Improved blood pressure control associated with a large-scale hypertension program

Abstract

Importance: Hypertension control for large populations remains a major challenge.

Objective: To describe a large-scale hypertension program in Northern California and to compare rates of hypertension control in that program with statewide and national estimates.

Design, setting, and patients: The Kaiser Permanente Northern California (KPNC) hypertension program included a multifaceted approach to blood pressure control. Patients identified as having hypertension within an integrated health care delivery system in Northern California from 2001-2009 were included. The comparison group comprised insured patients in California between 2006-2009 who were included in the Healthcare Effectiveness Data and Information Set (HEDIS) commercial measurement by California health insurance plans participating in the National Committee for Quality Assurance (NCQA) quality measure reporting process. A secondary comparison group was included to obtain the reported national mean NCQA HEDIS commercial rates of hypertension control between 2001-2009 from health plans that participated in the NCQA HEDIS quality measure reporting process.

Main outcomes and measures: Hypertension control as defined by NCQA HEDIS.

Results: The KPNC hypertension registry included 349,937 patients when established in 2001 and increased to 652,763 by 2009. The NCQA HEDIS commercial measurement for hypertension control within KPNC increased from 43.6% (95% CI, 39.4%-48.6%) to 80.4% (95% CI, 75.6%-84.4%) during the study period (P < .001 for trend). In contrast, the national mean NCQA HEDIS commercial measurement increased from 55.4% to 64.1%. California mean NCQA HEDIS commercial rates of hypertension were similar to those reported nationally from 2006-2009 (63.4% to 69.4%).

Conclusions and relevance: Among adults diagnosed with hypertension, implementation of a large-scale hypertension program was associated with a significant increase in hypertension control compared with state and national control rates. Key elements of the program included 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.

Figure 1

(A) National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) hypertension control rates comparing Kaiser Permanente Northern California (KPNC), National, and California between 2001–2009; (B) KPNC NCQA HEDIS hypertension control rates versus KPNC internal hypertension registry control rates between 2001–2009. Confidence intervals for the KPNC NCQA HEDIS hypertension rates are indicated by the vertical bars on the graph. Confidence intervals for the KPNC internal hypertension registry control rates are not displayed as they are extremely small (<0.3%). See eTable 1 for complete details.

Figure 1

(A) National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) hypertension control rates comparing Kaiser Permanente Northern California (KPNC), National, and California between 2001–2009; (B) KPNC NCQA HEDIS hypertension control rates versus KPNC internal hypertension registry control rates between 2001–2009. Confidence intervals for the KPNC NCQA HEDIS hypertension rates are indicated by the vertical bars on the graph. Confidence intervals for the KPNC internal hypertension registry control rates are not displayed as they are extremely small (<0.3%). See eTable 1 for complete details.

Figure 2

Percentage of ACEI prescriptions dispensed as single-pill combination ACEI-HCTZ combination tablets for Kaiser Permanente Northern California members between 2001–2009. ACEI = Angiotensin Converting Enzyme Inhibitor; HCTZ = Hydrochlorothiazide