1.  The Hypertension Initiative and OQUIN  Programs and Progress to Date: CVD Mortality in SC improved from 50 th in 1995 to 34 th nationally in 2009  Use of database to facilitate and advance quality improvement  Summary

2. Strategies (effective, low cost/complexity, scalable): Healthy lifestyles – physical activity & good nutrition 1. Healthy lifestyles – physical activity & good nutrition 2.Effective health care – access to care & medications Mission Statement: To facilitate the transition of SC and the Southeast from a leader in CVD to a model of heart & vascular health Goal: 1. Improve overall health 2. Cut heart attack & stroke in ½

3. Intervention Requirement High cost Time intensive High level staff expert Not well packaged Ignore user needs Not self-sustaining Setting specific Not ‘customizable’ Target Setting Limitations Competing demands Client needs Outside program Limited resources/ support Established work patterns Inadequate incentives Low-quality implementat’n Research Design Not relevant Not representative of patients, practices Fail to evaluate cost, RE-AIM, sustainability Interactions among intervention, setting, and design barriers Given participation barriers, program reach and/or participation are low Interventions are inflexible, inappropriate for target population Staffing not matched to intervention needs/requirements Practice setting organization and intervention team philosophies misaligned Practice setting unable to implement intervention as designed Glasgow RE, Emmons KM. Ann Rev Publ Health. 2007;28:413–433.

4. Healthy Food can taste good and not cost more ! DASH for Good Health Southern Style Cookb ook Faith-Based Study Guide & Website http://worst2first. musc.edu/dash/files/ cookbook2008.pdf

5. Double the number of OQUIN sites from 108 to 216 in SC Increase the number of adult patients in OQUIN from 800,000 to 1.7 million and the number of pediatric patients from 100,000 to 250,000 in SC Increase number of ASH-Designated Hypertension Specialists in SC from 47 to 70 Contracts in place to add 75 clinical sites (blue=adult, green=pediatric) Contracts in place to add ~300K adults and ~150K pediatric patients OQUIN Overview July 31, 20125 Coverage/Growth in the Practice Network Practices as of 2010 (108 sites) Current sites plus new adult and pediatric practice sites (183 sites)

6. ASH Clinical HTN Specialists in the Carolinas & Georgia Clinical HTN Specialists in GA, NC, SC. ASH goal: At least 1 HTN Specialist in every country / parish with 1 Specialist for every 20 primary care physicians

7. There are too many uncontrolled hypertensive patients to be managed by Specialists, so their expertise must be leveraged through–  Education of patients and colleagues  Patient Care; manage challenging HTN / CVD risk management referrals  Research; practical clinical trials, comparative effectiveness research. Am J Hypertens 2002;15:372-379.

8. Quality Reports and Certifications Learn your ABC’S

9. Quality Reports and Certifications ABC’S Report Providers can see at a glance how they are performing compared to ABC’S Standards Confidential Report for each physician and provider Results by patient to identify potential actions and see results of actions taken Averages by category to identify areas for improvement and role model behavior Linked to Recognition programs and bonus payments

10. OQUIN: Control of BP and LDL in Hyperlipidemic Hypertensives (2000-2011) OQUIN Overview October, 2012 10 In one decade, SC OQUIN practices had a relative improvement of: 56% in BP Control to <140/<90 mm Hg 78% in LDL Control to <100 mg/dL 167% in both BP and LDL Control, which reduces CHD  50%

11. National Rankings and Improvement SC Improvement in CV Mortality Rank vs. Other ‘Stroke Belt’ States: 1995 – 2009. STROKE BELT 1995 Rank2008 RankChange 31—Virginia27—Virginia +4 34—North Carolina32—North Carolina +2 35—Indiana34—South Carolina +16 41—Arkansas39—Indiana −4 43—Alabama40—Georgia +4 44—Georgia44—Kentucky +2 46—Kentucky45—Tennessee +4 47—Louisiana46—Arkansas −5 49—Tennessee48—Louisiana −1 50—South Carolina50—Alabama −7 51--Mississippi 0 Source: CDC WONDER Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1979- 1998. CDC WONDER On-line Database, compiled from Compressed Mortality File CMF 1968-1988, Series 20, No. 2A, 2000 and CMF 1989-1998, Series 20, No. 2E, 2003. Accessed at http://wonder.cdc.gov/cmf-icd9.html on Jun 11, 2012 2:54:38 PM and CDC WONDER Online Database, compiled from Compressed Mortality File 1999-2008 Series 20 No. 2N, 2011. OQUIN Overview July 31, 201211 WORST (50 th in US,1995) FIRST (34 th & Most Improved in Stroke Belt)

12. Million Hearts: ABCS Status Source: CDC Million Hearts: Strategies to Reduced the Prevalence of Leading Cardiovascular Disease Risk Factors --- United States, 2011, Early Release, Vol. 60. Source: OQUIN CY 2011 network total. These are patients in treatment, not total population. Indicator Target Population US Population Targets US Population Current Averages US Clinical Targets OQUIN Practice 2011 Results A spirin People at increased risk of cardiovascular disease who are taking Aspirin 65%47%70%36% B lood Pressure People with hypertension who have adequately controlled blood pressure 65%46%70%73% C holesterol People with high cholesterol who have adequately managed hyperlipidemia 65%33%70%72% S moking People trying to quit smoking and who get help 65%23%70%72%

13. Okonofua, et al: Hypertension, 2006. Therapeutic inertia accounted for 19% of the variance in BP control

14. Hypertension. 2012; 59:1124–1131.

15. Data on 50 HTN Pts. The 1 st BP reading was taken by the physician using the BpTRU. The 2 nd through 6 th BP readings were taken using the BpTRU with only the Pt in the exam room. Myers. Blood Press Monit 2006; 11:59–62. The white coat response associated with office BP can be virtually eliminated with the BpTRU device. Myers, et al. J Hypertens 2009; 27:280–286.

16. Selassie, et al. Hypertension 2011;58:579 – 587. White

17. Database:  Guide & evaluate CME  Inform practice-based QI, CER interventions  Preliminary data for grant apps esp T3, T4, i.e, CER, PCT; D & I  Publications: CVD and non-CVD

18.  The Hypertension Initiative and OQUIN  Programs and Progress to Date: CVD Mortality in SC improved from 50 th in 1995 to 34 th nationally in 2009  Use of database to facilitate and advance quality improvement  Summary