Since its inception in 1994, quality improvement has been a major focus and commitment for New West Physicians, a physician-owned primary care practice group in the Denver, Colorado metropolitan area. Each year, significant funding is dedicated to studies that explore and improve outcomes for multiple primary care related conditions. Hypertension has been a sole focus three times and is often intertwined with diabetes and heart disease studies.
For more than a decade, the group has successfully moved the needle in high blood pressure control. When the Measure Up/Pressure Down® campaign launched in November 2012, New West Physicians saw similarities between the campaign planks and the tactics it had already taken, as well as an opportunity to reinvigorate its efforts.
To date, New West Physicians has implemented a number of campaign planks and other interventions, including:
Retrained direct care staff, specifically medical assistants, in accurate blood pressure management through a lunch and learn at each site and a self-teaching video for new hires
Engaged medical assistants to flag hypertensive patients (after any reading higher than 140/90 mmHg) by placing a blood pressure sticky note next to the exam room keyboard to draw attention for physicians
Adopted the Kaiser Permanente hypertension treatment algorithm, with modifications, from the Measure Up/Pressure Down® Provider Toolkit (plank 2)
Built a patient registry and provided daily problem lists to all physicians that identify any patients with an uncontrolled vascular diagnosis with a scheduled appointment on that particular day (plank 6)
Communicated with specialists regarding blood pressure guidelines and recommended actions for patients with high readings at specialty appointments
Identified the underutilization of aldosterone blocker for patients with resistant hypertension and worked with providers to prescribe for these patients
Coached physicians on provider inertia to ensure hypertension is evaluated and/or adequately treated at every visit (plank 3)
Disseminated quarterly, unblinded quality reports by individual, site, and group that detail hypertension control and other metrics
Displayed blood pressure control education materials on patient bulletin boards in exam rooms (plank 5)
As a result of these efforts and the group’s commitment to hypertension control, from 2012 through September 2013, New West Physicians improved control rates from approximately 73 percent to 79 percent, and continue to make high blood pressure control a priority for their patients.