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Canadian Journal of Cardiology

Systemic Implementation Strategies to Improve Hypertension: The Kaiser Permanente Southern California Experience

Published:January 13, 2014DOI:https://doi.org/10.1016/j.cjca.2014.01.003

      Abstract

      The past decade has seen hypertension improving in the United States where control is approximately 50%. Kaiser Permanente has mirrored and exceeded these national advances in control. Integrated models of care such as Kaiser Permanente and the Veterans Administration health systems have demonstrated the greatest hypertension outcomes. We detail the story of Kaiser Permanente Southern California (KPSC) to illustrate the success that can be achieved with an integrated health system model that uses implementation, dissemination, and performance feedback approaches to chronic disease care. KPSC, with a large ethnically diverse population of more than 3.6 million, has used a stepwise approach to achieve control rates greater than 85% in those recognized with hypertension. This was accomplished through systemic implementations of specific strategies: (1) capturing hypertensive members into a hypertension registry; (2) standardization of blood pressure measurements; (3) drafting and disseminating an internal treatment algorithm that is evidence-based and is advocating of combination therapy; and (4) a multidisciplinary approach using medical assistants, nurses, and pharmacists as key stakeholders. The infrastructure, support, and involvement across all levels of the health system with rapid and continuous performance feedback have been pivotal in ensuring the follow-through and maintenance of these strategies. The KPSC hypertension program is continually evolving in these areas. With these high control rates and established infrastructure, they are positioned to take on different innovations and study models. Such potential projects are drafting strategies on resistant hypertension or addressing the concerns about overtreatment of hypertension.

      Résumé

      Au cours de la dernière décennie, les États-Unis ont connu une amélioration de l’hypertension artérielle où la maîtrise se situe à près de 50 %. La Kaiser Permanente a reflété et dépassé ces avancées nationales en matière de maîtrise. Les modèles de soins intégrés comme la Kaiser Permanente et les systèmes de santé de la Veterans Administration ont mis en évidence les meilleurs résultats sur l’hypertension artérielle. Nous décrivons en détail l’histoire de la Kaiser Permanente Southern California (KPSC) pour illustrer le succès qu’il est possible d’atteindre au moyen d’un modèle intégré des systèmes de santé qui utilise des approches de rétroaction sur la mise en place, la diffusion et la performance des soins en maladies chroniques. La KPSC qui compte une vaste population d’ethnies diverses de plus de 3,6 millions d’individus a utilisé une approche par étape pour atteindre des taux de maîtrise au-dessus de 85 % chez ceux qui sont connus pour l’hypertension artérielle. Cela a été réalisé par la mise en place de stratégies particulières : 1) la saisie au registre de l’hypertension artérielle des membres hypertendus; 2) la standardisation des mesures de la pression artérielle; 3) l’élaboration et la diffusion d’un algorithme thérapeutique interne qui est fondé sur les preuves et qui préconise la multithérapie; 4) une approche multidisciplinaire utilisant les assistants médicaux, les infirmiers et les pharmaciens comme principaux intervenants. L’infrastructure, le soutien et la participation à tous les niveaux du système de santé, et la rétroaction rapide et continue de la performance ont été essentiels pour assurer le suivi et le maintien de ces stratégies. Le programme d’hypertension artérielle de la KPSC est en évolution constante dans ces domaines. Par ces taux de maîtrise élevés et cette infrastructure établie, ils sont en mesure d’assumer les différents modèles d’études et innovations. Ces projets potentiels élaborent des stratégies sur l’hypertension artérielle réfractaire ou répondent aux questions liées au surtraitement de l’hypertension.
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