In less than six months, about 20 percent of adult patients at sites piloting the M.A.P. BP Improvement Program within Loyola University Medical Center (LUMC) in Maywood, Illinois, experienced an improvement in their blood pressure (BP) category.
This happened after LUMC joined Target: BP™, a national initiative co-led by the AMA and American Heart Association. The AMA has developed tools and resources 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.
“Controlling high blood pressure is a top priority,” said Beatrice Probst, MD, an emergency physician and associate chief medical officer for Ambulatory Quality and Safety at LUMC.
“Uncontrolled hypertension is tied to so many comorbidities that once one can adequately address controlling high blood pressure, the expected benefit reaches far beyond that,” she added.
Here are five ways LUMC established a successful start to their improvement journey.
Prioritize BP control. In the U.S., uncontrolled hypertension accounts for more cardiovascular disease deaths than any other modifiable risk factor, and there are about 27,000 patients with hypertension in primary care at LUMC. Dr. Probst advises others to prioritize BP control because uncontrolled hypertension impacts so many comorbidities.
Update your workflow. “From a process perspective, it is important to ensure that the entire care team is aware of workflow updates and best practices to measure BP accurately," said Dr. Probst.
LUMC ensures each participating team has additional automated office blood pressure (AOBP) devices and receives continual support. The AMA also continues to guide workflow improvements to minimize care disruption, conducting additional site visits and observing “to recommend processes improvement,” she said.
Engage in ongoing quality improvement. Implementing the M.A.P. BP Improvement Program requires a lot of work. “Even with engaged practices, do not underestimate the amount of work it takes to get there,” said Dr. Probst. From the initial assessment period and training to kick-off and data collection, LUMC continues to work with physicians and other staff to ensure a successful program. LUMC is also working to supply Self-Measured Blood Pressure (SMBP) loaner devices for patients, as well as conduct further outreach.
Coach providers. Some doctors have the mindset that, “my manual blood pressure interpretation is still the gold standard,” said Dr. Probst.
To get providers on board with these changes, it was important for them to hear it from another physician. Michael Rakotz, MD, a Fellow of the AHA through their council on hypertension, and vice president of health outcomes at the AMA gave a presentation to LUMC’s primary care physicians. “When you have physicians talking to physicians, it creates more engagement,” said Dr. Probst.
Share learnings. For implementation, be vigilant, touch base with physicians and staff, and discuss barriers. Engagement and learning opportunities across the multi-disciplinary team are also important to move the needle.
“We’re implementing it [M.A.P. BP Improvement Program] at four primary care locations that are geographically separated, but we bring them together for conference calls,” said Dr. Probst. “We learn from those shared effort discussions about what each of them could do better.”
More senior physicians might exhibit some “skepticism when you introduce a process not part of their initial education,” she added.
Overcoming this requires further conversation and education to demonstrate to physicians that there is a better way. Dr. Probst suggests following “the AMA’s recommended process” and trying to “devote as many dedicated resources to it as possible.”
“It will allow you to get to goal quicker or reach success quicker,” she said. “I think the AMA really steps you through it.”
In addition to tools and resources to help health care organizations improve BP control, Target: BP offers annual, recurring gold-level recognition for all participating sites that achieve hypertension control rates of 70 percent or higher among their patient population of adults with hypertension, and participation level recognition for those sites that prioritize improving BP control each year and submit data. In 2018, more than 800 organizations were recognized for their efforts focusing on BP control within the populations they serve.
