Kaiser Permanente Northern California nearly doubled the rate of blood pressure control among adult members with diagnosed hypertension between 2001 and 2009 through one of the largest, community-based hypertension programs in the nation, as reported today in the Journal of the American Medical Association.
The rate of hypertension control throughout Kaiser Permanente Northern California increased from 43.6 in 2001 to 80.4 percent in 2009, as measured by the Healthcare Effectiveness Data and Information Set quality measurement set by the National Committee for Quality Assurance.
In contrast, the national mean control rate increased from 55.4 percent to 64.1 percent during that period. Control rates throughout California, available since 2006, were similar but slightly higher than the national average – 63.4 percent versus 69.4 percent from 2006 to 2009.
“This successful program is evidence that large-scale and comprehensive monitoring and intervention systems can improve blood pressure control,” said lead author Marc G. Jaffe, MD, an endocrinologist and clinical leader of the Kaiser Permanente Northern California Cardiovascular Risk Reduction Program. “More importantly, this model has tremendous potential to improve the health of millions of people. High blood pressure is an important modifiable risk factor for life-threatening illnesses including heart disease, stroke and kidney disease. As the population ages, high blood pressure will become an even bigger problem unless we act now.”
Hypertension affects 65 million adults in the United States, or 29 percent of Americans age 18 years or older, and is a major contributor to cardiovascular disease. Blood pressure control remains elusive nationally, despite widespread availability of effective therapies, and limited data exist about the implementation and results of large, sustained hypertension programs.
Kaiser Permanente Northern California introduced the hypertension program in 2001 as a multifaceted approach to blood pressure control and quality improvement. A number of differentiating practices drove the program’s success, including a comprehensive hypertension patient registry, which increased from 349,937 or 15.4 percent of adult membership to 652,763 or 27.5 percent of adult membership between 2001 and 2009. By using frequent hypertension control quality reports, Kaiser Permanente was able to quickly identify high-performing medical centers and implement their successful practices and innovations system-wide. The program also supplied clinicians with a frequently updated evidence-based, four-step hypertension control algorithm.
The program encouraged single pill combination therapy – combining multiple drugs into one pill. This strategy has advantages, including improved adherence, lower patient cost and improved blood pressure control. Medical assistants also followed up with patients two to four weeks after medication adjustments and informed the primary care physician, who then directed treatment decisions and follow-up planning. This process accelerated treatment intensification without significantly increasing the need for repeat clinician visits while simultaneously improving patient convenience and affordability.
“This is the first successful, large-scale program sustained over a long period of time,” said Dr. Jaffe. “Following the study period, our hypertension control rates have continued to improve from nearly 84 percent in 2010 to 87 percent in 2011. This has huge implications for the health of our members because this success translates into reduced risk of stroke and heart disease.”
This study is part of Kaiser Permanente’s ongoing work to address hypertension and cardiovascular health overall. Last year, the U.S. Department of Health and Human Services recognized Kaiser Permanente Colorado for its success in controlling hypertension across its entire patient population. And for the last few years, Kaiser Permanente has encouraged diabetes patients who are at least 55 years old to participate in an aggressive initiative to prevent heart attacks and strokes. The ALL initiative is a therapeutic program that includes the use of aspirin, lisinopril and a lipid-lowering medication. The initiative, which also now includes the use of a beta blocker, is also actively promoted and shared with other health systems outside Kaiser Permanente.
Additional authors on the study include GraceA. Lee, MD, of the Department of Endocrinology, Kaiser Permanente South San Francisco Medical Center; Joseph D. Young, MD, of the Department of Medicine, Kaiser Permanente Oakland Medical Center; and Stephen Sidney, MD, MPH, of the Division of Research, Kaiser Permanente Northern California, Oakland.