Kaiser Permanente’s large-scale hypertension program nearly doubles BP control rates

Kaiser Permanente (KP) Northern California nearly doubled the rate of blood pressure control among adult members with diagnosed hypertension between 2001 and 2009 through a large-scale community-based program, the Journal of the American Medical Association reported recently.

In 2001, lead author Marc G. Jaffe, MD, an endocrinologist and clinical leader of the Kaiser Permanente Northern California Cardiovascular Risk Reduction Program, and colleagues set out to improve blood pressure control among KP members in Northern California and ended up creating one of the largest community-based hypertension programs in the nation.

“The paper published in JAMA explores how we combined a number of innovations, including a patient registry, single-pill combination-therapy drugs and more, to nearly double blood pressure control rates,” Dr Jaffe told Formulary.

The numbers

The rate of hypertension control throughout Kaiser Permanente Northern California increased by more than 35%, from 43.6% in 2001 to 80.4% 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% to 64.1% during that period.

“If you had told us at the onset that blood pressure control among members would be more than 80% - and it was actually almost 90% in 2011 - we wouldn’t have believed you,” Dr Jaffe said. “These results are truly incredible.”

He continued, “Our blood pressure control program in Northern California had a few key elements that we think led to its success, although we can’t definitively say any of the measures in isolation led to these incredible rates of blood pressure control.”

Data-tracking

Through the program, the researchers were able to track all KP members through a hypertension patient registry, a database that included all the hypertension patients, whose numbers increased from 349,937 patients to 652,763 between 2001 and 2009.

“We also used hypertension control quality reports so we could quickly identify high-performing medical centers and clinics, and implement their successful practices systemwide,” he said. “Using the program data, we frequently updated and circulated an evidence-based, 4-step hypertension-control algorithm so our medical teams had all the information they needed to treat their hypertension patients effectively.

“We also encouraged single pill combination therapy - combining multiple drugs into 1 pill,” Dr Jaffe added. “Putting more than 1 drug in a pill improves patient adherence, since patients have to take fewer pills every day, and it actually lowers the cost of medications overall. Medical assistants also followed up with patients 2 to 4 weeks after any medical adjustments, improving patient convenience and affordability.”

It keeps getting better

One of the unique elements of this study is that the researchers examined a program that was already in progress, instead of examining these elements in a controlled environment. And the program in Northern California has gone on to improve blood pressure control to 87% in 2011.

“Even though the study is over, the program continues, and we continue to see improved results.” Dr Jaffe said.

“The take-away message is that this model is replicable,” he added. “We published the JAMA article so other hospitals and health systems could implement elements of this system that was so successful for us; perhaps we can improve blood pressure control nationwide.”

Hypertension affects 65 million adults in the United States, or 29% of Americans 18 years of age or older, and is a major contributor to cardiovascular disease.