VA Electronic Health Record Clinical Improvement in Hypertension Ross Fletcher, MD

VHA Doctor. 1 Demo Patient /01/1901 (00) Progress Note Text Updates for PCE 1. Select Reminder 2. Select from Dialogs to Resolve the Reminder Reminders

How VA Care Compares: Quality Measures

Hypertension Treatment

Analysis at 4 month Interval

Hypertensive Patients Returning to < 140 / < 90 Months Percent Patients Jan 99 Jul 99 Jan 00 Jul 00 Jan 01 Jul 02 Jan 03 Jul 03 Jan 04 Jul 01 Jan 02

Anchorage, AK Honolulu, HI Boston, MS Washington, DC Baltimore, MD Miami, FL Los Angeles, CA Houston, TX Fargo, ND Chicago, IL San Juan, PR Philadelphia, PA New York, NY Minneapolis, MN Portland, OR Hypertension Study – 15 Cities

Hypertensives Returned to Normal Month Percent Normal Control rate %, 95% CI 3.1 – 4.3 P < Control rate %, 95% CI 1.9 – 2.2 P < Summer – Winter Seasonal Variation 6.8 % ,881 Hypertensive Patients

Hypertensives vs. Normotensives Blood Pressure Month Systolic – Patients with Hypertension Diastolic – Patients with Hypertension Systolic – Patients with Normal Blood Pressure Diastolic – Patients with Normal Blood Pressure

Percent Hypertensives Controlled by Race Month Percent Normal Black Hispanic Caucasian Race not specified

Percent Normal <55 55 < < 80 > 80 Month Percent Hypertensives Controlled by Age

Systolic / Diastolic BP by Age Group Systolic BP Diastolic BP Month < < <

Percent Hypertensives Controlled by Gender Month Percent Normal female male

Percent Hypertensives Controlled by Climate Month Percent Normal warm cold Warm = Sja, Hon, Mia, Hou Cold = Anc, Frg, Por, Min

Seasonal Variation in Weight

Hypertensive Rx Patients Receiving Rx Beta Blocker Calcium Channel DiureticAce Inhibitor Central Acting Sep-03Sep-05Sep-07Sep-09

Mortality Percent Survival Months after 3rd elevated reading < 70 (75 – 100%) < 70 (50 – 74%) < 70 (25 – 49%) < 70 (0 – 24%) % Months Controlled > 70 (75 – 100%) > 70 (50 – 74%) > 70 (25 – 49%) > 70 (0 – 24%) Patients < 70 Patients > 70

1.Adopt reminders with EHR 2.Assess treatment rapidly – 2 weeks 3.Use diuretic medications 4.Improve compliance – Treat all patients 5.Decrease Winter Dip 6.Improve control in Black Patients 7.Reduce obesity Control of Hypertension