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

Published byRosamond O’Brien’ Modified over 9 years ago

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Presentation on theme: "VA Electronic Health Record Clinical Improvement in Hypertension Ross Fletcher, MD."— Presentation transcript:

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

2 VHA Doctor. 1 Demo Patient 1 000-00-0001001/01/1901 (00) Progress Note Text Updates for PCE 1. Select Reminder 2. Select from Dialogs to Resolve the Reminder Reminders

3 How VA Care Compares: Quality Measures

4 Hypertension Treatment

5 Analysis at 4 month Interval

6 Hypertensive Patients Returning to < 140 / < 90 Months 0.3 0.35 0.4 0.45 0.5 0.55 0.6 Percent Patients Jan 99 Jul 99 Jan 00 Jul 00 Jan 01 Jul 02 Jan 03 Jul 03 Jan 04 Jul 01 Jan 02

7 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

8 Hypertensives Returned to Normal 40 45 50 55 60 65 70 75 80 Month Percent Normal Control rate 2000-2007 3.7%, 95% CI 3.1 – 4.3 P < 0.0001 Control rate 2007-2010 2.0%, 95% CI 1.9 – 2.2 P < 0.0001 Summer – Winter Seasonal Variation 6.8 % 2000-092000-122001-032001-062001-092001-122002-032002-062002-092002-122003-032003-062003-092003-122004-032004-062004-092004-122005-032005-062005-092005-122006-032006-062006-092006-122007-032007-062007-092007-122008-032008-062008-092008-122009-032009-062009-092009-122010-032010-06 582,881 Hypertensive Patients

9 Hypertensives vs. Normotensives 50 60 70 80 100 110 120 130 140 150 Blood Pressure Month 2000-092000-122001-032001-062001-092001-122002-032002-062002-092002-122003-032003-062003-092003-122004-032004-062004-092004-122005-032005-062005-092005-122006-032006-062006-092006-122007-032007-062007-092007-122008-032008-062008-092008-122009-032009-062009-092009-122010-032010-06 90 Systolic – Patients with Hypertension Diastolic – Patients with Hypertension Systolic – Patients with Normal Blood Pressure Diastolic – Patients with Normal Blood Pressure

10 Percent Hypertensives Controlled by Race Month 30 40 50 60 70 80 90 Percent Normal Black Hispanic Caucasian Race not specified 2000-092000-122001-032001-062001-092001-122002-032002-062002-092002-122003-032003-062003-092003-122004-032004-062004-092004-122005-032005-062005-092005-122006-032006-062006-092006-122007-032007-062007-092007-122008-032008-062008-092008-122009-032009-062009-092009-122010-032010-06

11 40 45 50 55 60 65 70 75 80 Percent Normal 2000-092000-122001-032001-062001-092001-122002-032002-062002-092002-122003-032003-062003-092003-122004-032004-062004-092004-122005-032005-062005-092005-122006-032006-062006-092006-122007-032007-062007-092007-122008-032008-062008-092008-122009-032009-062009-092009-122010-032010-06 <55 55 < 70 70 < 80 > 80 Month Percent Hypertensives Controlled by Age

12 Systolic / Diastolic BP by Age Group 135 140 145 150 Systolic BP 65 75 85 Diastolic BP Month <55 55 - <70 70 - < 80 80+ 2000-092000-122001-032001-062001-092001-122002-032002-062002-092002-122003-032003-062003-092003-122004-032004-062004-092004-122005-032005-062005-092005-122006-032006-062006-092006-122007-032007-062007-092007-122008-032008-062008-092008-122009-032009-062009-092009-122010-032010-06

13 Percent Hypertensives Controlled by Gender Month Percent Normal 40 45 50 55 60 65 70 75 80 female male 2000-092000-122001-032001-062001-092001-122002-032002-062002-092002-122003-032003-062003-092003-122004-032004-062004-092004-122005-032005-062005-092005-122006-032006-062006-092006-122007-032007-062007-092007-122008-032008-062008-092008-122009-032009-062009-092009-122010-032010-06

14 Percent Hypertensives Controlled by Climate Month Percent Normal 40 45 50 55 60 65 70 75 80 warm cold Warm = Sja, Hon, Mia, Hou Cold = Anc, Frg, Por, Min 2000-092000-122001-032001-062001-092001-122002-032002-062002-092002-122003-032003-062003-092003-122004-032004-062004-092004-122005-032005-062005-092005-122006-032006-062006-092006-122007-032007-062007-092007-122008-032008-062008-092008-122009-032009-062009-092009-122010-032010-06

15 Seasonal Variation in Weight

16 Hypertensive Rx Patients Receiving Rx 0 10 20 30 40 50 60 70 Beta Blocker Calcium Channel DiureticAce Inhibitor Central Acting Sep-03Sep-05Sep-07Sep-09

17 Mortality 50 55 60 65 70 75 80 85 90 95 100 01224364860728496108120132144 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

18 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

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