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Hypertension Control Strategies in a Patient Centered Medical Home

Niharika Khanna, Fadia Shaya, Viktor Chirikov, Ben Steffen, David Sharp


Background: Partnership betweenMaryland’sMulti-payerPatient CenteredMedical Home programand Maryland Million Hearts programhasbeen thecatalyst for focused quality improvementstrategiesspecific to chronic disease managementandcontrol.

Methods: This project was initiated in the 52 NCQA recognizedPCMH practices from theMMPP. A nested cohort of19 practices received technical assistance to includestaff training, new workflows implementation, dissemination ofevidence-based guidelines, optimizing HITuse, patientself-managementand linkage to communityand state resources. Observations weredocumented in 2011, 2012, 2013 and at the end of the PDSA in June2014. Annually reported quality metricsbypractices during this time period were analyzed byeach individual metric and theoverallaverage change was calculated and tested forstatistical significance. All tests were two-tailed.

Results: NQF 18 and NQF 28A maintained theirachievement threshold from December 2013 toJune2014. NQF 28Ademonstratednon-significantdecrease from94.6% in December2013 to93.4% in June 2014 (p value=0.646),but maintained values greater than achievement threshold. NQF 28Bdemonstrated significant change from2011 at 23.5% followed bypractices trainingand resource linkages to 52.2% in June 2014 (p value<0.01 for totalchange from2011-2014). NQF 59 demonstratedan increase from17% in December2013 to 24.9% inJune2014, which wasnot statisticallysignificant (p value= 0.342). NQF 575 demonstrated a non-significant increase from62.8% December2013 to 71.1% inJune2014 (p value=0.217).

Conclusions: Focusedquality improvementprograms have greatpropensity forsuccess inchronic disease management whensystematically implemented.


Cardiovascular outcomes, cardiovascular risk, chronic disease management, coaching, hypertension, hypertension control, leadership support, learning collaborative for best practice sharing, patient-centered medicine, Patient Centered Medical Home (PCMH)

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