How the Million Hearts Initiative is Improving Hypertension

April 14, 2015|2:39 p.m.| Jane Esworthy

ASTHO has partnered with Million Hearts to help prevent one million heart attacks and strokes by 2017, with a specific goal of helping state health agencies reduce high blood pressure, or hypertension, incidence in their states. High blood pressure can increase risk of heart attacks, strokes, heart failure, and kidney disease. According to CDC, approximately 70 million American adults have high blood pressure.

As part of its Million Hearts Learning Collaborative, ASTHO selected 17 health agencies, each working with two to five sites, to implement best practices and policies to identify, control, and improve blood pressure. With CDC support, learning collaborative recipients received funding from ASTHO to measure progress and outcomes. Recipients include Alabama, Arkansas, the District of Columbia, Georgia, Illinois, Kansas, Maryland, Michigan, Minnesota, New Hampshire, New York, North Dakota, Ohio, Oklahoma, Palau, Vermont, and Virginia. Each state team, led by the health agency, is made up of local public health agencies, healthcare partners, quality improvement organizations, health information technology experts, and public and private payers. The teams use Deming’s Plan, Do, Study, Act quality improvement model to test and spread systems-level changes by standardizing practice and using data, financing, policy, protocols, and community-clinical linkages.  

In February, HHS recognized 30 public and private healthcare practices and systems as 2014 Hypertension Control Champions for their success in helping patients control high blood pressure. “Million Hearts launched this challenge in 2012 to recognize clinicians and healthcare teams across the country for helping their patients protect heart health,” says CDC Director Tom Frieden. The 2014 champions cared for more than 3.5 million adult patients in 19 different states, and were able to achieve hypertension control rates of 70 percent or above.

Among these champions are clinical sites located in six states participating in ASTHO’s Million Hearts Learning Collaborative. Three of the 30 recipients are active partners in the ASTHO’s Million Hearts Learning Collaborative: P.S. Rudie Medical Clinic and Essentia Health in Duluth, Minnesota, and Green Spring Internal Medicine, LLC, in Lutherville, Maryland.

Minnesota Department of Health

Through a year-long collaboration with state partners, including P.S. Rudie Medical Clinic and Essentia Health, the Minnesota Department of Health (MDH) worked with each site to identify and manage patients with hypertension using a team based approach. To measure clinic performance, MDH and site partners used National Quality Forum - Measure 18.

Over the course of the project, P.S. Rudie Medical Center improved its patient blood pressure control rate from 73 percent to 86 percent through home blood pressure monitoring, implementing hypertension treatment protocol, and improving the accuracy of blood pressure measurement. This increase means that an additional 137 patients diagnosed with high blood pressure had it controlled by the end of the project. “Northeastern Minnesota has some of the highest hypertension rates in the state and we are pleased to see the significant improvement our patients have had controlling high blood pressure,” says Toni Roberts, physician assistant at P.S. Rudie Medical Clinic.

Essentia Health was able to achieve a control rate of 82 percent among its approximately 63,000 patients with hypertension. “There are so many people in our health system who have had a hand in getting us to our current hypertension performance. It starts, of course, with our dedicated primary care physicians, but also includes cardiologists and nephrologists,” says Patrick Twomey, Essentia’s chief medical quality officer and chief medical officer.

Maryland Department of Health and Mental Hygiene

The Maryland Department of Health and Mental Hygiene’s (MDHMH) Million Hearts learning collaborative includes 52 practices, each receiving funding from MDHMH to provide clinical coaching on ways to control hypertension and diabetes in their patients. Since 2013, Green Spring Internal Medicine (GSIM) has had a hypertension control rate of 81 percent, up from 48 percent in 2011. To achieve this, GSIM used team-based care models that increased contact with patients to promote blood pressure control. It also strategically used electronic health records for clinical decision-support tools, patient reminders, and registry functionality.

“Controlling blood pressure prevents heart attacks and strokes—two of the leading causes of death in Maryland,” says MDHMH Secretary Van T. Mitchell. “We look forward to translating the key components of Green Spring’s success to all our Million Hearts partners in Maryland.”

ASTHO has developed a Million Hearts online toolkit, which includes resources for states and territories to improve hypertension identification and treatment, information on evidence-based programs, guidance for financing and policy change, hypertension data, and examples of state-developed materials. Additionally, the toolkit includes an interactive map of activities and state-developed tools such as protocols, provider and patient education materials, referral forms, and manuals for all 15 participating states, Palau, and the District of Columbia.