November 05, 2014
To control high blood pressure, patients for years have been encouraged to “know your numbers.” Now medical practices in the Finger Lakes are heeding their own advice.
This week 26 Finger Lakes healthcare practices received their first high blood pressure “numbers”—a report showing the percentage of patients in each practice who are keeping their high blood pressure under control. The innovative data initiative puts the region at the forefront of the national effort to improve population health through the use of neutral, transparent statistics.
“These scores help us see what our forest looks like, not our trees,” explains Dr. Christian Wightman from Tri-County Family Medicine, which has participating offices in Livingston and Steuben counties. “In the office, the vast majority of time is spent focusing on the person sitting in front of us. The report reminds us to step back and look at patient outcomes as a whole.”
The project is made possible through a partnership among medical practices, eight county health departments, the Rochester Business Alliance’s health care planning team, and the Finger Lakes Health Systems Agency, the region’s independent health planning organization which collects and analyzes the data.
“As far as we know, this project is the nation’s only community-wide hypertension registry that involves more than one hospital system,” says Dr. Thomas Mahoney, chief medical officer for the agency. “This is cutting edge.”
The reports are based on electronic medical records that have been stripped of all personally identifying information and will be issued twice per year. This first report includes data from more than 40,000 individuals, about one third of residents estimated to have high blood pressure in the Finger Lakes. Although scores for individual practices are confidential, the tally shows that the overall high blood pressure control rate for Chemung, Livingston, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates counties stands at 72 percent.
High blood pressure contributes to one-half of heart disease deaths and is a leading cause of stroke and liver failure, explains Al Bradley, the agency’s senior program manager for high blood pressure initiatives. “This is one condition we know how to fix. With the right medications, high blood pressure is relatively easy and inexpensive to keep in check.”
The effectiveness of treatment is a key reason that high blood pressure—also known as hypertension—has been identified as an important priority by Finger Lakes counties in their County Health Improvement Plans.
Based on national and local rates, 125,000 people—one third of adults in the Finger Lakes—are estimated to have high blood pressure. “If, as a community, we can move from a control rate of 72 percent to 85 percent, more than 16,000 people can reduce their health risks,” says Mary Beer, public health director for Ontario County.
The new Finger Lakes initiative grew out of the ongoing work of the RBA’s health care planning team. Formed nine years ago, that team brings together the area’s largest employers, insurers, and physician groups to find effective new ways of improving health in the region, from encouraging the use of generic drugs to reduce costs to improving physician pay to prevent staffing shortages.
The group’s high blood pressure initiative, launched nearly five years ago, has included coaching in medical practices, peer counseling in churches, worksite wellness programs in businesses and the placement of blood pressure kiosks in barbershops, libraries, churches, and worksites. To track the success of these efforts, the Finger Lakes Health Systems Agency created the Monroe County blood pressure registry. Over the course of the project, control rates in Monroe County have increased from 63 to 71 percent, with more than 100,000 people now included in the data.
The Practice Reports
Like its predecessor, the new Finger Lakes high blood pressure report provides medical practices with a breakdown of their own patients by age, race, gender, and other factors to help staff identity which groups may need additional assistance. One of the most important numbers, says Dr. Wightman, is the percentage of patients with high blood pressure who have not been seen in the past 13 months.
“A lot of the people who need the most help aren’t showing up for appointments,” he says. “The report will be an ongoing reminder to reach out to these patients, especially those who also have diabetes and heart disease. Hypertension does not exist in a vacuum.” Treating these vulnerable individuals before they end up in the emergency room with complications is an important goal of primary care, he explains.
Over time, the report allows practices to test new approaches and track the results. “The feedback is nice, because it’s difficult for staff to know if the extra effort makes a difference,” says Wightman. “For example, if a nurse takes the time to go into the medical record to see how a patient’s blood pressure has changed over time, does that additional step lead to improved control rates?”
Developed using evidence-based guidelines, the report offers suggestions for improving outcomes. For example, if a patient is on three medications and is still struggling with high numbers, “pause and look for confounding variables,” reads the tool.
“That’s great advice,” says Dr. Wightman. “A common reason is excess alcohol; this is a good segue to talking about it. A person who is drinking too much, but does not have hypertension, may not see much value in cutting back. But if you can relate alcohol directly to the pills a patient is on, then they are much more receptive to the idea that the alcohol is working against them. Making that connection can create an aha moment.”
In this initial Finger Lakes report, the number of patients by county varies widely, from 11,733 in Wayne County to only 28 in Schuyler County, making the data for underrepresented counties less statistically meaningful, according to Bradley. The agency is working to enlist more practices and eventually hopes to have records for at least half of Finger Lakes residents with the condition.