A systematic approach to hypertension management that meets clinical and community needs holds promise for both bringing blood pressure under control for the general population and reducing prevalent racial disparities around hypertension and heart disease.
The approach, headed by Lisa Cooper, MD, director of the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, uses a pragmatic trial design and specifically targets multiple levels within health care systems. Dr. Cooper’s work in the study, called Project ReD ChiP (Reducing Disparities and Controlling Hypertension in Primary Care), is one of the first to address hypertension using multiple quality improvement approaches and combining community-based participatory and implementation science principles.
The study is ongoing, taking place from 2010 through 2015, and implements quality improvements at six clinical sites in Maryland to standardize blood pressure measurement, provide patient care management services and offer increased physician education. The expectation is that approaching hypertension on a variety of levels—and adjusting interventions to reflect the needs of each clinical site and community—will lead to a reduction in hypertension disparities.
Heart disease is the leading cause of death for people of most ethnicities in the United States, and it accounts for more than one-third of the differences in life expectancy between African Americans and whites, largely attributed to hypertension and poor blood pressure control. In population-based surveys, African Americans are more likely to have hypertension and are treated for it less often than non-Hispanic whites, according to the study.
In its Improving Health Outcomes initiative, the AMA is collaborating with Dr. Cooper and leveraging her work to pilot a program in ambulatory settings to reduce the incidence of hypertension.
Building on the Project ReD CHiP processes, the AMA is tackling hypertension with a similar approach:
- Improve blood pressure measurement methods. The AMA pilot program is developing and adapting tools to help practices measure blood pressure more accurately.
- Enhance education for physicians and their practice staff. The program includes assessment tools and webinars aimed at helping the pilot sites establish a culture of quality improvement.
- Partner with patients. In addition to providing resources to improve provider and staff communication with patients, the program will use patient surveys to better understand how to engage, motivate and support patients to take control of their blood pressure management.
- Encourage community engagement. The program asks practices to identify organizations and resources within their communities that can help patients achieve their health goals.
Focusing on patient-, practice- and community-level factors will allow each pilot site to identify its own key strengths and opportunities for improvement. This approach also will allow sites to track whether interventions lead to changes in practice culture over time, which may contribute to reducing health disparities in hypertension within that clinic and community.
