James Seiler, MD, Hypertension (HTN) Task Force Member
Cheryl Robinson, MD, HTN Task Force Member
Gil Templeton, MD, HTN Task Force Member
Douglas Magenheim, MD, MBA, Medical Director
Judy Hayes, RN, MBA, Chief Operating Officer
Robert E. Matthews, Executive Director
Thomas Greer, MD,  Physician Manager
Julie Burckle, Administrative Resident
Kathy Beighle, Data Analyst
Michael Miller, MBA, Director Six Sigma and Quality

90 percent of all hypertension (HTN) patients achieve the JNC-7 defined blood pressure goal.

Percentage of patients to goal

• Created an analysis of all known reasons why patient hypertension is not treated to the evidence-based goal
• Created and presented educational sessions to improve physician understanding of the physiology and hemodynamics of HTN and the effects pharmacological agents
• Did a preliminary assessment of the usefulness of outpatient, non-invasive impedance cardiography (ICG) as a tool to assist in increasing the percent of patients in the population who achieve their goal blood pressure
• Created a standard process for evaluating, treating and documenting HTN care and implemented for all patient encounters for the HTN population
• Achieved an overall 63 percent improvement for our group in the percentage of patients at goal; this percentage increases monthly
• 1st Quartile of providers averages 83 percent of patients to goal; 2nd Quartile averages 69 percent of patients to goal; 3rd Quartile averages 61 percent to goal; 4th Quartile averages 49 percent of patients to goal (national studies show 31 percent and 34 percent of HTN patients treated to goal)
• Demonstrated that frequency of using ICG on patients who are not to goal does have a positive effect on a providers overall ability to get his/her patients to goal
• Provided significant experience to community-based physicians in applied Six Sigma within the context of clinical care

Achieved consistent improvement over a course of a nine month period; starting at 41 percent pre-project increasing to 65 percent.  Results measured using randomly selected visits from entire HTN patient population of a large community-based practice. 

Lessons Learned:

• Give providers one-on-one support in learning the process in addition to group education sessions.
• Identify “early adopters” and mark their progress quickly and then publish to all.
• Constantly communicate how important it is to rigorously follow Six Sigma process; communicate, communicate, communicate that “short cuts” erode process efficacy.
• Publish all data monthly and discuss individually and publicly the factors that are driving high performance to the top quartile.  Identify individual providers when publishing data.
• Accept the reality that a complex disease is going to require a complex process and deal with it.

Robert E. Matthews, Executive Director
PriMed Physicians
bob.matthews@medisync.com

[Storyboard presentation at IHI's National Forum, December 2005]