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Successful Approaches to Reduce Hypertension: A Perspective from the South Carolina OQUIN

Successful Approaches to Reduce Hypertension: A Perspective from the South Carolina OQUIN. The Hypertension Initiative and OQUIN Programs and Progress to Date: CVD Mortality in SC improved from 50 th in 1995 to 34 th nationally in 2009

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Successful Approaches to Reduce Hypertension: A Perspective from the South Carolina OQUIN

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  1. Successful Approaches to Reduce Hypertension: A Perspective from the South Carolina OQUIN • The Hypertension Initiative and OQUIN • Programs and Progress to Date: CVD Mortality in SC improved from 50th in 1995 to 34th nationally in 2009 • Use of database to facilitate and advance quality improvement • Summary

  2. Mission Statement: To facilitate the transition of SC and the Southeast from a leader in CVD to a model of heart & vascular health Goal: 1. Improve overall health 2. Cut heart attack & stroke in ½ • Strategies (effective, low cost/complexity, scalable): • 1. Healthy lifestyles – physical activity & good nutrition • Effective health care – access to care & medications

  3. Barriers to Dissemination of EBM: Efficacy vs Effectiveness; Cost & Complexity • Target Setting Limitations • Competing demands • Client needs • Outside program • Limited resources/ support • Established work patterns • Inadequate incentives • Low-quality implementat’n • Intervention Requirement • High cost • Time intensive • High level staff expert • Not well packaged • Ignore user needs • Not self-sustaining • Setting specific • Not ‘customizable’ • Research Design • Not relevant • Not representative of patients, practices • Fail to evaluate cost, RE-AIM, sustainability • Interactions among intervention, setting, and design barriers • Given participation barriers, program reach and/or participation are low • Interventions are inflexible, inappropriate for target population • Staffing not matched to intervention needs/requirements • Practice setting organization and intervention team philosophies misaligned • Practice setting unable to implement intervention as designed Glasgow RE, Emmons KM. Ann Rev Publ Health. 2007;28:413–433.

  4. Healthy Food cantaste good and notcost more !DASH for Good Health Southern Style Cookbook Faith-Based Study Guide & Website http://worst2first.musc.edu/dash/files/cookbook2008.pdf

  5. Coverage/Growth in the Practice Network • Double the number of OQUIN sites from 108 to 216 in SC • Increase the number of adult patients in OQUIN from 800,000 to 1.7 million and the number of pediatric patients from 100,000 to 250,000 in SC • Increase number of ASH-Designated Hypertension Specialists in SC from 47 to 70 Practices as of 2010 (108 sites) Current sites plus new adult and pediatric practice sites (183 sites) • Contracts in place to add 75 clinical sites (blue=adult, green=pediatric) • Contracts in place to add ~300K adults and ~150K pediatric patients OQUIN Overview July 31, 2012

  6. ASH Clinical HTN Specialists in the Carolinas & Georgia Clinical HTN Specialists in GA, NC, SC. ASH goal: At least 1 HTN Specialist in every country / parish with 1 Specialist for every 20 primary care physicians

  7. Role of ASH Clinical Hypertension Specialists There are too many uncontrolled hypertensive patients to be managed by Specialists, so their expertise must be leveraged through– • Education of patients and colleagues • Patient Care; manage challenging HTN / CVD risk management referrals • Research; practical clinical trials, comparative effectiveness research. Am J Hypertens 2002;15:372-379.

  8. Quality Reports and Certifications Learn your ABC’S

  9. Quality Reports and Certifications ABC’S Report • Providers can see at a glance how they are performing compared to ABC’S Standards • Confidential Report for each physician and provider • Results by patient to identify potential actions and see results of actions taken • Averages by category to identify areas for improvement and role model behavior • Linked to Recognition programs and bonus payments

  10. OQUIN: Control of BP and LDL in Hyperlipidemic Hypertensives (2000-2011) • In one decade, SC OQUIN practices had a relative improvement of: • 56% in BP Control to <140/<90 mm Hg • 78% in LDL Control to <100 mg/dL • 167% in both BP and LDL Control, which reduces CHD 50% OQUIN Overview October, 2012

  11. SC Improvement in CV Mortality Rank vs. Other ‘Stroke Belt’ States: 1995 – 2009. WORST (50th in US,1995) FIRST (34th & Most Improved in Stroke Belt) National Rankings and Improvement STROKE BELT Source: CDC WONDER Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1979-1998. CDC WONDER On-line Database, compiled from Compressed Mortality File CMF 1968-1988, Series 20, No. 2A, 2000 and CMF 1989-1998, Series 20, No. 2E, 2003. Accessed at http://wonder.cdc.gov/cmf-icd9.html on Jun 11, 2012 2:54:38 PM and CDC WONDER Online Database, compiled from Compressed Mortality File 1999-2008 Series 20 No. 2N, 2011. OQUIN Overview July 31, 2012

  12. Million Hearts: ABCS Status Source: CDC Million Hearts: Strategies to Reduced the Prevalence of Leading Cardiovascular Disease Risk Factors --- United States, 2011, Early Release, Vol. 60. Source: OQUIN CY 2011 network total. These are patients in treatment, not total population.

  13. Therapeutic Inertia is a Major ‘Determinant’ of BP Control Therapeutic inertia accounted for 19% of the variance in BP control Okonofua, et al: Hypertension, 2006.

  14. ‘Predictors’ of BP Control in the 1st Rx Year Hypertension. 2012; 59:1124–1131.

  15. Automated BP & Office Hypertension:Accurate and Representative BP Data on 50 HTN Pts. The 1st BP reading was taken by the physician using the BpTRU. The 2nd through 6th BP readings were taken using the BpTRU with only the Pt in the exam room. Myers. Blood Press Monit 2006; 11:59–62. The white coat response associated with office BP can be virtually eliminated with the BpTRU device. Myers, et al. J Hypertens 2009; 27:280–286.

  16. Progression is Accelerated from Pre-HTN to HTN in Blacks White Selassie, et al. Hypertension 2011;58:579 – 587.

  17. OQUIN Opportunities Network: Quality improvement —CV, diabetes —most chronic diseases —NCQA, PQRI, BTE —Pay-For-Quality  CME, QI, Meaningful Use  CER, Practical Clinical Trials with outcomes; potential for genetic epi, pharmacogenomics Database: • Guide & evaluate CME • Inform practice-based QI, CER interventions • Preliminary data for grant apps esp T3, T4, i.e, CER, PCT; D & I • Publications: CVD and non-CVD

  18. Successful Approaches to Reduce Hypertension: A Perspective from the South Carolina OQUIN • The Hypertension Initiative and OQUIN • Programs and Progress to Date: CVD Mortality in SC improved from 50th in 1995 to 34th nationally in 2009 • Use of database to facilitate and advance quality improvement • Summary

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