The COVID-19 public health crisis has disproportionately affected historically marginalized racial and ethnic groups, which Cook County Health in Chicago primarily serves. And leaders at the public health system became increasingly aware of another health issue that needed greater attention: high blood pressure.
In the fall of 2020, Cook County Health made the decision to launch a pilot AMA MAP BP™ program to improve its overall BP-control rate, which was at about 40%. AMA MAP BP is a six-month continuous quality improvement program. Each component is implemented for about two months and includes evidence-based strategy and action steps, supporting tools and resources, practice coaching (practice change facilitation), and performance metrics displayed through dashboards and in monthly reports.
“Despite the fact that it is widely recognized that uncontrolled blood pressure—the nation’s No. 1 risk factor for heart attack, stroke and premature death—contributes to nearly 850,000 deaths each year, the percentage of people with controlled blood pressure has been declining for nearly a decade,” said AMA President Jack Resneck, Jr., MD. “We know these statistics reflect the fact that many patients and physicians face a variety of challenges, including the COVID-19 pandemic, making it difficult to successfully manage the condition.”
“The COVID-19 pandemic also illuminated the stark inequities that exist in the U.S., including blood pressure control,” Dr. Resneck said. “Through the AMA MAP BP program, we will be able to help many more physicians, care teams and health care organizations better partner with their patients to help them avoid the deadly consequences associated with high blood pressure—improving health outcomes for patients nationwide.”
The AMA helped guide Cook County Health in developing its Cerner embedded dashboard seven months later at a time when their technical team was also preparing a rollout of an online platform for mass vaccination registration at multiple locations throughout the Chicagoland area. The technical team was pivotal in assisting the system in vaccinating over one million residents, including those who reside in our most vulnerable communities while supporting the development and launch of the MAP BP dashboard. Since implementation, the health system has seen a 13-percentage point improvement in blood pressure control at AMA MAP BP practice sites, which is now in place at 11 practices.
“We knew that a lot of people would die if we don’t do this,” said Charles Edoigiawerie, MD, a family doctor and one of the lead physician champions of the MAP BP program at Cook County Health, which provides care to more than 500,000 patients through the health system and health plan across two hospitals and more than a dozen community health centers.
Here is how Cook County Health improved BP control given the many competing priorities during an earlier, pre-vaccine period of the COVID-19 pandemic.
“We spent most of our time reaching out to most of this patient population. We specifically had to bring them back in and reach out to them during the pandemic,” said Dr. Edoigiawerie.
To do this, there were special groups that went to patients’ homes to monitor their blood pressure. At each house visit, the health professional would report back to the physician with information about the patient’s blood pressure. But the key was ensuring that BP was measured accurately.
“One way to do that was to either have people who go to the house to do self-measured BP measurement or at a clinic having multiple recording and measurement of their blood pressure,” Dr. Edoigiawerie said. The focus is specifically on how health professionals are “managing blood pressure in the clinic.”
“Meeting patients where they were at home really helped us address their blood pressure throughout the pandemic,” said Kesha Love, MSN, RN, meaningful use analyst and technical trainer at Cook County Health.
“Regardless of their ability to pay, we understood that our patients may not have access to technology, so our patients were enrolled in the remote-patient monitoring program,” Love said. “For those patients who were enrolled in the program, we provided them with tablets that were already Wi-Fi enabled.”
Five hundred tablet computers and some extra-large BP monitors were distributed to patients.
That meant “they had a data plan and patients were able to monitor their vitals at home and those vitals automatically came over to the chart so that” physicians and other clinicians could take action, Love said.
The AMA, in collaboration with the American Heart Association, also provided Cook County Health with several hundred validated BP devices to support patients with hypertension in self-measurement as part of AMA’s investment with West Side United.
“With the global pandemic, we were severely impacted, as were other health organizations by not being able to bring patients in at a certain point,” Love said. “Then continuing throughout the pandemic, not being able to bring patients in at the volumes that we were bringing them in before in the clinics.”
“But with the remote-patient monitoring, we were able to stay engaged with our patients. We were able to have a telephone or video appointment with our patients, but you were also able to assess vital signs with the patients,” she said.
Discover why telehealth is key to turning the tide on BP control.