Clinical Quality Improvement: Achieving BP Control Kelly Means, MPH Health Systems Quality Improvement Specialist Renzo Amaya, MPH Chronic Disease & Health Systems Coordinator

Evidence-Based Intervention: Utilizing National Guidelines Problem: 89% of adults with uncontrolled hypertension see a PCP Underlying Factors Variability in care and therapeutic inertia Implementation Use of screening and treatment algorithms “Which protocol is selected is less important than the decision to select, adopt, implement, and evaluate implementation of any evidence-based protocol.” -Thomas Frieden, MD, MPH - CDC

Algorithms Systematic approach Standardize care Facilitates clinical decision making Engages multiple providers in a coordinated manner.

Accurate blood pressure measurement Proper techniques Equipment calibration

Evidence-Based Intervention: Utilizing a Team-Based Care Model Problem 42% of physicians report not having enough time with their patients. Underlying Factors Primary care practices are taxed, chronic disease patients are high need, PCPs do not have the time to address all medical and social needs, burn-out. Implementation Patient empanelment Integrating pharmacists, nurses, patient navigators, patients, etc. Specific roles and responsibilities, use of protocols Appropriate competency (i.e. training) Huddles

FREE for Colorado residents! www.patientnavigatortraining.org Patient Navigator Fundamentals (hybrid course) Advanced Care Coordination  Advanced Health Behavior Change (hybrid course) Advanced Health Literacy Advanced Motivational Interviewing Using Evaluation for Program Improvement and Capacity Building FREE for Colorado residents!

Evidence-Based Intervention: Implementing Med Adherence Tools Problem Medication adherence is a complex issue leading to huge burden on the healthcare system Underlying Factors Presence or extent of non-adherence often overlooked, multi-factorial barriers to adherence. Implementation SIMPLE approach Medication adherence assessment Reducing out of pocket costs

Evidence-Based Intervention: Providing Self-Management Support Problem While patient education is often provided to patients to control their blood pressure, alone it is not sufficient to impact clinical outcomes Underlying Factors Patients lack skills to manage disease and make behavioral changes. Implementation Health coaching, motivational interviewing Collaborative goal setting (self-management plans) Referrals to community resources Systematic-follow up

Trainings: Motivational Interviewing Patient Navigator Training Collaborative University of Colorado In-person session in the fall Online education HealthTeamWorks Video scenarios and handouts

Evidence-Based Intervention: Home Blood Pressure Monitoring Problem As many as 20% of hypertensive patients have increased blood pressure levels while in clinic but not when measuring blood pressure levels at home. Many of those patients end up on blood pressure medicine that they don’t need. Underlying Factors White coat hypertension Masked hypertension Long intervals between in-clinic readings Implementation Equipment validation Patient education on proper techniques Regular communication of SMBP readings Clinician support and advice based on readings, titration of medications

Heart360 (AHA & ASA)

Evidence-Based Intervention: Linking to Healthy Living Interventions Problem Many individuals lack the knowledge, skills, support or confidence to make behavioral changes and manage their chronic condition(s). This may be compounded by the physical, social, and emotional impacts of chronic disease. Underlying Factors Lack of coping, problem solving skills Lack of resources within practice. Implementation Stanford’s Chronic Disease Self-Management Program (CDSMP) Diabetes Self-Management Education/Training (DSME) Diabetes Prevention Program (DPP)

Self-Management Colorado Consortium for Older Adult Wellness Tools Self-Management Colorado Consortium for Older Adult Wellness DSME program accredited by ADA and AADE Local Public Health Recreation centers

Evidence-Based Intervention: Utilizing Health Literacy Concepts Problem 88% of U.S. adults do not have the health literacy skills needed to manage all the demands of our complex health care system. Underlying Factors Widespread low health literacy, shame and embarrassment to admit low literacy. Providers have trouble identifying patients with limited health literacy. Implementation Guidelines for print, audio, visual, web content Translated materials Input from populations served in design and/or evaluation Strategies for interpersonal communication, confirm understanding at all points of contact. Universal approach

Help Patients Understand (AMA guide)

How do you know which intervention to select?

Workflow Assessment Goal Process Results To review existing policies and protocols for management of diabetes and hypertension in a clinical setting in order to identify gaps and/or opportunities for improvement. Process A survey conducted on-site by engaging appropriate clinic staff and making observations. Results Survey items link to the quality improvement portfolio of evidence-based interventions (EBIs). A summary of findings and recommendations for implementation of EBIs is provided to help inform clinical teams’ decision making. Next Step - contact Renzo Amaya (see cover page)