MiCMRC Educational WebinarHypertension

February 14th 2018

MiCMRC Care Management Educational Webinar:Hypertension

Expert Presenter:

Kristina Dawkins, MPH, Clinical and Public Health Consultant.

Karen Fuller, MPH, Public Health Consultant Heart Disease and Stroke Prevention Unit

HypertensionKristina Dawkins, MPH, Clinical and Public Health Consultant &

Karen Fuller, MPH, Public Health Consultant

Heart Disease and Stroke Prevention Unit

Cardiovascular Health, Nutrition, and Physical Activity Section

Michigan Department of Health and Human Services

Presentation Objectives• Identify prevalence and consequences of uncontrolled high blood

pressure.

• Understand risk factors that influence blood pressure.

• Use guidelines to identify hypertension.

• Identify steps to controlling high blood pressure.

• Recognize key evidence-based health systems strategies.

• Recognize key evidence-based community-clinical linkage strategies.

• Identify available resources.

Heart Disease and Stroke in the United States

• More than 1.5 million people in the U.S. suffer from heart attacks and strokes per year1

• More than 800,000 deaths per year from cardiovascular disease (CVD)1

• CVD costs the U.S. hundreds of billions of dollars per year1

• CVD is the greatest contributor to racial disparities in life expectancy2

References1. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017;135(10):e146–603.2. Kochanek KD, Arias E, Anderson RN. How did cause of death contribute to racial differences in life expectancy in the United States in 2010? NCHS data brief, no 125. Hyattsville, MD: National Center for Health Statistics. 2013

Heart Disease and Stroke in Michigan

www.Michigan.gov/vitalstatistics

Hypertension Quick Facts:• In 2015, 33.1% of Michigan adults reported being told they have

HBP. 78.1% are currently taking medications.

• Heart Disease - #1 cause of death

• Stroke - #4 cause of death

High blood pressure remains one of the most important modifiable risk factor - small reductions in systolic blood pressure of 12-13 mm Hg

could reduce cardiovascular deaths by 25 percent. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_state_hbp.htm

Prevalence

Data Source: Michigan Department of Health and Human Service, LifecourseEpidemiology and Genomics Division, Behavioral Risk Factor Surveillance System (BRFSS), [2013-2015]. http://www.michigan.gov/documents/mdhhs/2013-2015_MiBRFSS_Reg__LHD_Tables_9.16.16_535671_7.pdf

Uncontrolled Hypertension Can Cause…• Atherosclerosis

• Stroke

• Myocardial Infarction

• Heart Failure

• Heart Disease

• Chronic Kidney Disease

• Vision Loss

High blood pressure was a primary or contributing cause of death for more than 410,000 Americans in 2014—that’s more than 1,100 deaths each day. Centers for Disease Control

and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 1999-2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program: http://wonder.cdc.gov/ucd-icd10.html. Accessed on Feb 3,

2015.

Hypertension Risk FactorsRelatively Fixed Risk Factors

Increased age

Family history

Chronic Kidney Disease

Low socioeconomic status

Male sex

Obstructive sleep apnea

Modifiable Risk Factors

Prehypertension

Diabetes Mellitus

Smoking tobacco

Eating foods high in sodium and low in potassium

Dyslipidemia/hypercholesterolemia

Not getting enough physical activity

Being obese

Drinking too much alcohol

Hypertension Prevention

https://millionhearts.hhs.gov/learn-prevent/prevention.html

Identification of Hypertension

Are you implementing the ACC/AHA guidelines • Yes

• Not yet, will be within the year

• Undecided

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Basic and Optional Laboratory Tests for Primary Hypertension

http://tools.acc.org/ASCVD-Risk-Estimator

BP Measurement• Guideline recommends ≥ 2 readings from ≥ 2 occasions averaged for

diagnosis

• Automated Office BP Measurement Those related to measurer hearing deficits Talking with patient Terminal digit preference (rounding the reading to 0 or 5)

127/84 becomes 130/80 Rapid deflation

Million Hearts® 2022

Aim: Prevent 1 million—or more—heart attacks and strokes in the next 5 years

• National initiative co-led by: Centers for Disease Control and Prevention (CDC) Centers for Medicare & Medicaid Services (CMS)

Partners across federal and state agencies and private organizations

Priority Populations

Optimizing Care

COMMUNITY

Keeping People Healthy

Million Hearts® 2022 Design

Million Hearts® 2022Priorities

*Aspirin when appropriate, Blood pressure control, Cholesterol management, Smoking cessation

Improving Outcomes for Priority PopulationsBlacks/African Americans

35- to 64-year-olds

People who have had a heart attack or stroke

People with mental illness or substance use disorders

Optimizing Care

Improve ABCS*

Increase Use of Cardiac Rehab

Engage Patients inHeart-healthy Behaviors

Keeping People Healthy

Reduce Sodium Intake

Decrease Tobacco Use

Increase Physical Activity

CDC-Recognized Lifestyle Change Programs for Hypertension• Key Components CDC approved curriculum A lifestyle coach, specially trained to lead the program. A support group of people with similar goals and challenges.

