Module 6 Self-measured blood pressure monitoring to improve BP control Share your experiences: Module 6 Self-measured blood pressure monitoring to improve BP control August 10, 2016 Please note, all speaker notes are suggestions only. Speaker Hello, my name is Devin Detwiler, Program Specialist with Telligen. I’d like to welcome everyone to the “Share your experiences” webinar of the Improving Health Outcomes: Blood Pressure (IHO: BP) program for Module 6. Today we have Dr. Lisa Lubomski, Assistant Professor with The Johns Hopkins Armstrong Institute for Patient Safety and Quality, and Laken Barkowski, RN, Improvement Specialist for the American Medical Association on the line as our partners, serving as content experts and to assist in answering questions. [at this point Dr. Lubomski and Laken can greet the audience]. The purpose of this webinar is to come together as a group and share what you [the practices and health centers] have done since the last webinar. These webinars are intended to be interactive and participatory. We highly encourage attendees to share what they have done to improve hypertension control.

Expectations Share how you have modified the SMBP program to meet the needs of your practice or health center. Share your challenges and successes, and learn from project faculty and other improvement teams. Please note, all speaker notes are suggestions only. Speaker The expectations for today include: Report your progress to the group. Share modifications to the SMBP program to meet the needs of your practice or health center. Share your challenges and successes, and learn from project faculty and other improvement teams. ******************************************************************* Supplemental information [Do not read this section out loud during the webinar; all content below this line is for your reference only; it is a good idea for all speakers and presenters to review this content prior to the webinar.] Definitions Technical: This is the “what you will do”; Technical work, addresses problems where there is knowledge to implement a solution often involves a skill or task. When we develop and use a checklist or protocol to ensure accurate blood pressure measurement we are engaging in technical work. Adaptive: This is the people side of change, the “how you will do it”; Adaptive work is harder than technical work because it requires changes in values, beliefs, attitudes, and behaviors. When we develop and use a checklist or protocol and people WANT to use those tools, then the practice or health center has addressed an adaptive change. Defect/hazard: A defect is anything either clinical or operational that you do not want to happen again.  Hazards have the potential to become defects, but have not yet occurred.  A defect occurs when several hazards in a practice system line up like the holes in pieces of Swiss cheese. Learning from Defects (LFD) A team can learn from defects by answering four basic questions: What happened? (From view of person involved.) Why did it happen? How will you prevent it from happening again? How will you know the risk is reduced? Module 6 is comprised of two podcasts, one on the technical components and one on the adaptive components relating to SMBP to improve BP control. In addition, each podcast is accompanied by a fast fact sheet. Highlights of each podcast/fast fact sheet are below. TECHNICAL From the technical podcast/fast facts sheet SMBP alleviates some of the burden of managing hypertension from the primary care practice. SMBP helps patients take more responsibility for their own care. SMBP can be of assistance in diagnosing hypertension and/or ensuring hypertension treatments are effective. Four steps to teach patients: (1) which type of SMBP device to purchase; (2) when to use the SMBP device; (3) how patients should prepare themselves prior to performing the BP measurement and factors that affect the results; (4) communicating the results of their BP measurements back to the clinical team. ADAPTIVE From the adaptive podcast/fast facts sheet The Module 6 adaptive segment focuses on the third and fourth steps from “Learning from defects.” Step three asks “How will you reduce the likelihood of this defect happening again?” and step four asks “How will you know that the likelihood of this defect is reduced?” To address step three, it is recommended that care teams create a plan that reduces the risk that the defect will occur again; that they carry out the plan, observe and record what happens and adjust the plan as needed. To address step four, care teams are recommended to develop measures of success, collect data and continuously improve their processes. Action Items Continue to generate BP control rates by clinician or team and share with your entire staff. Use the SMBP program to facilitate implementation of SMBP in your practice or health center. Use the SMBP program to develop and implement a protocol for reliably collecting and recording SMBP readings in your practice or health center. Objectives (After the module, IHO: BP QI teams should be able to do the following.) Describe the evidence linking SMBP with improved BP control. Describe to patients the key steps for obtaining and recording SMBP readings and taking action to improve BP control. List the resources, staff and training needed to integrate SMBP into your team’s daily workflow. Tools SMBP program

Polling question #1 Who is on our webinar today? Physician Physician assistant or Nurse practitioner Nurse (RN, LPN, LVN) Medical assistant (MA, CMA) Educator Executive Office manager or staff QIN-QIO staff Other Please note, all speaker notes are suggestions only. Speaker We would like to know who we have in attendance. We know that some of you may be attending as teams while you attend the webinar. Please take a moment to check the box or boxes next to the roles of everyone on your team who is in attendance today. Check all that apply. It’s good to know who we have in attendance for peer-to-peer sharing of ideas, best practices, and so forth, thank you so much!

