District of Columbia Fights Hypertension by Targeting Deeply Affected Parts of City

July 13, 2015|9:36 a.m.| ASTHO Staff

Through the ASTHO Million Hearts State Learning Collaborative, which is supported by CDC, the District of Columbia is working to improve hypertension management among its highest-risk population: African American residents ages 18 and older living in Wards 5 and 7.

Cardiovascular disease is the number one cause of death among D.C. residents (27.8 percent of total deaths in 2010), and the second leading cause of hospitalizations (5,583 hospitalizations in 2010).

African American residents of the District of Columbia are almost three times more likely to die from heart disease than their white counterparts (333.0 deaths per 100,000 compared to 116.6 deaths per 100,000). Death rates are also significantly higher among residents of Wards 5 and 7, with these two wards accounting for 35 percent of all deaths. Hypertension is a major contributing factor to the morbidity and mortality associated with heart disease.

Led by the District of Columbia Department of Health (DC DOH), an interdisciplinary team of stakeholders is working to identify patients with uncontrolled and undiagnosed hypertension to provide targeted interventions and referrals to community resources.

Steps Taken

The DC DOH is working with healthcare sites, including community health centers, in Wards 5 and 7 to establish a baseline number of patients in the target population with undiagnosed hypertension (defined as patients with three or more visits in a one-year period with blood pressure measurements of 140/90 or greater and no diagnosis of hypertension). Using the Plan, Do, Study, Act (PDSA) quality improvement model, the team’s goals include:

  • Assess the ability of healthcare sites to identify patients within the target population with uncontrolled or undiagnosed hypertension.
  • Create uncontrolled and undiagnosed patient panels.
  • Assess the feasibility of monthly data runs to track progress in patient panels.

In the first PDSA cycle, healthcare sites with access to health information technology (health IT) and quality improvement (QI) staff pulled data from their electronic medical record systems for a one-year measurement period, which was 2012. In a second PDSA cycle, they pulled the same data for the “last quarter,” a three-month measurement period from November 2013 to January 2014.

The DC DOH staff provided technical assistance and funding to the healthcare sites through its CDC-funded ASTHO Million Hearts State Learning Collaborative grant. In addition, ability to pull and report on the data required clinic staff expertise, time, and buy-in.

As of April 2014, six community health center sites had reported data and found in the 2012 target population 6,074 patients with undiagnosed or uncontrolled hypertension.

Next Steps

Key partners determined next steps should include scaling up clinical data reporting to include additional health care partner sites across the District, as well as establishing a data reporting and monitoring system using electronic tools. The vision for this system is to improve data sharing between clinical, public health, and community partners to facilitate collaboration, monitor hypertension at the city and clinic levels, improve data sharing among partners, and establish targets to align partner efforts. Million Hearts-related work is expanding to additional primary care clinics within the District (16 total).

Working with additional healthcare partner sites across D.C. to scale up the baseline data collection process. The District has 14 hospitals, 51 health centers (including six federally qualified health centers), 8,000 physicians, and six government agencies with public health functions. DC DOH will play a critical role in this work by sharing information with other health systems and partners, such as the DC Primary Care Association.

For more on this program and lessons learned, view the full story (published April 2014) which is featured in ASTHO’s “Have You Shared?” story-sharing initiative. Updated information on the progress of the District of Columbia and several states toward fighting hypertension as part of the ASTHO Million Hearts Learning Collaborative will be released soon.