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

2. 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

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

4. Accurate blood pressure measurement
Proper techniques
Equipment calibration

6. 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

9. FREE for Colorado residents!
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!

10. 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

13. 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

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

16. 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

19. Heart360 (AHA & ASA)

21. 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)

22. 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

23. 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

24. Help Patients Understand (AMA guide)

26. How do you know which intervention to select?

27. 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)