Follow-up on Blood Pressure Protocols September 20, 2017
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Welcome and Introductions Please type in the chat: Your geographical location What health news are you paying attention to? 3
HealthInsight Cardiac Project Leads Rebekah Bally Facilitation & Improvement Specialist, Project Lead HealthInsight Oregon rbally@healthinsight.org Rebecca Durham Project Manager HealthInsight Utah rdurham@healthinsight.org
HealthInsight Cardiac Project Leads Alison Shipley Project Manager HealthInsight Nevada ashipley@healthinsight.org Edy Taylor Project Manager HealthInsight New Mexico etaylor@healthinsight.org
HealthInsight Quality Innovation Network (QIN) Quality Improvement Organization (QIO) CMS Quality Strategy: Eliminating disparities Strengthening infrastructure and data systems Enabling innovation Fostering learning organizations 6 Source: Quality Improvement Organizations. 2014. About QIN-QIOs, QIO Program Fact Sheet. Accessed March 20, 2017: qioprogram.org/about/why-cms-has-qios
Learning Objectives Goals for this call: Discover successful strategies that can be easily replicated to improve cardiac care Identify two or more tactics that can be adapted to your own care setting Identify and share actionable resources from cardiac project participants and the HealthInsight project team 7
What is a Blood Pressure Protocol? A detailed written set of instructions to guide the care of a patient May include: Accurate measurement, detection of white-coat hypertension Patient adherence to treatment Timely titration and intensification of treatment Population management Other depending on setting 8
August LAN Summary Hypertension protocols reduce clinical variability Adopting a standardized approach sends a strong signal to clinical staff that hypertension control is a priority Diagnosis, treatment and self-management are areas to target Data tracking as you improve guides your team-based care 9
Reminder: Strategies Know your population Utilize walk-in BP measurement protocols Develop medication treatment protocols and order sets Set-up alert and action for abnormal BPs Ensure excellent technique in blood pressure measurement Build patient self-monitoring of BP programs 10
Blood Pressure Care Self-Assessment Million Hearts tools HealthInsight Self-assessment 11
Follow-up What is one thing you modified or started since the last webinar? AND/OR What is one thing you would like to start or add to your BP processes?
Overview What protocol are you using? e.g., JNC 8, homegrown What outcomes are you measuring? e.g., clinical, experience
Successes, Challenges, Questions Please describe any specific successes Please share any challenges you are working to overcome What questions you would like to ask of the group?
KNOW YOUR POPULATION 15
Know Your Population Registries and/or Population Management Systems Critical for assessing improvement of interventions Use to communicate excellence in care with payers Ensure connection to reporting systems Recall and reminder systems Communicate back to providers if interventions are working 16
WALK-IN BP MEASUREMENT PROTOCOLS 17
Walk-in BP Measurement Protocols Best practice in Kaiser system Allows patient excellent measurement of BP Provider trust in readings reduces therapeutic inertia Less time for clinicians Protocols or order sets allow for prompt reaction to results and next steps 18
MEDICATION TREATMENT PROTOCOLS 19
Medication Treatment Protocols and Order Sets Simplify decision making (for most cases) Allow for team-based care Allow for non-visit medication titration Ensure access to generics Easy to update system when evidence changes Allow for measurement, improvement and identification of gaps Guide to Community Preventive Services. Cardiovascular disease prevention and control: team-based care to improve blood pressure control 2014. 20
Medication Treatment Protocols Example and Order Sets (continued) millionhearts.hhs.gov/files/hypertension-protocol.pdf 21
ALERTS FOR ABNORMAL BPS 22
Alert and Action for Abnormal BPs 23
ENSURE EXCELLENT MEASUREMENT TECHNIQUE 24
Excellent Technique When measuring patients for high blood pressure always: Use automated calibrated devices Use the correct cuff size Ensure patients are positioned correctly Feet flat on the floor, legs uncrossed Seated with back supported Bare arm supported on table at heart level Resting quietly five minutes Ask the patient to not speak during measurement Also Consider: Is the patient s bladder empty? Recent tobacco and caffeine intake Modified from Improving Health Outcomes: Blood Pressure, AMA, Johns Hopkins 2015. 25
