 2016. They found that only 55.6% of their patients had their BP under control. To improve the BP control rate in their patient population, the system turned to medical assistants (MA).
After pulling the data, Amita Health realized hypertension was a key area for improvement. An Amita hypertension task force helped identify patient barriers and clinics that could improve their BP-control rates.
The AMA has developed online tools and resources created using the latest evidence-based information to support physicians to help manage their patients’ high BP. These resources are available to all physicians and health systems as part of Target: BP™, a national initiative co-led by the AMA and American Heart Association.
“We were able to drive our numbers above the 90th percentile nationally,” said Socorro Juarez, a clinical supervisor and medical assistant at Amita, during a Target: BP webinar. “We received the gold award from the American Medical Association as one of the top three medical groups in Illinois for blood pressure control.”
Juarez outlined four steps that MAs at Amita have taken to help accomplish Target: BP goals, and help Amita achieve an overall BP-control rate of 76%.
Working at their highest level
During a hypertension taskforce brainstorming session, it was suggested that physicians need more support from their teams. This helps address patients’ need during visits.
“We train these practices on the team-based care model to ensure staff members are functioning at their highest level,” said Juarez.
This has translated into having the same medical assistants work with the same physician every day. MAs also focused on previsit planning and making sure they use the daily appointment report.
Performing daily huddles
Each morning, the MAs meet with the physician during a daily huddle to review the schedule for the day. By using the daily appointment report, MAs can review who is coming in, what services are due and whether the patient’s BP was elevated at their last visit. Medication refills, ancillary services and referrals will also be discussed.
The report is emailed to the team daily and is also available on the intranet. MAs can access a list of patients who have at least one visit with their family physician and an uncontrolled blood pressure for the past 12 months. It also helps MAs conduct regular patient outreach.
Enhancing patient interaction
MAs help patients get prepared for the exam. If any of the MAs have trouble getting a patient’s BP reading, they will seek assistance from others.
“We will also provide patients with any blood pressure tools and resources,” said Juarez. “If they bring in their blood pressure machines, we do ensure they know how to properly use them and then provide any logs if they need it.
“After the visit, if they are doing self-measured blood pressure we do follow up over the phone or through the patient portal,” Juarez said, adding that this is performed to recognize if their numbers are increasing or stabilizing. It is also a way to follow up with patients who are out of range.
Completing hands-on training
“The team also identified that medical assistant training on accurate measuring of blood pressures has led to our success,” said Juarez. “We incorporated hands on blood pressure training to our medical assistants’ skills day and comprehensive medical assistant training program.”
The MA skills day is a four-hour program that consists of teaching combined hands on training and validation of the skill every medical assistant in Amita Health received on how to accurately measure BP.
Offered three times a year, the MA training program includes 23 different primary care related topics and is presented over four days. At the end, MAs will present a group project to better understand how to apply their new skills for their daily work, such as role playing how to coach patients with hypertension about self-management.
