Hypertension Registry Initiative
For an update on this initiative, click here to see the Impacting Population Cardiovascular Health Through a Community-Based Practice Network: Update on an ASH-Supported Collaborative article in the August 2011 issue of the Journal of Clinical Hypertension.
INTRODUCTION: Over the past five (5) decades tremendous progress has been made in reducing age-adjusted cardiovascular morbidity and mortality. However, with a growing and aging population that has become more obese, the absolute burden of clinical cardiovascular disease has not declined and costs have continued to climb. Despite challenges, promising opportunities exist to develop and/or enhance cost-effective strategies for primary and secondary prevention of cardiovascular and renal diseases.
BACKGROUND INFORMATION: In accord with this progress, the Care Coordination Institute Patient Registry, a program initiated by the ASH Carolinas, Florida and Georgia Regional Chapter in 1999 and initially seated at the Medical University of South Carolina, has enrolled community-based practices in a quality improvement program based on practice data audit and feedback reporting. This framework offers the capability (a) to reveal areas of and reasons for high and low hypertension control and (b) to track physician prescribing patterns, therapeutic inertia, frequency of key laboratory testing, and the control of hypertension, hyperlipidemia and diabetes in their patients.
The Society is committed to enhance the efforts of the Carolinas, Florida, Georgia Chapter, as the data collection protocol it has established (a) supports practice audit and feedback reports to enhance quality improvement, (b) provides the opportunity for performance improvement initiatives, and (c) identifies continuing medical education topics. This type of information will enable ASH to better target and address the education and practice needs of physicians and patients, target initiatives and move swiftly forward in its mission to eliminate hypertension and its consequences. ASH intends to grow the depth and breadth of this initiative to extend the database across all of the eight (8) ASH Regional Chapters, beginning with the Midwest.
ASH is committed to quality improvement initiatives, improving hypertension outcomes and to serving as the agent for change in modifiable cardiovascular risk factors. The data collection protocol developed by the Hypertension Initiative offers the capability to accomplish these objectives.
HYPERTENSION REGISTRY INITIATIVE PROTCOCOL
#1: ELECTRONIC MEDICAL RECORD DATA
Healthcare providers voluntarily participate in this sophisticated yet user-friendly monitoring and feedback program, capturing the following information, mainly from electronic medical record systems including:
- Blood pressure
- Lab data: Serum K+, serum creatinine (estimated glomerular filtration rate [eGFR]), LDL cholesterol (mg/dL) (full lipid profiles are captured), HbA1c, urine albumin/creatinine, CBC
- Medication class and generic name equivalent, dose and frequency of antihypertensive, lipid-lowering, and diabetes medications
- ICD-9 and CPT codes
Presence of type 2 diabetes mellitus
- Specific diagnoses of interest: Hypertension, hypercholesterolemia / hyperlipidemia, diabetes mellitus (Type 1 and Type 2)
- The presence of concomitant cardiovascular risk factors and diseases (e.g., smoking, menopausal status, nephropathy, congestive heart failure, hypercholesterolemia, family history of cardiovascular disease, [when captured in coding or discrete fields of EMR, e.g., problem list])
#2: PRACTICE DATA AUDIT & FEEDBACK
The reporting database is linked to practice, provider, and patient identifiers. This information is used for quality improvement purposes (feedback reporting), which qualifies as a treatment, payment, and operations (TPO) activity. The Hypertension Initiative has a signed Business Associate Agreement with each practice, which establishes the Initiative as their Business Associate for quality improvement purposes. The BAA also permits use of de-identified data (without patient, provider or practice identifiers) for general reporting, publication, and other research purposes. Thus, the quality improvement and research activities conducted by the Initiative are performed in a HIPAA-compliant manner. In addition, ASH has developed an initial template for contemporary CME beginning with an in-depth needs assessment that includes provider evaluation and of established NCQA/HEDIS-PQRI indicators in this Agreement.
Providers participating in the Initiative receive feedback reports every three (3) months, which include a 'dash board' showing control rates using established NCQA/PQRI indicators (BP <140/<90 in hypertensive patients 18-85 years; BP <140/<90, <130/<80 and <140/<80 in diabetics, LDL <100 (diabetics, patients with ischemic vascular disease, and HbA1c <7%, <8% and >9% for diabetics. The report also includes control rates by age, gender and race subgroups, the medication class and number of medications prescribed, therapeutic inertia, frequency of care, and frequency of evidence-based laboratory testing for each of the 3 major risk factors. Providers can securely access a list of their patients that have uncontrolled risk factors, haven't been seen in the past 6 months, or don't have recommended laboratory tests performed in the prior year.
Currently the Registry for this Initiative covers more than 1.9 million patients and 9,000 physicians.
#3: CONTINUING MEDICAL EDUCATION (CME) ACTIVITIES
As the practice data audit and feedback is reported data is also amassed regarding current educational needs assessments for physicians and other health care providers in the enrolled practices. Armed with this data ASH is developing appropriate educational programs regarding effective treatment strategies for hypertension patients.
This needs assessment provides the foundation for a structured, targeted CME program to address the needs of the health care providers in these practices. This phase would be followed by ongoing monitoring of targeted quality of care indicators with subsequent CME based on addressing barriers and facilitators to reaching goals mutually established by practices and ASH. The process involves practice data audit and feedback, assistance in practice re-design, efficient sharing and delivery of best practices across practices and regions, and implementation of evidence-based tools to improve communication with patients and patient adherence with lifestyle and medication therapies potentially including a patient portal with facilitated relay of timely and important health information.