Blood Pressure Management:An Improvement Story

Annie Sy, PharmD, MHSADirector, SMF Integrated Quality Services

Capital Region Right Care Initiative University of Best Practices MeetingOctober 8, 2018

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Sutter Medical Foundation

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Physician Partners• Sutter Medical Group (SMG)• Sutter North Medical Group (SNMG)• Sutter Independent Physicians (SIP)• Aligned MDs:

• Medical Groups: 1000+• SIP: 541

Site Specifics• Sutter Surgical Hospital – North Valley• Care Centers: 84 locations• Surgery Centers: 2 locations• Diagnostic Imaging: 45 locations• Lab: 30 locations• Physical Therapy: 15 locations• Sutter Walk-In Care: 4 locations

2017 Quick Facts• Active Patients: 890k• 2017 Employees: 3,400

Theresa FreiCEO

Years in Position: 3 Years with Sutter: 15

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Where We Were• In 2016, among 36,626

SMF patients with hypertension and/or diabetes, only 66% had their blood pressure (BP) under control

• Top reason was failure to review and act on results– Only about 48% of patients

with elevated BP were being addressed during clinic visits

SMG SNMG SIP TotalMeasure Rate 65.84% 71.88% 61.07% 65.97%P90 Benchmark 80.50% 80.50% 80.50% 80.50%P50 Benchmark 68.50% 68.50% 68.50% 68.50%Denominator 29,113 3,755 3,758 36,626

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Performance by Group (Data Through 12/31/2016)

Measure Definition: The percentage of members 18–85 years of age who had a diagnosis of hypertension, or 18-75 years of age with diabetes, and whose most recent BP within the past 12 months was adequately controlled according to the appropriate criteria based on their age and diabetic status.

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What We Did• Monthly performance

reports, with data at care center and physician levels

• Hypertension guideline and measure FAQs

• BP measurement training/education

• Standard workflow to take second BP if first one is high

• Improve documentation (Vitals, CPT-2 codes)

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What We Did• Visual cues for PCPs for

patients with elevated BP levels during clinic visits

• Engage specialists• Telephonic Disease

Management engagement• Outreach efforts (e.g.,

patients without follow up appointments)

• Link it to patient wellbeing and decrease risk of cardiovascular events

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Care Center Highlight: Davis Family Practice Group

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Where We Are

• Since 12/31/2016:– Overall BP control rate increased

from 66% to 79%– About 4,218 more SMF patients

have their BP under control

• Number Needed to Treat (NNT) for BP-lowering treatment to prevent one CVD event in 5 years is between 26 (highest risk group) and 71 (lowest risk group)1

SMG SNMG SIP Total12/31/2016 65.84% 71.88% 61.07% 65.97%8/31/2018 79.47% 77.24% 75.27% 78.85%P90 Benchmark 80.50% 80.50% 80.50% 80.50%P50 Benchmark 68.50% 68.50% 68.50% 68.50%

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1 Estimated based on results from: Blood Pressure Lowering Treatment Trialists' Collaboration, Sundström J, Arima H, et al. Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data. Lancet 2014; 384:591.Measure Definition: The percentage of members 18–85 years of age who had a diagnosis of hypertension, or 18-75 years of age with diabetes, and whose most recent BP within the past 12 months was adequately controlled according to the appropriate criteria based on their age and diabetic status.

65.97%

78.85%

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Und

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ontr

olBlood Pressure Control in Patients with Hypertension and/or Diabetes

(Rolling 12-Month Data)

SMG

SNMG

SIP

Total

P90 Benchmark

P50 Benchmark

Measure Definition: The percentage of members 18–85 years of age who had a diagnosis of hypertension, or 18-75 years of age with diabetes, and whose most recent BP within the past 12 months was adequately controlled according to the appropriate criteria based on their age and diabetic status. 8

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Success Ingredients

• Leadership champions• Clinician engagement• Care team support • Standard workflows • Visual management• Leverage friendly competitions• Recognize achievements

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Questions / Comments / Feedback

Annie Sy, PharmD, MHSADirector, SMF Integrated Quality ServicesChair, SMF Quality & Patient Safety Committee(916) 731-7848 | Direct(916) 521-2591 | MobileSyAZ@sutterhealth.org

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