Learning Session 4

Speaker: Patrick Twomey, MD, Chief Medical Director, Chief Medical Quality Officer, Essentia Health, Duluth, Minnesota

Date: June 15, 2015

Listen to the presentation here. (23 minutes)

Resources:

• Dr. Patrick Twomey biography 
• Presentation Slides
• Presentation Transcript

Objectives of the Presentation: 

• Describe the problem with hypertension control in the Essentia Health population
• Describe the planning process to identify hypertension control strategies
• Describe the key successes and challenges to implement strategies for hypertension control
• Describe the results achieved through the implementation of strategies

Main points to be covered:

•  How an 82% hypertension control rate was achieved at Essentia Health:
  • Current reality of hypertension diagnosis, treatment and control in the Essentia Health client population.
  • Main planning and implementation actions that were taken in the clinic to improve hypertension diagnosis, management and control.
  • Key successes and challenges for the clinic in achieving hypertension control rates at 70% or more.
• Gaps that continue to exist to getting more persons with hypertension under control:
  • How state and local health departments and clinicians can work collaboratively to affect hypertension diagnosis, treatment and control.

Main points presented:

• Essentia Health has been working for ten years to improve the health of their population.
• Minnesota Community Measure Initiative is a state quality improvement initiative which include measures, such as hypertension, to determine the level of care provided by physicians to patients.
• Essentia Health Primary Care physicians looked to the future of primary care and determine that chronic disease management was a key focus for the 64 clinics within the system.
• A hypertension registry was created to identify patients with hypertension and to manage control of hypertension.
• Over 60,000 hypertension patients are in the registry. Through their hypertension management efforts they have prevented 800 strokes and over 500 heart attacks within their population.

Main take-away points:

• Team-based approach using all professional and allied healthcare professionals was critical to continuous management of clients.
• Advanced Nurse Practitioners and Physician Assistants provided much of the care coordination with non-complex cases with only one chronic disease issue, allowing physicians the time to manage more complex multi-chronic disease cases with hypertension control problems.
• Registered Nurses followed written protocols provided by physicians to follow patients under control, allowing ANPs and NPs time to manage cases with medium–level complications.
• ANPs conducted motivational interviews with patients to learn patient’s story on future goals and wants to develop, with the patient in shared decision making, an action plan that fit their particular need.
• Use of data and patient outcomes, and making that data open to all employees within the health system, spurred awareness and action among healthcare providers to identify patients with hypertension and manage control through lifestyle and/or medical therapy management.