Transcript OQUIN - National Forum for Heart Disease and Stroke Prevention


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
•High cost
•Time intensive
•High level staff expert
•Not well packaged
•Ignore user needs
•Not self-sustaining
•Setting specific
•Not ‘customizable’
Target Setting Limitations
•Competing demands
•Client needs
•Outside program
•Limited resources/ support
•Established work patterns
•Inadequate incentives
•Low-quality implementat’n
Research Design
• Not relevant
• Not representative
of patients,
practices
• Fail to evaluate
cost, RE-AIM,
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
(108 sites)
•
•
Current sites plus new adult and pediatric
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
ABC’S Report
• Providers can see at a
glance how they are
performing compared to
ABC’S Standards
• Confidential Report for
each physician and
provider
• Results by patient to
identify potential actions
and see results of actions
taken
• Averages by category to
identify areas for
improvement and role
model behavior
• Linked to Recognition
programs and bonus
payments
NCQA, Bridges to Excellence, DHEC, and OQUIN
Confidential Report for "Example Provider" Summer 2011
in control
minimum
out of control
#
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Patient Name
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Provider Results
Blood Pressure
min, <145/95
control, <140/90
min=5, cont=10
sort by ↑↓
125/75
10
no data
0
135/88
10
145/95
5
125/75
10
125/75
10
145/95
5
135/88
10
155/100
0
135/88
10
125/75
10
125/75
10
125/75
10
145/95
5
125/75
10
140/95
5
125/75
10
125/75
10
125/75
10
125/75
10
125/75
10
140/95
5
125/75
10
125/75
10
125/75
10
≥75%
82%
LDL Cholesterol
min, <130
control, <100
min=5, cont=10
sort by ↑↓
129
5
145
0
99
10
99
10
90
10
no data
0
129
5
85
10
no data
0
99
10
120
5
85
10
129
5
145
0
120
5
99
10
90
10
85
10
85
10
85
10
85
10
120
5
99
10
90
10
120
5
≥50%
70%
Complete
Lipid
Profile
yes=10
sort by ↑↓
yes
10
yes
10
yes
10
yes
10
yes
10
no
0
yes
10
yes
10
no
0
yes
10
yes
10
yes
10
yes
10
yes
10
yes
10
yes
0
yes
10
yes
10
yes
10
yes
10
yes
10
yes
0
yes
10
yes
10
yes
10
≥80%
92%
Uses last labs, must have labs within last 2 years or values will show 0
Aspirin /
Antithrombotic
yes=10
sort by ↑↓
yes
10
yes
10
yes
10
yes
10
yes
10
no
0
yes
10
yes
10
no
0
yes
10
yes
10
yes
10
no
0
yes
10
yes
10
yes
10
yes
10
yes
10
yes
10
yes
10
yes
10
no
0
no
0
yes
10
no
0
≥80%
76%
Smoking
Status/Advice
Treatment
yes=10
sort by ↑↓
yes
10
no
0
yes
10
yes
10
yes
10
yes
10
yes
10
yes
10
no
0
yes
10
yes
10
yes
10
yes
10
yes
10
yes
10
no
0
yes
10
yes
10
yes
10
yes
10
yes
10
yes
10
yes
10
yes
10
yes
10
≥80%
88%
Heart/Stroke
ABC'S Points
min=40
cont=50
sort by ↑↓
45
20
50
45
50
20
40
50
0
50
45
50
35
35
45
25
50
50
50
50
50
20
40
50
35
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
(50th in US,1995)
STROKE BELT
Source: CDC WONDER
Centers for Disease Control and
Prevention, National Center for Health
Statistics. Compressed Mortality File 19791998. CDC WONDER On-line Database,
compiled from Compressed Mortality File
CMF 1968-1988, Series 20, No. 2A, 2000
and CMF 1989-1998, Series 20, No. 2E,
2003. Accessed at
http://wonder.cdc.gov/cmf-icd9.html on
Jun 11, 2012 2:54:38 PM and CDC
WONDER Online Database, compiled from
Compressed Mortality File 1999-2008
Series 20 No. 2N, 2011.
FIRST (34th & Most
Improved in Stroke Belt)
National Rankings and Improvement
1995 Rank
2008 Rank
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
44—Georgia
44—Kentucky
+2
46—Kentucky
45—Tennessee
+4
47—Louisiana
46—Arkansas
−5
49—Tennessee
48—Louisiana
−1
50—South Carolina
50—Alabama
−7
51--Mississippi
51--Mississippi
0
OQUIN Overview July 31, 2012
Change
11
Million Hearts: ABCS Status
Indicator Target Population
US
US
US
Population
Population
Targets
Current
Averages
Clinical
Targets
OQUIN
Practice
2011
Results
Aspirin
People at increased risk
of cardiovascular disease
who are taking Aspirin
65% 47% 70% 36%
Blood
People with hypertension
who have adequately
controlled blood pressure
65% 46% 70% 73%
Cholesterol
People with high
cholesterol who have
adequately managed
hyperlipidemia
65% 33% 70% 72%
Smoking
People trying to quit
smoking and who get
help
65% 23% 70% 72%
Pressure
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
Therapeutic inertia
accounted for 19%
of the variance in
BP control
70
60
50
40
First visit
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:
 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
Network

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