Hypertension affects about half of adults in the U.S. It is the biggest risk factor for heart disease and stroke, especially among Black adults, said AMA member Willie E. Lawrence, Jr., MD, an interventional cardiologist in Saint Joseph, Michigan. That is why interventions are needed to improve hypertension control.
But interventions to improve heart health take time, said Dr. Lawrence. Navigating patient privacy and EHRs to make this happen is a slow process. Yet early intervention is key.
“You have to get upstream if you want to change the culture of health in a community,” he said.
Recognized by the American Heart Association for serving under-resourced communities, Dr. Lawrence helped launch the AMA MAP™ Hypertension program at his Michigan-based health system.
AMA MAP Hypertension is an evidence-based quality improvement program that provides a clear path to significant, sustained improvements in BP control. With the AMA MAP program, health care organizations can increase BP-control rates quickly. The program has demonstrated a 10% increase in BP control in six months with sustained results at one year.
Dr. Lawrence helped officially launch AMA MAP in January 2023 in six clinics—four primary care and two cardiovascular clinics—at his health system. Since then, MAP has been scaled to all ambulatory clinics in the south and west arms of Corewell Health.
The advantage of MAP is it helps tease out why health inequities exist, said Dr. Lawrence. “You can't expect those inequities to go away unless you do a better job of managing hypertension for all Americans.”
In an interview with the AMA, Dr. Lawrence shared how he helped launch and scale the MAP program at his health system.
Don’t wait for conditions to worsen
Taking care of end stage heart disease isn’t enough to change health in a community. In the ambulance at the bottom of the cliff analogy, what hospital systems too often do is “wait for people to fall off the cliff and hit the ground before providing care,” said Dr. Lawrence.
Outcomes are better “when you build a fence and prevent people from falling off that cliff and then moving the fence back, and you prevent people from ever even getting to the edge of the cliff,” he said. “To me, that has to be the real goal.”
Such goals take work. For example, just writing a prescription for blood pressure medication and expecting the patient to comply won’t get the job done, said Dr. Lawrence. “A good percentage of our health is determined by the things that don't happen in the provider's office.”
That is why Dr. Lawrence is focusing on partnering with patients, understanding what's going on in their lives, and making them an ally in these efforts to improve their blood pressure control.
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Keep health equity in mind
For example, “the no-show rate on follow up visits in one of my clinic locations is higher than in others,” Dr. Lawrence noted. “We have found that transportation was a factor. This year Corewell Health moved its Center for Wellness into a 26,000 sq ft building in Benton Harbor and committed to providing primary care thus “meeting people where they are.”
Social and economic factors play into these situations, he said. “That’s why we are trying to develop self-measured home blood pressure programs where urban and rural communities don’t have to travel miles to get to a provider.”
“It is important that we address the social drivers of health in the community of Benton Harbor Michigan,” Dr. Lawrence said.
Partnerships matter
Managing hypertension is a team effort that requires more than just physician involvement. It requires engagement with nurse practitioners, pharmacists, community health workers, dieticians and other experts focused on lifestyle interventions.
It’s also about creating partnerships outside of your organization, advised Dr. Lawrence. “The good news is that we have a lot of partners out there. And the American Medical Association is leading the way.”
But “not enough people know about AMA MAP and the commitment that the American Medical Association has had in these efforts. I didn’t really truly appreciate it until I started working with the AMA on the MAP program here at Corewell,” he said. “The beauty of MAP is that in working with the AMA, they’re helping me to tease out why overall we’re not controlling better blood pressure for all of our patients.”
