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The Hypertension Initiative and OQUIN
Programs and Progress to Date: CVD Mortality in SC
improved from 50th in 1995 to 34th nationally in 2009
Use of database to facilitate and advance quality
improvement
Summary
Mission Statement:
To facilitate the transition
of SC and the Southeast
from a leader in CVD to a
model of heart & vascular
health
Goal:
1. Improve overall health
2. Cut heart attack &
stroke in ½
Strategies (effective, low cost/complexity, scalable):
1. Healthy lifestyles – physical activity & good nutrition
2.Effective health care – access to care & medications
Intervention Requirement Target Setting Limitations Research Design
•High cost •Competing demands
• Not relevant
•Time intensive •Client needs
•High level staff expert • Not representative
•Outside program
•Not well packaged of patients,
•Limited resources/ support practices
•Ignore user needs
•Not self-sustaining •Established work patterns
• Fail to evaluate
•Setting specific •Inadequate incentives cost, RE-AIM,
•Not ‘customizable’ •Low-quality implementat’n sustainability
Interactions among intervention, setting, and design barriers
• Given participation barriers, program reach and/or participation are low
• Interventions are inflexible, inappropriate for target population
• Staffing not matched to intervention needs/requirements
• Practice setting organization and intervention team philosophies misaligned
• Practice setting unable to implement intervention as designed
Glasgow RE, Emmons KM. Ann Rev Publ Health. 2007;28:413–433.
Coverage/Growth in the Practice Network
• Double the number of OQUIN sites from 108 to 216 in SC
• Increase the number of adult patients in OQUIN from 800,000 to 1.7 million and
the number of pediatric patients from 100,000 to 250,000 in SC
• Increase number of ASH-Designated Hypertension Specialists in SC from 47 to 70
Practices as of 2010 Current sites plus new adult and pediatric
(108 sites) practice sites (183 sites)
• Contracts in place to add 75 clinical sites (blue=adult, green=pediatric)
• Contracts in place to add ~300K adults and ~150K pediatric patients
OQUIN Overview July 31, 2012 5
ASH Clinical HTN Specialists
in the Carolinas & Georgia
Clinical HTN
Specialists in
GA, NC, SC.
ASH goal: At
least 1 HTN
Specialist in
every country
/ parish with
1 Specialist
for every 20
primary care
physicians
There are too many uncontrolled hypertensive
patients to be managed by Specialists, so their
expertise must be leveraged through–
Education of patients and colleagues
Patient Care; manage challenging HTN / CVD
risk management referrals
Research; practical clinical trials, comparative
effectiveness research.
Am J Hypertens 2002;15:372-379.
Quality Reports
and Certifications
Learn your
ABC’S
Quality Reports
and Certifications
OQUIN Heart and Stroke Recognition Program Patient Report
NCQA, Bridges to Excellence, DHEC, and OQUIN
ABC’S Report Confidential Report for "Example Provider" Summer 2011
• Providers can see at a in control Blood Pressure LDL Cholesterol Complete Aspirin / Smoking Heart/Stroke
minimum min, <145/95 min, <130 Lipid Anti- Status/Advice ABC'S Points
glance how they are out of control control, <140/90 control, <100 Profile thrombotic Treatment min=40
performing compared to # Patient Name
min=5, cont=10
sort by ↑↓
min=5, cont=10
sort by ↑↓
yes=10
sort by ↑↓
yes=10
sort by ↑↓
yes=10
sort by ↑↓
cont=50
sort by ↑↓
ABC’S Standards 1 Doe, John 125/75 10 129 5 yes 10 yes 10 yes 10 45
2 Doe, John no data 0 145 0 yes 10 yes 10 no 0 20
• Confidential Report for 3 Doe, John 135/88 10 99 10 yes 10 yes 10 yes 10 50
4 Doe, John 145/95 5 99 10 yes 10 yes 10 yes 10 45
each physician and 5 Doe, John 125/75 10 90 10 yes 10 yes 10 yes 10 50
provider 6
7
Doe, John
Doe, John
125/75
145/95
10
5
no data
129
0
5
no
yes
0
10
no
yes
0
10
yes
yes
10
10
20
40
8 Doe, John 135/88 10 85 10 yes 10 yes 10 yes 10 50
• Results by patient to 9 Doe, John 155/100 0 no data 0 no 0 no 0 no 0 0
identify potential actions 10
11
Doe, John
Doe, John
135/88
125/75
10
10
99
120
10
5
yes
yes
10
10
yes
yes
10
10
yes
yes
10
10
50
45
and see results of actions 12 Doe, John 125/75 10 85 10 yes 10 yes 10 yes 10 50
