By Ann Wallace, senior communications consultant, Kaiser Permanente Division of Research
Kaiser Permanente’s highly successful hypertension control program in Northern California is praised and held up as a national model in an article this month in an influential clinical journal. The essay in the Journal of Clinical Hypertension outlines clear, easy-to follow steps that could allow other health care systems to achieve comparable improvements in getting patients’ blood pressure under control.
“Governments and hypertension organizations should promote the Kaiser Permanente hypertension program as a model to encourage clinics to adopt similar approaches,” writes Mark L. Niebylski, PhD, chief executive officer of the World Hypertension League, in an accompanying introduction. “Clear, easy-to follow steps are outlined that could allow other health care systems to achieve similar remarkable improvements in hypertension control.”
Increased blood pressure is the leading risk factor for death and disability globally, according to the World Health Organization’s Global Burden of Disease Study. In the United States, one in three adults — about 80 million people — has high blood pressure, but only about half have achieved recommended blood pressure readings, according to the American Heart Association.
In 2000, after a year of strategic planning, Kaiser Permanente Northern California initiated a hypertension program as a multifaceted approach to blood pressure control and quality improvement. From 2001 to 2013, hypertension control in the integrated health care system increased from 44 percent to 90 percent. Over approximately the same period of time, the rate of heart attacks fell 24 percent and death from stroke fell 42 percent.
A number of differentiating practices drove the program’s success, including a comprehensive hypertension patient registry. By using frequent hypertension control quality reports, Kaiser Permanente was able to quickly identify high-performing medical centers and implement their successful practices and innovations system-wide. The program also supplied clinicians with a frequently updated evidence-based, four-step hypertension control process.
The program encouraged single pill combination therapy — combining multiple drugs into one pill. This strategy improved adherence, lowered patient costs and improved blood pressure control. Medical assistants also followed up with patients two to four weeks after medication adjustments and informed the primary care physician, who then directed treatment decisions and follow-up planning. This process accelerated treatment intensification without significantly increasing the need for repeat clinician visits while simultaneously improving patient convenience and affordability.
“In the late 1990s, when uncontrolled blood pressure was the norm, blood pressure control rates of 90 percent seemed unimaginable,” say authors Marc G. Jaffe, MD, Department of Endocrinology, Kaiser Permanente South San Francisco Medical Center, and Joseph D. Young, MD, Department of Medicine, Kaiser Permanente Oakland Medical Center.
“This was, and continues to be, a team effort — with thousands of physicians, pharmacists, nurses, managers, data analysts and others who work tirelessly to help our patients maintain healthy blood pressure levels.”