1. References 1.Buse JB, Ginsberg HN, Bakris GL, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation 2007; 115:114. 2.Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289:2560. 3.27.ACCORD Study Group, Cushman WC, Evans GW, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010; 362:1575. Background 25.8 million people in US (8.3%) have diabetes 67% of US adults with diabetes have blood pressure ≥ 140/90 mmHg or use prescription medications for hypertension Early treatment of HTN is particularly important in diabetic patients to prevent CVD and minimize progression of renal disease and diabetic retinopathy In patients with type 2 diabetes, benefit of tight blood pressure control may be as great or greater than the benefit of strict glycemic control All diabetic patients with persistent blood pressure ≥140/90 should be started on antihypertensive therapy along with non-pharmacological methods Problem Statement Only 70% of our adult patients with diabetes (compared to 61% of Medicaid HMO patients with diabetes nationwide) met blood pressure goal of ≤140/90 and we lacked a standardized approach to management of hypertension. Study Design Objective 90% of our adult patients with diabetes will achieve blood pressure ≤140/90 via a standardized approach to management.  Barriers & Solutions Offered transportation resources Lack of transportation Allowed patients to phone in home BPs Prescribed generic medications Cost to patient Scheduled nurse rather than physician visits Accepted home BP readings over telephone Educated on disease state Lack of patient buy-in Demonstrated that we are dedicated to helping patients reach their goal Conclusion /Recommendations Implementation of a protocol for management of HTN in patients with diabetes led to an increase in the percentage of patients at their blood pressure goal from a baseline of 70% to 94% in 7 months. A marked initial improvement was seen which was successfully sustained over a period of 6 months in a population of nearly 500 patients. A similar protocol (updated per JNC 8 guidelines) could be used at other sites or translated for use in other chronic disease states. The active involvement of a care coordinator was invaluable in the success of this quality improvement process, as was a team-based approach to care with buy-in from our Medical Assistants. Achieving Blood Pressure Control in Patients with Diabetes Elizabeth Lawrence, MD, Latha Pandurangan, MD, Eli Freilich, MD University of South Florida – Morton Plant Mease Family Medicine Residency Dr. Joseph A. Eaddy Family Medicine Research Center Identify target population (Adult diabetic patients with BP>140/90 seen within the last 2 years with valid contact info ) Identify target population (Adult diabetic patients with BP>140/90 seen within the last 2 years with valid contact info ) Assemble a multidisciplinary team ( Physician, resident, pharmacist, care coordinator and nurse manager ) Assemble a multidisciplinary team ( Physician, resident, pharmacist, care coordinator and nurse manager ) Create a guided pharmacotherapy tool for HTN including follow up protocol Contact target population to schedule appointments Implement the intervention Revise pharmacotherapy tool for clarity/ease of use Ongoing care coordination and tracking results of the intervention Educate patients Reach out to no-shows/ cancellations Track patient progress Help overcome barriers Results Percentage of patients with DM with blood pressure ≤140/90 2013-2014 Coordinate team-based care