Polling question #2 Did you attend the Module 5 Webinar on July 13, 2016? Yes No Speaker We are excited to know who attended the “Share your experiences” webinar for Module 5 [Engaging patients through evidence-based communication strategies] that was held on July 13! Please take a quick moment to select your answer.

I am attending alone One Two Three Four or more Polling question #3 Please select the number of additional team members that are joining you in the room today: I am attending alone One Two Three Four or more Speaker We know that some of you may be attending as teams, with several team members in the same room together. Please select the number of additional team members that are joining you in the room today: I am attending alone One Two Three Four or more

No (other, please describe in the chat) Polling question #4 Did you listen to Module 6 podcasts before dialing in for today’s webinar? Yes No (too busy) No (other, please describe in the chat) [This question is asked to engage conversation and to get participants who listened to the podcasts to share their learnings with participants that did not listen to the podcast.] Speaker For those who listened to the Module 6 podcasts, please share with the group what you and/or your team learned.

Please note, all speaker notes are suggestions only. We’d like to take a moment or two to have a few of you introduce yourselves. We want to encourage dialogue as that is key to “sharing experiences.” So, we know we have representatives from ____ in the audience. Will one of you volunteer to take your phone off mute and share who is with you in the room and what the temperature is where you are at today? How about ___? Do we have anyone who will volunteer from ___?

Follow-up to questions or topics discussed at our prior SYE Please note, all speaker notes are suggestions only. Speaker Before we get started, we’d like to follow-up on items from our previous SYE. [Be prepared with the individuals and topics raised during the prior SYE.]

Share your experiences Share how you have modified or adapted the SMBP program guide to your practice or health center. Please note, all speaker notes are suggestions only. Speaker It’s time to share your experiences. [Read the statement on the slide and ask prompting questions as appropriate; find additional information below for reference only.] ******************************************************************** Supplemental information Possible facilitation questions, to draw people out. Has anyone on the call today used the SMBP program guide and modified it for your particular practice, health center or patient population? How have you engaged your entire care team in the SMBP program implementation? Or what roles does each care team member have in your SMBP program? Has anyone had issues with a patient’s inability to purchase a device? If so, what was your recommendation to that/those patient/s? [If no responses, then do a round robin and call attendees out.]

Share your experiences Describe any obstacles or barriers that you have faced or that you foresee having to face when implementing an SMBP program. Please note, all speaker notes are suggestions only. Speaker It’s time to share your experiences. [Read the statement on the slide and ask prompting questions as appropriate; find additional information below for reference only.] ******************************************************************** Supplemental information Possible facilitation questions, to draw people out. Have you, or do you foresee any barriers or obstacles in implementing an SMBP program? If barriers are identified: what solutions did you use or could you use to address these barriers? [If no responses, then do a round robin and call attendees out.]

Share your experiences What defect have you investigated using the “Learning from defects” tool? Please note, all speaker notes are suggestions only. Speaker It’s time to share your experiences. [Read the statement on the slide and ask prompting questions as appropriate; find additional information below for reference only.] ******************************************************************** Supplemental information Module 5 focused on the first and second steps in “Learning from defects.” Those steps include asking “What happened?” and “Why did it happen?” Module 6 adaptive segment focuses on the third and fourth steps from “Learning from defects.” Step three asks “How will you reduce the likelihood of this defect happening again?” and step four asks “How will you know that the likelihood of this defect is reduced?” To address step three, it is recommended that care teams create a plan that reduces the risk that the defect will occur again; that they carry out the plan, observe and record what happens and adjust the plan as needed. To address step four, care teams are recommended to develop measures of success, collect data and continuously improve their processes.

M.A.P. checklists Please note, all speaker notes are suggestions only. Throughout the IHO: BP program, we will be sharing the M.A.P. checklists to reinforce the framework and to provide an indication of where we are in the program. For this module, we will be focusing on “Acting rapidly” and “Partnering with patients, families and communities.” ******************************************************************** [Supplemental information for the speaker, if needed.] The American Medical Association and Johns Hopkins Medicine have created a framework to achieve blood pressure control and checklists based on that framework. We call these the M.A.P checklists for improving blood pressure control. These checklists are updated annually, and incorporate decades of evidence put into practical checklists to help clinicians, staff and patients work together to manage HTN.

