Hypertension

HTN guideline sparks clinics’ push for accurate BP measurement

With a great opportunity to affect hypertension rates, leaders at CentraCare Health in St. Cloud, Minnesota, knew they needed to do more about encouraging accurate blood-pressure (BP) measurements to align with guideline recommendations.

CentraCare implemented a new quality-improvement program in their clinics that helped nearly 1,000 patients get their hypertension under control and improve the organization’s BP-control rate to 83 percent.

Changes to BP measurement were implemented as part of a Target: BP, a joint initiative between the AMA and AHA to improve blood pressure control, after the release of the 2017 hypertension guideline. This guideline was written by a joint task force formed by the American College of Cardiology (ACC) and the American Heart Association (AHA).

The ACC and AHA partnered with several organizations representing physicians and other health professionals to create the guideline. CentraCare Health subsequently submitted data to show it achieved a BP control rate of greater than 70 percent and as a result earned Gold Status recognition from Target: BP

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In 2017, the AMA and AHA acknowledged early adopters of the Target: BP recognition program by identifying over 300 organizations. And in 2018, more than 800 organizations were recognized for their efforts focusing on BP control within the populations they serve.

“We realized that we needed to do more with hypertension,” said Dane Nelsen, a performance improvement consultant at CentraCare Health. The organization put together a committee of more than a dozen physicians, nurses and administrators from areas as diverse as cardiology, nephrology, internal medicine and family medicine to tackle the BP control challenge.

Here is how CentraCare updated the way it accurately measures BP and implemented a quality improvement program to improve BP control after the release of the hypertension guideline.

Changing the way BP is measured

The health professionals at CentraCare also have worked to eliminate discomfort associated with changes in measuring BP accurately.

“We’re encouraging all our clinics to adopt automated blood-pressure analyzers and that’s been a little bit of a challenge because this is a different way of doing it,” said Nelsen. “Some of our clinics have traditionally used manual checks.”

CentraCare has also focused on BP rechecks to ensure accuracy. This includes identifying the measurement sequence and best practices to evaluate blood pressure and ensure the same practice is happening at most—if not all—clinics.

Creating an algorithm to improve care. CentraCare developed a Hypertension Pharmacologic Innovation Tool, which significantly improved workflows to prescribe, adjust and titrate anti-hypertensive drugs.

The tool highlights patients who are not on anti-hypertensive drugs who are at high risk of stroke or heart disease. It also indicates opportunities where more effective pharmacologic intervention is possible. Use of this tool has encouraged interdepartmental collaboration and improved patient compliance with their care plans.

“What I appreciate most about what Target: BP has done is it’s a one-stop shop for everything that you use,” said Nelsen. “When you visit targetbp.org and you go to ‘Tools & Downloads,’ everything that we’re encouraging our clinics to do is there. ... The infographics and the things that [the AMA] has created are very easy to put into use at our clinics.”

Engaging and educating staff

“We’ve had some pretty nice improvements in our data, but that wasn’t overnight work,” said Nelsen. “The hardest challenge is engaging care teams to look at their medication practices a little bit differently.”

Health care teams are now encouraged to schedule BP visits in which nurses monitor patients on behalf of the physicians. During these visits, nurses will encourage BP changes as they relate to medication as well as lifestyle interventions.

“Registered nurses can provide education within our clinics to essentially do both pharmacologic and nonpharmacologic interventions to improve hypertension,” said Nelsen. “We saw some pretty significant improvements from just engaging nurses and the blood pressure evaluation.”