Dr. Sarah Woolsey Uses Health IT to Improve Blood Pressure Control
Dr. Sarah Woolsey is a family medicine physician at Community Health Centers, Inc. (CHC), a federally qualified health center (FQHC) with four sites in Utah. CHC’s 26 providers serve approximately 27,000 patients, more than half of whom are uninsured. Dr. Woolsey also serves as Medical Director of HealthInsight, Utah’s Regional Extension Center (REC), and the Utah Beacon Community Collaborative, one of 17 communities in the Beacon Community Program building out local Health IT infrastructure and testing innovative approaches to make measurable improvements in health, care, and cost. As a member of the Beacon Community, CHC used its electronic health record (EHR) system to improve blood pressure control among its patients with diabetes.
Improving Data Quality and Establishing a Baseline
As participants in the Beacon Community project, CHC discovered that many of its patients with diabetes did not have adequate hypertension control, which increased their risk for adverse events such as heart attacks and strokes. As CHC’s providers began to determine how it could use its EHR system and clinical processes to improve blood pressure control, they realized two things: first, the clinical teams were probably not accurately measuring blood pressure, and second, the clinical teams were making errors in entering patient blood pressure measurements into the EHR system. Thus, when the Quality Improvement team used the EHR system to generate quality reports, the reports were inaccurate.
Early in the project, CHC invested in Food and Drug Administration-approved automatic blood pressure monitors and retrained its staff to properly use them. Using the automated cuffs, CHC staff members are now able to focus on correctly positioning their patients’ arms during measurements, making sure patients are not talking during measurements, and using the proper cuff size – all of which improve accuracy in blood pressure readings. Accurate readings prevent misdiagnosis of hypertension, and providers can trust the measurements.
Next, to ensure providers were appropriately entering the measurements into the EHR system, Dr. Woolsey and her colleagues standardized the clinic’s processes for blood pressure data entry and trained clinical teams on the new processes. “Correcting the data entry processes gave us an accurate baseline that we could then work from to improve health care quality,” Dr. Woolsey said. “With high quality data we are now able to measure our improvement and see if our new processes work.”
When Dr. Woolsey and her colleagues examined EHR data on blood pressure control among their patients with diabetes, their suspicions were confirmed. CHC found that, with only 63% blood pressure control among its patients with diabetes, its performance was below the Beacon Community benchmark.
Health IT, Engaging Patients, and Removing Barriers to Blood Pressure Control
After establishing a baseline, CHC’s providers set out to improve blood pressure control for their patients with diabetes. Among other strategies and initiatives, CHC began using the EHR system to generate lists of patients with diabetes with blood pressure readings outside the normal range to target for follow-up visits.
Additionally, CHC began providing affordable, Food and Drug Administration-approved automatic blood pressure cuffs to hypertensive patients with diabetes so they could measure and monitor their blood pressures at home. Using patient-specific educational materials loaded into the EHR for easy access, CHC’s clinical teams and health educator taught patients how to use the cuffs appropriately to keep track of their blood pressure.
CHC also instituted a policy to allow patients to walk into the FQHC and have their blood pressure measured at no charge. After instituting the policy, CHC set up a computerized provider order entry process to ensure providers could easily and efficiently order the blood pressure measurements.
The three strategies are helping CHC’s providers adjust their patients’ blood pressure medications more rapidly, rather than waiting for patients to schedule follow-up appointments. More importantly, the health care quality improvement program is engaging and encouraging patients to take ownership of their own health care. “We would never think of sending a patient with diabetes out the door with insulin without the ability to monitor their blood sugar with a glucometer. Now, we can also have patients on hypertension medicines help us monitor their blood pressure,” Dr. Woolsey said. “We view our patients as partners in quality improvement.” In 2014, CHC hopes to begin encouraging patients to use the patient portal to communicate with providers about their blood pressures. CHC also plans to embark on a telemonitoring program for high-risk patients with diabetes.
Improved Patient Outcomes
As a result of CHC’s hard work, CHC’s patients with diabetes showed great improvement. The percentage of CHC’s patients with diabetes with controlled blood pressure increased from 63% to 73% in one year, exceeding the community benchmark. “Our patient outcomes show that patients can make a difference when they are involved in health care,” Dr. Woolsey said. “Patients can improve their blood pressures if we give them the right tools and support them throughout the process.”
Motivated by the Million Hearts program, which aims to prevent 1 million heart attacks and strokes by 2017, Dr. Woolsey and HealthInsight are planning to spread their tools and success to other providers. They are partnering with the Utah Department of Health’s Healthy Living through Environment, Policy, and Improved Clinical Care Million Hearts Program to improve blood pressure control and management in Utah. “We believe our model for blood pressure control is effective, and we want other providers in Utah to be able to reproduce the model in their own practices,” explained Dr. Woolsey.