How clinical data and coaching are driving improvement in high blood pressure

How clinical data and coaching are driving improvement in high blood pressure

August 23, 2018

Gerry Gunner Jr. found out he had high blood pressure after his daughter was born. Now he’s eating more vegetables, working out and taking medication to stay healthy for her.

 By Robin L. Flanigan

 It’s one thing for medical practices to push for better blood pressure rates among patients. It’s another for them to see—with colorful numbers, charts and graphs—whether their efforts are making a difference.

 And in large part because of the High Blood Pressure Registry, they are.

 Created in 2010, the registry is a communitywide resource that aggregates electronic clinical data from nearly 200 area medical practices, representing more than 60 percent of residents with hypertension in the nine-county Finger Lakes region. Reported twice a year, the registry shows practices what percentage of patients have their hypertension under control, defined as blood pressure of 140/90 millimeters of mercury or less. Practice control rates are also compared, anonymously, to control rates at other local primary care offices.

Twice a year, practices receive a poster summarizing their progress.

Results are printed on posters that get hung in exam rooms, break rooms, bathrooms and other visible areas.

 “People who go to medical school aren’t used to coming in second, so when they see their data and then see that others they respect are doing better, they become quite motivated to change their behavior,” says Dr. Howard Beckman, director of strategic innovation at Common Ground Health and a clinical professor of medicine and family medicine at the University of Rochester School of Medicine and Dentistry.

The registry is part of the High Blood Pressure Collaborative, a community-wide health campaign supported by the region’s largest employers, hospitals and health insurance companies and managed by Common Ground Health. The clinical data in the registry provides an objective way to track efforts to reduce high blood pressure, a leading cause of stroke, heart attack and kidney failure—and is just one part of a far-reaching clinical project designed to reduce health disparities and drive innovation in medical care.

 The collaborative also provides targeted training so that health care professionals analyze data more effectively, and the program increases community involvement by, among other things, encouraging screenings at churches, barbershops and salons.

 This creative approach to medicine has produced impressive results.

 The region’s control rate has improved 4.5 percent from 2013 to 2017. Even more impressive, rates of dangerously high blood pressure of 160/100 millimeters of mercury or higher has shown double digit improvement, falling 25 percent for African Americans, 38 percent for Hispanics and 46 percent for whites from 2010 to 2017.

 Practitioners in urban, suburban and rural communities all have documented improvements in high blood pressure rates.

 In fact, despite assumptions to the contrary, three of the top-performing medical practices served patients from low socioeconomic backgrounds.

 Yet disconcerting disparities remain. The region’s control rate for whites is about 83 percent, 21 percentage points higher than the control rate for African Americans.

 To hold practices accountable, consultants walk clinicians through their registry results and help identify areas for improvement. The more they’re familiar with this valuable asset, the easier it is to engage and empower consumers to make better health decisions.

 This is particularly true for men, who tend to see physicians less often than women.

 “Notoriously, it’s almost that Superman effect [with men] where they say, ‘I’m fine. Nothing’s gonna happen to me. I don’t need the doctor, period,’” notes Dr. Mathew Devine, a practice improvement consultant for the collaborative and associate medical director at UR Medicine’s Highland Family Medicine. “But what happens to them, obviously, is we see them down the road with [problems] that are at times irreversible.”

Thirty-six-year-old Gerry Gunner Jr. wanted to steer clear of that group. Though high blood pressure runs in his family—he has witnessed the headaches, swollen limbs and other painful symptoms it brings—the Rochester native had no indication his own blood pressure was a problem until he had it checked soon after his daughter was born.

Then he got to work. In addition to taking medicine, Gunner started eating more vegetables and working out at least three times a week. He has lost about 20 pounds, feels more energized, and has reduced his blood pressure—something he wishes he had known to do years ago, which is why he supports efforts to increase community awareness and communication about hypertension.

“It’s sad that we really don’t discuss it much,” he says. “It’s a conversation we should have more often.”

 Multifaceted interventions play a role in spreading the word, leading to greater participation and more achievable goals.

 Even goals once considered out of reach by some—such as the original control rate goal of 85 percent when the project was launched—have been met by many practices.

 “When I first looked at the goal, I was convinced that there was no way that we would ever get near it,” recalls Dr. Devine. “I thought it had to be a made-up number, that it was almost impossible. And I’ve realized it’s not.

 “There are practices that have reached it, and we can learn from them.”

 Teamwork and technology already have successfully reduced the burden of chronic disease and save lives—a valuable, evidence-based asset for improving the health of an entire community.

 “We’re heading in the right direction,” says Dr. Beckman. “And as we learn more about how to work together effectively, we’ll start to be even more successful.”