Sustained success leads to reduced risk of stroke and heart disease for patients
OAKLAND, Calif., Aug. 20, 2013 /PRNewswire/ -- 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 study authors include Grace A. 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.
About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates
epidemiologic and health services research to improve the health and medical
care of Kaiser Permanente members and the society at large. It seeks to
understand the determinants of illness and well-being and to improve the quality
and cost-effectiveness of health care. Currently, DOR's 600-plus staff is
working on more than 250 epidemiological and health services research projects.
For more information, visit www.dor.kaiser.org.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We
are recognized as one of America's leading health care providers and
not-for-profit health plans. Founded in 1945, our mission is to provide
high-quality, affordable health care services and to improve the health of our
members and the communities we serve. We currently serve more than 9.1 million
members in nine states and the District of Columbia. Care for members and
patients is focused on their total health and guided by their personal
physicians, specialists and team of caregivers. Our expert and caring medical
teams are empowered and supported by industry-leading technology advances and
tools for health promotion, disease prevention, state-of-the-art care delivery
and world-class chronic disease management. Kaiser Permanente is dedicated to
care innovations, clinical research, health education and the support of
community health. For more information, go to kp.org/newscenter.
For more information, contact:
Catherine Hylas Saunders, firstname.lastname@example.org, 202-585-2603
Ann Wallace, email@example.com, 510-891-3653
SOURCE Kaiser Permanente