For too long the news about high blood pressure for Americans has been dismal. Sixty-seven million Americans, that's one in three, have high blood pressure, including two out of three people over 65. More than half don't have it under control.
That's a huge problem because high blood pressure can lead to heart attack and stroke, two of the top causes of death for Americans.
This week, the news about blood pressure got much better. Kaiser Permanente Northern California reported on a remarkable success. They nearly doubled the rate, and nearly quadrupled the number, of patients with their blood pressure under control.
How did they make this dramatic improvement? Here are a few key lessons from one of most important medical articles of the year.
First: using standardized care is key. Standardizing care is not at odds with the clinician making decisions. The Kaiser approach meant care teams had evidence-based options and that made it easier to evaluate and compare different approaches.
Second: engaging the entire health care team is critical. For example, Kaiser authorized nurses, pharmacists and others to help with medication doses.
Third: an information system with accountability for every patient is essential. Kaiser used its internal registry to identify more than 600,000 patients and then tracked progress for each of them and provided feedback to their care team at least quarterly.
Fourth: the organization of care must be truly patient-centered. In Kaiser's case, single pill combination treatment was recommended as a first or second step. Inexpensive, widely available, once-a-day medication makes it easier for patients to take medications as they should.
Fifth: there must be continuous innovation, evaluation and improvement. Kaiser accomplished this by giving real-time feedback to their medical centers. The hypertension program evolved over time as they received new information about what worked, and what didn't.
Not part of this study, but over the same time period, they saw a decrease in heart attacks by 24 percent and fatal strokes by 42 percent, likely in significant part as a result of this program.
Their success is even more exciting because their winning approach aligns with our Million Hearts® focus on helping 10 million more Americans get their blood pressure under control and help prevent 1 million heart attacks and strokes by 2017. If more systems achieved results like these, we'd be there already.
A year ago, Million Hearts® recognized two other practices for getting high blood pressure under control for more than 80 percent of their patients: Kaiser Permanente Colorado in Denver and the Ellsworth Medical Clinic in rural, western Wisconsin.Like Kaiser Permanente Northern California, they focused on three things:
- Blood pressure control: a common goal for the health care team and patient.
- A registry: health information technology that allowed them to track patient care over time, and incorporate prompts and reminders to improve care.
- Team-based care so that every member of the team provides patient support and follow-up care to help patients manage their medicines and stick to a blood pressure control plan.
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