Large-Scale Program Boosts Hypertension Control

A large-scale hypertension program was associated with a significant increase in hypertension control compared with state and national control rates, according to a recent JAMA study.

The Kaiser Permanente Northern California (KPNC) hypertension program, developed in 2001, provided a multifaceted approach to blood pressure control. Key elements included a comprehensive hypertension registry, development and sharing of performance metrics, evidence-based guidelines, medical assistant visits for blood pressure measurement, and single-pill combination pharmacotherapy.

Patients identified as having hypertension within an integrated health care delivery system in Northern California from 2001 to 2009 were included in the study. The KPNC hypertension registry included 349,937 patients when established in 2001 and 652,763 patients by 2009.

The comparison group was made up of insured patients in California between 2006 and 2009 who were included in the Healthcare Effectiveness Data and Information Set (HEDIS) commercial measurement by California health insurance plans participating in the National Committee for Quality Assurance (NCQA) quality measure reporting process. A secondary comparison group was included to obtain the reported national mean NCQA HEDIS commercial rates of hypertension control between 2001 and 2009 from health plans that participated in the NCQA HEDIS quality measure reporting process. Hypertension control as defined by NCQA HEDIS was the main outcome.

The NCQA HEDIS commercial measurement for hypertension control within KPNC increased from 43.6% to 80.4% during the study period, compared with an increase from from 55.4% to 64.1% in the national mean NCQA HEDIS commercial measurement. The California mean NCQA HEDIS commercial rates of hypertension were similar to those reported nationally from 2006 to 2009 (63.4% to 69.4%).

Hypertension affects 65 million adults in the United States and is a major contributor to cardiovascular disease, according to the study authors. Effective therapies have been available for more than 50 years, but fewer than half of Americans with hypertension had controlled blood pressure in 2001-2002.

There are many quality improvement strategies for control of hypertension, but no successful large-scale program sustained over a long period has been described, it was noted.

A review of 72 clinical trials identified several interventions that improve blood pressure control in primary care settings. The strongest evidence was for an organized, comprehensive system of regular population review and intervention.

Implementation of a large-scale hypertension program was associated with improvements in hypertension control rates between 2001 and 2009, the researchers concluded.

In an accompanying editorial, Abhinav Goyal, MD, MHS, and William A. Bornstein, MD, PhD, of the Emory School of Medicine, Atlanta, commented on the study findings:

“The transition to value-based models in all sectors of US health care and the looming growth of accountable care organizations and shared savings models provides a framework wherein health care organizations have the flexibility to implement care models optimized to deliver the best outcomes at the lowest cost, without being constrained to face-to-face physician encounters to drive reimbursement. In this context, studies such as the one by Jaffe et al on the science of health system–level quality improvement are particularly powerful and hopefully will prompt hypertension guidelines and perhaps other guidelines to include recommendations about system-level approaches to managing risk factors.”