Epidemiologic Support for a Practice Facilitation Model: Improvement in Blood Pressure Control at Primary Care Clinics in Minnesota

BACKGROUND:  Control of High Blood Pressure is a major priority for federal health agencies, as evidenced by the Million Hearts^© initiative.  Through funding provided by the Association of State & Territorial Health Officials (ASTHO), the Minnesota Department of Health (MDH) partnered with a local public health (LPH) agency in northeastern Minnesota to enhance clinics’ ability to identify and manage patients with hypertension using a team-based approach.  This region is noted for having among the highest mortality rates due to heart disease and stroke in Minnesota.   This project supports Domain 3: Health Systems Interventions from CDC’s State Public Health Actions grant.

METHODS: Clinic performance was assessed through the implementation of the National Quality Forum-endorsed measure entitled NQF 18: Controlling High Blood Pressure.  Clinics developed 18 different protocols, such as home blood pressure monitoring, health coaching, and data informatics for hypertension.  The MDH/LPH team supported clinic staff in developing a process to report NQF-18 performance data and to identify undiagnosed hypertensive patients.  Clinics used standard definitions to identify patients in their EHRs and submitted patient level data to MDH for analysis and interpretation.  Randomly-selected patient charts were also abstracted to identify self-management plans for hypertensive patients.  MDH created standardized clinic reports describing performance pre- and post-intervention.

RESULTS: In Minnesota, the statewide NQF-18 performance for 2011 was 75%, but only 69% in these four clinics. Over six months of intervention, control of high blood pressure increased by 4.2 percentage points, resulting in an additional 547 hypertensive patients under control.  Change in control by clinic ranged from +12.7 to -4.3 percentage points.  Improvements were noted across all age groups, in both sexes, and most race/ethnicity groups.  One clinic employed a health coach and observed a 25 percentage point increase in blood pressure control.  Stage II hypertension declined in three of four clinics.  In addition, three clinics scoured their EHRs and found an additional 1,361 patients with potentially undiagnosed hypertension.  A second phase with two additional clinics is now underway.

CONCLUSIONS: In addition to supporting primary data collection for CDC’s State Public Health Actions grant program, this work demonstrates the value of a practice facilitation method tied to epidemiologic data support for improving blood pressure control in a diverse set of clinics.  The success of this intervention has led to the dissemination of this MDH/LPH practice facilitation and data informatics model as a key intervention in multiple regions of the state in coming years.