• Program Locations Health care clinics Community-based organizations Faith-based organizations Pharmacies Wellness centers Worksites University-based continuing education programs

CDC-Recognized Lifestyle Change Programs for Hypertension• The Diabetes Prevention Program (DPP) 58 DPPs in Michigan For a complete list of CDC recognized DPP programs, visit

www.cdc.gov/diabetes/prevention

• Take Off Pounds Sensibly (TOPS) Weight loss support www.tops.org

• Weight Watchers Weight loss and weight maintenance program www.weightwatchers.com

Support Health Systems Interventions for Quality Improvement for High Blood Pressure

1. Use health information technology for population health management.2. Improve detection, referral, treatment, and follow-up of individual with hypertension

through the use of consistent and standardized methods and protocols.3. Track and report on clinical quality measures related to high blood pressure (e.g. NQF

0018).4. Use self-measured blood pressure monitoring programs accompanied by clinical

supports.

Build and Reinforce Community Clinical Linkages for High Blood Pressure

1. Standardize use of and referral to evidence-based or promising practice community programs.

2. Implement policy or systems that encourage a multidisciplinary approach to blood pressure control.

3. Engage non-physician team members in hypertension management (e.g. community health worker, pharmacist, medical assistant, care manager).

Hypertension Control Champions

More than 13 million adults have been served by the 59 Hypertension Control Champions that Million Hearts® has recognized since 2012. The Million Hearts Hypertension Control Champions, represent small and large, urban and rural, and private, federal, and tribal health practices and systems, that have used health information technology and electronic health records, patient communication, and health care team approaches to achieve blood pressure control for their patients.

https://millionhearts.hhs.gov/partners-progress/champions/index.html.

Highlight of Million Hearts® ChampionsSolo Provider: Lutherville, Maryland

• Used electronic health records (EHRs) to identify and monitor high-risk patients.

• Worked with patients to identify barriers to controlling blood pressure and strategies on how to overcome those barriers.

• Encouraged a health lifestyle, recommending the DASH eating plan. When the patients leave the office, notes were generated by the EHR.

Highlight of Million Hearts Champions• Large Health Systems: Kaiser Permanente Southern California

• Addressed Health Disparities through reducing the gap between blood pressure control rates of African Americans and whites from 6% to 3.8%.

• Used EHRs to create a hypertension registry, which included treatment and testing reminders, and patient reports.

• Sending automated reminders for prescription refills and checkups.

Million Hearts®

Resources and Tools • Action Guides—Hypertension control; Self-measured

blood pressure monitoring (SMBP); Tobacco cessation; Medication adherence

• Protocols—Hypertension treatment; Tobacco cessation; Cholesterol management

• Tools—Hypertension prevalence estimator; ASCVD risk estimator Health IT

• Clinical Quality Measures• Consumer Resources and Tools

Million Hearts Tools

https://millionhearts.hhs.gov/

• The Michigan Department of Health and Human Services is proud to partner with Million Hearts® and is leading a Michigan Stakeholders Network to advance Million Hearts®. Connected Inclusive Effective

Our Commitment

www.michigan.gov/hbpuwww.Michigan.gov/hbcu

HDSP ResourcesMDHHS HDSP Resources

HDSP supports the “Go Red” Campaign

https://www.goredforwomen.org/

Upcoming:CDC’s Public Health Grand Rounds Presents:

“Million Hearts® 2022: A Compelling Call to Action”

Tuesday, February 20, 2018

1:00 p.m. – 2:00 p.m. (ET)

Live Web stream: http://www.ustream.tv/channel/eSsrrwp9qKQ

Facebook: http://www.facebook.com/CDC

Contact UsKristina Dawkins, MPH

Clinical and Public Health Consultant

Michigan Department of Health and Human Services

Cardiovascular Health, Nutrition, and Physical Activity Section

HDSP Unit

(517) 335-9605 dawkinsk1@michigan.gov

Karen Fuller, MPH

Public Health Consultant

Michigan Department of Health and Human Services

Cardiovascular Health, Nutrition, and Physical Activity Section

HDSP Unit

(517) 373-3296 fullerk3@michigan.gov

Hypertension Topic Page:• Current guidelines• Quick tools for Care

Managers and their patients

Care Management Learning Resources provides more in depth information around hypertension. Provides additional resources and tools

Care Management Learning Resources:• MDHHS resource links• In depth articles• Reference guides

Certificate of CompletionTo receive a certificate of completion click on the link and follow the instructions to complete the evaluation. Once complete a certificate will be sent to the email address you provided in the form of a PDF file.