Adaptive Change in Ambulatory Practice (ACAP) 1 Conduct “Improvement science” training 2 Identify defects 3 Engage practice or health center leadership 4 Learn from defects 5 Use tools to improve Please note, all speaker notes are suggestions only. Speaker Just as we share the M.A.P. checklists to reinforce the framework, we share the Adaptive Change in Ambulatory Practice (ACAP) principles. ******************************************************************** Supplemental information [This content is not to be shared during every webinar; due to time constraints, this information is included in the slide notes as references if the speaker needs it or is queried by attendees.] Five steps of the ACAP program First, through the “Improvement science” webinar, teams learn the science of improving care. In the second step, teams identify the risks of suboptimal care that exist in their clinical environment using the “Staff hazard” assessment. In order to achieve lasting results, the QI team must include a member from practice or health center leadership and actively engage that leader in QI activities. In step four, the QI team engages in activities to learn from the defects that occur in the practice or health center and put interventions in place to reduce the threat that they will occur again. Because teams often find it easier to achieve their goals by using forms, checklists, and other tools to support their efforts, the final step of the ACAP program focuses on using tools to improve.

Action items for Module 6 Continue to generate BP control rates by clinician or team and share with your entire staff. Use the SMBP program to facilitate implementation of SMBP in your practice or health center. Use the SMBP program to develop and implement a protocol for reliably collecting and recording SMBP readings in your practice or health center. Please note, all speaker notes are suggestions only. Speaker These are your action items that should have already been completed. ******************************************************************** Supplemental information [For reference, this is a review of the action items from Module 6. If attendees ask what the action items were, you may refer to this list. These actions should have already been completed.] Action Items from Module 6 Continue to generate BP control rates by clinician or team and share with your entire staff. Use the SMBP program to facilitate implementation of SMBP in your practice or health center. Use the SMBP program to develop and implement a protocol for reliably collecting and recording SMBP readings in your practice or health center.

Next steps for Module 7 Dietary and lifestyle interventions to improve blood pressure controle Listen to two podcasts (one on the technical aspects and one on the adaptive aspects of Module 7) Complete Module 7 tasks using the tools discussed in the podcasts and referenced in the fast facts sheets All Module 7 materials may be found here (access the Module 7 folder) https://ama-assn.box.com/s/5wa519z2fhqbyz8fz8wi6w5uivdoetu0 Be prepared for the next “Share your experiences” webinar on September 14, 2016 – Register here Please note, all speaker notes are suggestions only. Speaker With Module 6 completed, these are your next steps as you move into Module 7. It is important to mention that the IHO: BP program is intended to be a continuous learning process, with each module building upon previous module content. ******************************************************************** Supplemental information [For reference, below please find action items for the upcoming module.] Module 6 Action Items Continue to generate BP control rates by clinician or team and share with your entire staff. Use the SMBP program to facilitate implementation of SMBP in your practice or health center. Use the SMBP program to develop and implement a protocol for reliably collecting and recording SMBP readings in your practice or health center.

How to claim CME credit The American Medical Association designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians can claim CME credit and non-physician participants can obtain a certificate of participation. https://cme.ama-assn.org/Activity/4451864/Detail.aspx Access code: 5000 Participants can claim credit until September 19, 2016 Please note, all speaker notes are suggestions only. Speaker To claim CME credit, please use the link provided in this slide and enter the access code. Participants can claim credit until September 19, 2016.

Thank you Please be sure to provide us feedback on the content by completing a short survey following this webinar. Please note, all speaker notes are suggestions only. Speaker Your feedback on this “Share your experiences” webinar content is very important. Following this webinar you will be directed to a short survey, please take a moment to complete the survey.

References Content included in this “Share your experiences” webinar slide deck includes references used in the M.A.P. checklists, the ACAP program and in the fast fact sheets. Please refer to the reference lists in the M.A.P. checklists, the ACAP program and in the fast fact sheets for additional information. For any questions, please contact your state’s Telligen cardiac lead: Colorado: Devin Detwiler at devin.detwiler@area-d.hcqis.org        Illinois: Kristen Marino at kristen.Marino@area-d.hcqis.org    Iowa: Frann Otte at frann.otte@area-d.hcqis.org                 Please note, all speaker notes are suggestions only.