Domain

Clinical Informatics

Type

Case Study or Comparative Case Study

Theme

effectiveness; population; quality

Start Date

7-6-2014 1:15 PM

End Date

7-6-2014 2:45 PM

Structured Abstract

1) Introduction: Hypertension is a major risk factor in the development of cardiovascular disease, heart failure and renal disease. Blood pressure control nationally is sub-optimal. Self-monitored or home blood pressure measurements allow for more robust tracking of blood pressure and are more highly correlated with morbidity than office readings. Building off a successful pilot program, the Colorado Clinical Translational Sciences Institute, partnering with Colorado HealthOp and the University of Colorado Department of Family Medicine are sponsoring a state-wide home blood pressure monitoring system with the goal of reducing the population blood pressure of the state of Colorado.

2) Methods Background: A pilot project, Advancing Cardiovascular Excellence in Colorado (ACARE), operated from 2006 to 2010 formed the basis for revisions to an existing home blood pressure data collection system. The original web-based system was revised and the telephone based interactive voice response system was dropped. The new system, Just Check It, was designed to be patient driven allowing individual only viewing of results or sharing of blood pressure results with the individual’s medical office, pharmacist or community organization.

3) Findings: The ACARE pilot operated in 26 primary care offices. The system was offered to 3500 patients and 2600 entered data on > two occasions. Over an 18 month evaluation phase the mean blood pressure for these individuals dropped by 6.5 mmHg systolic. Chart audits of individuals not participating in the same offices demonstrated no change over this time period. Both clinicians and patient appreciated the system, The new system, Just Check It, was developed with the RE-AIM framework in mind, focusing on Reach, Adoption, Implementation and Maintenance at the patient and data receiving organizations.

The Just Check It system is an open access system. The telephony component was dropped at self-registration via phone was very difficult. The web-site was mobile enabled but a standalone application was not seen as useful by potential end users. Individuals control their data flow and can easily share the information with an associated community organization, their pharmacist, and/ or their primary care medical home. Direct reading blood pressure cuffs were considered and not enabled as they increase complexity with little perceived benefit.

Colorado HealthOp is also supporting the system, sending an enrollment kit to the primary care office of all members with hypertension. Payment for medical management of hypertension without an office has been added as a benefit. A pharmacy based chronic disease support system has directly linked their software to the blood pressure results. Multiple community based organizations are also engaging their members to track blood pressure and improve overall control.

4) Discussion: An open access statewide system for home blood pressure monitoring has been successfully deployed. To increase Reach, Adoption, Implementation and Maintenance a straightforward, patient run system was seen as preferable to one with greater degrees of technological sophistication. The system is looking to be added to the state health information exchange so that data can be sent electronically to an individual’s health care providers.

Acknowledgements

Colorado Department of Public Health and Environment

“Colorado Clinical and Translational Sciences Institute”, NIH-NCATS,UL1TR001082, TL1TR001081, KL2TR001080,

Colorado Health OP

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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Jun 7th, 1:15 PM Jun 7th, 2:45 PM

Just Check It: RE-AIMing for Success

1) Introduction: Hypertension is a major risk factor in the development of cardiovascular disease, heart failure and renal disease. Blood pressure control nationally is sub-optimal. Self-monitored or home blood pressure measurements allow for more robust tracking of blood pressure and are more highly correlated with morbidity than office readings. Building off a successful pilot program, the Colorado Clinical Translational Sciences Institute, partnering with Colorado HealthOp and the University of Colorado Department of Family Medicine are sponsoring a state-wide home blood pressure monitoring system with the goal of reducing the population blood pressure of the state of Colorado.

2) Methods Background: A pilot project, Advancing Cardiovascular Excellence in Colorado (ACARE), operated from 2006 to 2010 formed the basis for revisions to an existing home blood pressure data collection system. The original web-based system was revised and the telephone based interactive voice response system was dropped. The new system, Just Check It, was designed to be patient driven allowing individual only viewing of results or sharing of blood pressure results with the individual’s medical office, pharmacist or community organization.

3) Findings: The ACARE pilot operated in 26 primary care offices. The system was offered to 3500 patients and 2600 entered data on > two occasions. Over an 18 month evaluation phase the mean blood pressure for these individuals dropped by 6.5 mmHg systolic. Chart audits of individuals not participating in the same offices demonstrated no change over this time period. Both clinicians and patient appreciated the system, The new system, Just Check It, was developed with the RE-AIM framework in mind, focusing on Reach, Adoption, Implementation and Maintenance at the patient and data receiving organizations.

The Just Check It system is an open access system. The telephony component was dropped at self-registration via phone was very difficult. The web-site was mobile enabled but a standalone application was not seen as useful by potential end users. Individuals control their data flow and can easily share the information with an associated community organization, their pharmacist, and/ or their primary care medical home. Direct reading blood pressure cuffs were considered and not enabled as they increase complexity with little perceived benefit.

Colorado HealthOp is also supporting the system, sending an enrollment kit to the primary care office of all members with hypertension. Payment for medical management of hypertension without an office has been added as a benefit. A pharmacy based chronic disease support system has directly linked their software to the blood pressure results. Multiple community based organizations are also engaging their members to track blood pressure and improve overall control.

4) Discussion: An open access statewide system for home blood pressure monitoring has been successfully deployed. To increase Reach, Adoption, Implementation and Maintenance a straightforward, patient run system was seen as preferable to one with greater degrees of technological sophistication. The system is looking to be added to the state health information exchange so that data can be sent electronically to an individual’s health care providers.