Description of the Mississippi Hypertension Specialist Initiative

BACKGROUND: Mississippi adults have high rates of cardiovascular disease (CVD)-associated morbidity and mortality. Strategies that address leading CVD risk factors, such as hypertension, can greatly reduce the burden of CVD.  Therefore, the Mississippi State Department of Health developed the Mississippi Hypertension Specialist Initiative (MHSI), a unique, population- and evidence-based quality improvement project to enhance hypertension detection, prevention, and treatment. The goals of the MHSI are to:  1) increase physicians’ knowledge and skills in managing complex, treatment resistant forms of hypertension, 2) increase the number of certified Hypertension Specialists in Mississippi, and 3) increase the utilization of a nationally recognized hypertension registry in Mississippi.  We describe the overall purpose, development and implementation of the MHSI.

METHODS:  The initiative is comprised of five major components:  1) development of the project framework and selection of partners; 2) meetings with leaders of the healthcare provider community; 3) statewide recruitment of physicians and certification test preparation; 4) test administration and certification of results; and 5) pre- and post-test medical records review from patients of participating physicians.

RESULTS: The MHSI framework was developed.  Leadership buy-in was obtained from various state-wide healthcare provider associations.  A contractual arrangement was made with the American Society of Hypertension to handle application submissions and conduct test preparation services.  To date, 27 physicians were recruited and registered for the test prep course with 74% (20 physicians) attended the two-day, test prep course.  The course included specialized training in the best practices and quality of care monitoring for hypertension management. Twelve physicians (60%) who attended the test prep course also registered for the Hypertension Specialist Exam; Seven physicians (58%) took the exam while 42% (5 physicians who registered) didn't sit for the exam; 43% of those physicians who took the exam passed (3 out of 7 physicians); and five physicians signed business associate agreements to have patient information included in the Outpatient Quality Improvement Network (O'QUIN) national registry.

CONCLUSIONS:  MHSI increased the number of designated hypertension specialists in the state of Mississippi by 11% (from 27 to 30).  Participating physicians received specialized training in the best practices and quality of care monitoring for hypertension management.  More work needs to be done on physician retention in the training program.  Patient data on cardiovascular and risk factor outcomes will be collected in the next phase of the initiative.  MHSI could serve as a model of quality improvement initiatives that  focus on reducing CVD morbidity and mortality.