Excellence in Measurement Training Video youtube.com/watch?v=oioldkyigrq 26
PATIENT SELF-MONITORING OF BP 27
Patient Self-monitoring of BP Opportunity to engage the patient Adds information to the diagnosis and treatment of hypertension Allows for non-visit titration of therapy Can minimize un-needed visits Protocols and standardized training can improve the quality of data and patient confidence 28
Develop a Self-management Protocol healthinsight.org/resources/developing-a-patient-self-monitoring-program 29
Action Step Based on what you have heard today, please type your response in the chat: What is one area you will take on in your blood pressure care? 30
Confidence Level 1 2 3 4 5 6 7 8 9 10 Chat a number from 1-10 that reflects how confident you are you can accomplish this change 31
Action Step Please type your response in the chat: What can your team do by next Tuesday to improve your blood pressure care? 32
Questions? Comments? 33
Thank You! Please complete post-webinar survey Next LAN event: HealthInsight s Third Annual Quality Conference Albuquerque, New Mexico Tuesday, Oct. 24, 2017 Salem, Oregon Thursday, Oct. 26, 2017 West Jordan, Utah Tuesday, Nov. 7, 2017 Reno, Nevada Thursday, Nov. 9, 2017 This material was prepared by HealthInsight, the Medicare Quality Innovation Network Quality Improvement Organization for Nevada, New Mexico, Oregon and Utah, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-B1-17-25 34
Oregon - Rebekah Bally Rebekah Bally Facilitation & Improvement Specialist, Project Lead HealthInsight Oregon rbally@healthinsight.org Rebekah Bally, MPH, has been a facilitation & improvement specialist at Oregon Health Care Quality Corporation (Q Corp), now HealthInsight, since 2015. She guides a team of facilitators to support cardiac health improvement activities among more than 60 clinic sites and home health agencies in Oregon. She also supports 15 primary care practices in the south central region of Oregon to implement quality improvement initiatives around high impact disease burdens and prepare for Medicare reporting requirements. She also supports the Patient- Centered Primary Care Institute by connecting a network of clinical staff to practice transformation resources and tools especially those aligned with the Patient-Centered Primary Care Home program Oregon s version of medical home standards.
Utah - Rebecca Durham Rebecca Durham is a project manager at HealthInsight Utah. She works primarily in the physician office and home health settings. She is currently working on initiatives to improve cardiac care and increase immunization screening and vaccination rates in those settings. In addition, Rebecca facilitates and supports action groups from around the country that are made up of Health Care Innovation awardees. She graduated from the University of Utah with a Bachelor of Science degree in communications with an emphasis in health and medicine. She also recently earned recognition as a certified professional of healthcare quality. Rebecca Durham Project Manager HealthInsight Utah rdurham@healthinsight.org
Nevada - Alison Shipley Alison Shipley Project Manager HealthInsight Nevada ashipley@healthinsight.org Alison Shipley has more than 15 years of experience in various aspects of health care management where she has consistently increased productivity, improved processes and excelled in customer relations. As intake and clinic manager for Nevada Cancer Institute, she promoted the provision of optimum patient care and service. She improved patient satisfaction in these areas by redesigning work flow processes. As project coordinator for HealthInsight, Alison has worked on multiple teams, interacting with health care providers and other stakeholders to improve cardiac patient care and diabetes self-management. She is currently a project lead for the cardiac and diabetes tasks.
New Mexico - Edy Taylor Edy Taylor is a project manager who oversees both the cardiac and diabetes initiatives for HealthInsight in New Mexico. She brings more than 25 years of experience in health care, from teaching to managing medical offices. In addition to her health care experience in the private sector, Edy also served in the U.S. Navy. She is a certified medical assistant and psychiatric specialist. Edy Taylor Project Manager HealthInsight New Mexico etaylor@healthinsight.org