Hypertension Control at the Washington DC Veterans Affairs Medical Center

1
Hypertension Control at the Washington DC
Veterans Affairs Medical Center
Vasilios Papademetriou, David Wojciechowski,
Charles Faselis and Ross Fletcher Department of
Medicine, Veterans Affairs Medical Center and
Georgetown University Hospital
Abstract
Results
Washington DC VAMC Database
Hypertension control has become a high priority
for many health care providers. As part of a
system wide initiative to control hypertension,
the Washington DC VAMC employed a battery of
recommendations to primary care providers to
facilitate BP control. Recommendations included
patient and family member involvement, free BP
devices to patients, electronic reminders to
providers, virtual, electronic and curb side
consults, referral to specialty clinics, frequent
appointments until BP control was achieved, BP
recheck and regimen adjustment in all patients
with BP not at target. Outcomes were monitored
either by a random sample (performance measures)
or by data base. BP was considered controlled
when lt140/90 mmHg. Severe hypertension was
considered as BP gt160 systolic or gt100 diastolic.
The Number of patients enrolled in this
initiative increased from 3,133 in 1998 to 12,606
in 2003 and 13,485 in 2007. Using only electronic
records BP control improved from 32 in 1998 to
54 in 2003. Percent of patients with SBPgt160 or
DBPgt100 decreased from 28 in 1998 to 12 in
2003. Since the BP initiative was activated in
2004 the percentage of patients controlled
increased from 54 to 85 (Plt0.0001) using
performance measures and from 53 to 79
(Plt0.001) using data base (see Figure below). The
percentage of patients with severe hypertension
decreased from 12 in 2004 to 3 in 2007
(Plt0.001). The average number of medication used
in controlled patients was 1.82. In those with
mild BP elevation it was 1.86 and in those with
severe BP elevation it was 2.21. In patients with
severe hypertension referred to specialty clinics
the average number of meds used was 4.18. In
conclusion, blood pressure control can be
achieved in a high percentage of patients using
appropriate techniques that include electronic
records, patient involvement, provider reminders
and frequent regimen adjustments. Assessment of
this high BP control rate on cardiovascular
outcomes and target organ involvement is in
progress.
Figure 1 Percent of patients with BP control
from 2004 to 2007

• The Number of patients enrolled in this
  initiative increased from 3,133 in 1998 to 12,606
  in 2003 and 13,485 in 2007
• The percentage of patients controlled increased
  from
• 54 to 85 ( Plt0.0001) using performance
• measures and from 53 to 79 (Plt0.001) using
  data
• base (Figure 1)

CPRS Electronic Medical Records
Plt0.001
Plt0.001
Figure 2 Percent of patients with SBP gt160 or
DBP gt100
Plt0.001
Figure 3 Average number of medications required
for BP control by hypertension class
Progress NoteReminder Screen
Plt0001
Figure 4 Utilization of anti-hypertensive
medications by drug class
Health Care Provider Reminders
Plt0001
2003 2004 2005 2005 2006 2006
2006 2007 2007 2007
Figure Hypertension control increased from 54
in 2003 to 85 in 2007 patients with BPgt160/100
decreased from 15 to 3 in 2007
2. Selectfrom Dialogsto Resolvethe Reminder
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Background

• Blood Pressure Initiative at the Washington DC
  VAMC
• Recommendations included
• Patient and family member involvement
• Free BP devices to patients
• Electronic reminders to providers
• Virtual, electronic and curb side consults
• Referral to specialty clinics
• Frequent appointments until BP control was
  achieved
• BP recheck and regimen adjustment, lifestyle
  modification or compliance
• reinforcement in all patients with BP not at
  target

ProgressNote Text
Updatesfor PCE
Blood Pressure Records
Conclusions

• Blood pressure control can be achieved in a high
  percentage of patients using appropriate
  techniques that include
• Electronic records
• Patient involvement
• Provider reminders
• Frequent regimen adjustments
• Appropriate pharmacologic therapy
• Assessment of this high BP control rate on
  cardiovascular outcomes and target organ
  involvement is in progress.

Methods

• Outcomes were monitored by either
• A random sample (performance measures)
• A data base
• BP was considered controlled at lt140/90 mm Hg
• Moderate to severe hypertension was considered as
  a SBP gt160 mm Hg or a
• DBPgt100 mm Hg