A large-scale hypertension program that included evidence-based guidelines and performance metrics was associated with a near-doubling of hypertension control between 2001 and 2009 among, a study found.
Marc G. Jaffe, MD, ACP Member, of the Kaiser Permanente South San Francisco Medical Center, South San Francisco, Calif., and colleagues examined outcomes from the program, which 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 drug.
Results from this group were compared to insured patients in California between 2006-2009 who were included in the Healthcare Effectiveness Data and Information Set (HEDIS) maintained by the National Committee for Quality Assurance (NCQA) quality measure reporting process. A secondary comparison group included the reported national average NCQA HEDIS commercial rates of hypertension control between 2001-2009 from health plans that participated in the NCQA HEDIS quality measure reporting process.
Results appeared in the Aug. 21 issue of JAMA.
Between 2001 and 2009, the Kaiser hypertension registry increased from nearly 350,000 people to more than 650,000. Hypertension control increased after implementation of the hypertension program from 43.6% in 2001 to 80.4% in 2009. The national mean NCQA HEDIS control rate increased from 55.4% to 64.1% between 2001 and 2009.
Following the study period, the hypertension control rate within Kaiser continued to improve, from 83.7% in 2010 to 87.1% in 2011.
The authors also found that the rate of single-pill prescriptions within Kaiser increased from 13 to more than 23,000 prescriptions per month from 2001 to 2009. During this period, the percentage of ACE inhibitor prescriptions dispensed as a single pill in combination with a thiazide diuretic increased from less than 1 percent to 27.2%.
An accompanying editorial noted that, “The transition to value-based models in all sectors of U.S. 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.”