Best Practices in Hypertension and Hyperlipidemia


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Dr. David McCulloch, FRCP, medical director of clinical improvement and Diabetologist for Group Health talks at a Tacoma, WA, Continuing Medical Education conference about managing hypertension also known as high blood pressure and hyperlipidemia known as high cholesterol.

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Best Practices in Hypertension and Hyperlipidemia

  1. 1. David K. McCulloch, MD, FRCPMedical Director, ClinicalImprovement, and Diabetologist,Group Health PhysiciansClinical Professor of Medicine,University of WashingtonBest Practices inHypertension and Hyperlipidemia
  2. 2. General principles for quality improvement• The effectiveness of any intervention is dependent on thebaseline risk, so identify those at highest risk and target them.• Embed evidence-based interventions into routine standard workso that doing the right care is easy.• Develop robust tracking systems for both process measures andoutcome measures, make the data transparent, expect constantimprovement, and help develop countermeasures when targetsare not being met.
  3. 3. Cascade DashboardPhilosophy of Patient Centered CareOpportunistic Care OutreachFeedbackProvider andTeam Strategies• Post Bday Letter outreach• Case Management• CNS outreachProvider IndexIncentive CompMissed Opportunities ReportPatient ActivationStrategies• Birthday Letters• Interactive Voice Recognition• My Group Health• Health Profile• Health Coaching• HPD letters: Mam/Pap, Fx f/uProvider andTeam Strategies: GPD• Health Maintenance• Planned Care Exception Report• MHM Visit PrepContracted ProviderEngagement/Interventions(Clinical Integration Model)•Relationship Management•Pay for Performance (P4P•Reporting•QI ConsultationPatient Activation• HM based Patient Handout• After Visit Summary
  4. 4. How do we track how we are doing?• We use HEDIS measures plus ACE-inhibitor and Statin usage.• Using LEAN we have developed standard work in primary careteams. Tier 1: Individual primary care provider Tier 2: Each primary care clinic Tier 3: Primary care overall Tier 4: GPD overall Tier 5: GH overall
  5. 5. The Number Needed to Achieve Target (NNAT)• At the start of every year we get new enrollment and lose someprevious enrollees. Using HEDIS definitions we identify how many“gaps in care” each of our members has (not just in hypertensionand lipids but in all HEDIS areas of prevention and treatment).• Some enrollees have no gaps, others might have 1 or many morethan that. We set our targets for each of the 40+ measures to beabove the 90thpercentile in the nation. The overall NNAT is thenumber of “gaps” that need to be closed to achieve those targets.• We challenge ourselves to be able to close at least 50% of that gapduring the upcoming year.
  6. 6. Tier 5 rollup of HEDIS prevention measures
  7. 7. Tier 3 time trend within primary care
  8. 8. Tier 3 time trend within primary care
  9. 9. Tier 3 time trend within primary care
  10. 10. Tier 3 time trend within primary care
  11. 11. Tier 1: Individual providers can track their ownperformance over timeDiabetic patients with BP<140/90Initiative inQ4 to focuson BPmanagementThis showshow many ofhis/herpatients are>140/90
  12. 12. Individual providers can sort their own panel ofpatients to identify patients who need attentionSorted by those patients withdiabetes who BP is >140/90Each rowshows anindividualpatient with ALLof his/her unmet“gaps”
  13. 13. THANK YOU