How do you know whether or not you are receiving the care you need for high blood pressure?  The following is how SETMA demonstrates that your care for hypertension is optimal.  SETMA monitors both the process of your care and the outcome of your care.  Process defines the steps your provider takes to give you excellent care; outcome defines the effectiveness of that process.  Obviously, outcome is the most important, i.e., is your blood pressure treated to goal, but if a proper process is consistently following, the outcome is more probably going to be good.

The Process

When you have a diagnosis of hypertension, your blood pressure should be evaluated every time you come to the clinic, no matter the reason for the visit.  A part of this element of the process is that if your not treated to goal, your healthcare provider should contact you to schedule an appointment if you miss an appointment or if you fail to make an appointment.  Included in your visit should be the activation of the Hypertension Disease Management Tool, which your healthcare provider can do by clicking the button outline in red below.

The following steps should be taken with all patients who have a diagnosis of “hypertension” and the steps should be taken every time the patient is seen, no matter the reason for the visit:

1. Measure the blood pressure on all patients.
2. If the initial blood pressure measurement is elevated (>140/90 mmHg) repeat the blood pressure.
3. If the patient has already been diagnosed with hypertension, or if the blood pressure is elevated, assess the:

1.  Class of hypertension
2. Recommended follow-up by evidence-based medicine
3. Risk group of hypertension which tells you how important it is that the blood pressure is controlled.
4. Recommended treatment for the patient’s hypertension. 

At SETMA, these steps are completed by opening the Hypertension Disease Management Tool, and by clicking on the “Calculate Assessment” button shown in red below.

The information displayed will give your provider an indication of how imperative it is to aggressively treat your blood pressure.  This information will also appear on your plan of care and will also give your provider  assistance in engaging the you in their own care.

Next, your SETMA provider will open the “Lifestyle Changes” pop-up by clicking on the button outlined in red below

When this template is opened (see below) all of the information will already be activated which means it will appear on your plan of care and treatment plan.  (The check marks in the radial button on each element lets you know that the measures have been activated.) It gives your provider and you information on the lifestyle changes needed for the treatment of hypertension and it gives the expected improvement in the systolic pressure for each intervention.  As can be seen, many of the lifestyle changes provide more benefit to the patient than most medications.

Your provider should follow through by discussing these changes with you.  This will include the discussion of:

• Exercise,
• Weight loss,
• Sodium intake reduction
• Smoking cessation
• Alcohol moderation

On the hypertension plan template, your healthcare provider will complete the routine and acute follow-up fields so that you know when to return to the clinic.  These are also the same fields that are on the main plan template.  If they are completed in one place, they automatically show up in the other.

Your SETMA provider will then generate the hypertension follow-up document in order to give it to you.
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This document should be given to you if your blood pressure is not well controlled and//or annually if your blood pressure is well-controlled..

Once the above has been completed, your SETMA healthcare provider can review the summary of his/her  performance by clicking on the “Physician Role” button outlined in red below.

When that button is clicked the following pop-up appears.

It automatically displays and summarizes your provider’s performance on hypertension quality measures.  If your provider wants to review the entire Tutorial for SETMA’s Hypertension Disease Management Tool, he or she can do so by:

1. Clicking the “T” which appears beside the Hypertension  on the AAA Home
2. Going to SETMA’s Intranet and going to Clinical and accessing the Hypertension tutorial
3. Or you can review the tutorial from the web at: Hypertension Tutorial

Quality Analytics

Daily, SETMA reports to your healthcare provider, their performance on the quality metrics which apply to high blood pressure treatment.  The following is the audit for January 7, 2013.  All measures in “black” are good and all measures in “red” need improvement.

Monthly, all SETMA healthcare providers meet together for three hours in order to review their performance and to discuss how their care can be improved.  Quarterly, these results are posted at http://jameslhollymd.com/EPM-Tools/tutorial-hypertension-prevention so that the entire community can know how SETMA is performing in treating hypertension.

By continually measuring, monitoring and meeting to discuss excellence in care, you can have increased confidence that you are receiving excellent care.