13 Doe, John 125/75 10 129 5 yes 10 no 0 yes 10 35
taken 14 Doe, John 145/95 5 145 0 yes 10 yes 10 yes 10 35
15 Doe, John 125/75 10 120 5 yes 10 yes 10 yes 10 45
• Averages by category to 16 Doe, John 140/95 5 99 10 yes 0 yes 10 no 0 25
17 Doe, John 125/75 10 90 10 yes 10 yes 10 yes 10 50
identify areas for 18 Doe, John 125/75 10 85 10 yes 10 yes 10 yes 10 50
improvement and role 19
20
Doe, John
Doe, John
125/75
125/75
10
10
85
85
10
10
yes
yes
10
10
yes
yes
10
10
yes
yes
10
10
50
50
model behavior 21 Doe, John 125/75 10 85 10 yes 10 yes 10 yes 10 50
22 Doe, John 140/95 5 120 5 yes 0 no 0 yes 10 20
• Linked to Recognition 23 Doe, John 125/75 10 99 10 yes 10 no 0 yes 10 40
24 Doe, John 125/75 10 90 10 yes 10 yes 10 yes 10 50
programs and bonus 25 Doe, John 125/75 10 120 5 yes 10 no 0 yes 10 35
payments Provider Results ≥75% 82% ≥50% 70% ≥80%
Uses last labs, must have labs within last 2 years or values will show 0
92% ≥80% 76% ≥80% 88% 40
OQUIN: Control of BP and LDL in
Hyperlipidemic Hypertensives
(2000-2011)
In one decade, SC OQUIN practices had a relative improvement of:
• 56% in BP Control to <140/<90 mm Hg
• 78% in LDL Control to <100 mg/dL
• 167% in both BP and LDL Control, which reduces CHD 50% 10
OQUIN Overview October, 2012
SC Improvement in CV Mortality Rank vs. Other
‘Stroke Belt’ States: 1995 – 2009.
WORST FIRST (34th & Most
(50th in US,1995) Improved in Stroke Belt)
STROKE BELT National Rankings and Improvement
1995 Rank 2008 Rank Change
31—Virginia 27—Virginia +4
34—North Carolina 32—North Carolina +2
35—Indiana 34—South Carolina +16
41—Arkansas 39—Indiana −4
43—Alabama 40—Georgia +4
Source: CDC WONDER
Centers for Disease Control and
Prevention, National Center for Health 44—Georgia 44—Kentucky +2
Statistics. Compressed Mortality File 1979-
1998. CDC WONDER On-line Database,
compiled from Compressed Mortality File
46—Kentucky 45—Tennessee +4
CMF 1968-1988, Series 20, No. 2A, 2000
and CMF 1989-1998, Series 20, No. 2E, 47—Louisiana 46—Arkansas −5
2003. Accessed at
http://wonder.cdc.gov/cmf-icd9.html on
Jun 11, 2012 2:54:38 PM and CDC
49—Tennessee 48—Louisiana −1
WONDER Online Database, compiled from
Compressed Mortality File 1999-2008 50—South Carolina 50—Alabama −7
Series 20 No. 2N, 2011.
51--Mississippi 51--Mississippi 0
OQUIN Overview July 31, 2012 11
Million Hearts: ABCS Status
US US US OQUIN
Population Population Clinical Practice
Indicator Target Population Current
Targets Targets 2011
Averages
Results
People at increased risk
Aspirin of cardiovascular disease 65% 47% 70% 36%
who are taking Aspirin
People with hypertension
Blood who have adequately 65% 46% 70% 73%
Pressure
controlled blood pressure
People with high
Cholesterol cholesterol who have 65% 33% 70% 72%
adequately managed
hyperlipidemia
People trying to quit
Smoking smoking and who get 65% 23% 70% 72%
help
Source: CDC Million Hearts: Strategies to Reduced the Prevalence of Leading Cardiovascular Disease Risk Factors --- United States, 2011,
Early Release, Vol. 60. Source: OQUIN CY 2011 network total. These are patients in treatment, not total population.
% with BP < 140/90 mmHg mmHg
80
70
Therapeutic inertia
accounted for 19%
60
of the variance in
50
BP control First visit
40
Last visit
30
20
10
0
Q1 Q2 Q3 Q4 Q5
Quintiles of therapeutic inertia score
Okonofua, et al: Hypertension, 2006.
Hypertension. 2012; 59:1124–1131.
Data on 50 HTN Pts. The
1st BP reading was taken
by the physician using the
BpTRU. The 2nd through
6th BP readings were taken
using the BpTRU with only
the Pt in the exam room.
Myers. Blood Press Monit
2006; 11:59–62.
The white coat response
associated with office BP
can be virtually eliminated
with the BpTRU device.
Myers, et al. J Hypertens
2009; 27:280–286.
White
Selassie, et al. Hypertension 2011;58:579 – 587.
Database: Network
Guide & evaluate CME
Inform practice-based
QI, CER interventions
Preliminary data for
grant apps esp T3, T4,
i.e, CER, PCT; D & I
Publications: CVD and
non-CVD
The Hypertension Initiative and OQUIN
Programs and Progress to Date: CVD Mortality in SC
improved from 50th in 1995 to 34th nationally in 2009
Use of database to facilitate and advance quality
improvement
Summary
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