Heart disease is the leading cause of death in the United States, so why not leverage health information technology in the form of healthcare analytics to intervene more effectively in the treatment of patients with this condition? That’s exactly what a Kaiser Permanente North California (KPNC) program determined to figure out and has now shared in research published in the Journal of American Medical Association (JAMA).
In the study, “Improved blood pressure control associated with a large-scale hypertension program,” Jaffe et al. highlight the benefits of combining a “comprehensive hypertension registry, development and sharing of performance metrics, evidence-based guidelines, medical assistant visits for blood pressure measurement, and single-pill combination pharmacotherapy” in the treatment of adults diagnosed with hypertension.
“Although feedback at the individual clinician level has long been used to promote change, we focused on clinic-level feedback to facilitate operational and system-level change,” the authors write. “Health system–wide adoption, evaluation, and distribution of an evidence-based practice guideline that had timely incorporation of new evidence facilitated the ability to introduce new treatment options and to re-emphasize existing evidence-based recommendations.”
The results for the program spanning from 2001 to 2009 and including as many as 652,763 patients provide strong support for positively impacting population health through health data aggregation and the sharing of best practices among providers and across clinical settings.
Over that period of time, the integrated healthcare delivery system in Northern California increased its National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) measurement for hypertension control from 43.6 percent to 80.4 percent. The NCQA HEDIS national average paled in comparison, increasing from 55.4 percent to 64.1 percent, during the same timeframe.
According to Jaffe et al., the program’s success hinged on clinicians providers making use of a 4-step hypertension control algorithm made available to them through a variety of sources:
The guideline was updated every 2 years based on emerging randomized trial evidence and national guidelines. Clinicians were encouraged to follow the algorithm unless clinical discretion required otherwise. Dissemination of guidelines occurred through distribution of printed documents, e-mail, clinical tools (e.g., pocket cards), videoconferences, lectures, partnering with pharmacy managers, and use of the electronic medical record to optimize selection of medication.
With the healthcare industry shifting from a pay-for-service to a pay-for-performance model of reimbursement, this transformation places a significant emphasis on proactive rather than reactive care. As has become clear in innovative healthcare organizations, rising to this new challenge requires a new approach to care delivery and the health IT systems (e.g., healthcare analytics) to predict outcomes and intervene in the form most appropriate to the needs of individual patients.
If organizations such as KPNC were capable of achieving such positive results prior to the Health Information Technology for Economic and Clinical Health Act and meaningful use, today and tomorrow’s hospitals and practices should have tools available to them to make this sharing of evidence-based practices meaningfully useful to themselves and their patients.