Collaborative, Interdisciplinary Quality Improvement Initiative Aimed at Hypertension Compliance in a Clinic Setting

Friday, April 12, 2013

Penny C. Akers, DNP, RN1
Melody F. Sharp, DNP, RN2
Donald White, MD3
Leia Ince-Mercer, MD4
Kevin Loughry, DO5
Linda Overstreet, RN1
Emily Thomas, DO6
Michael Berry, MD5
(1)Internal Medicine, Carilion Clinic, Roanoke, VA
(2)Nursing Department, Jefferson College of Health Sciences, Roanoke, VA
(3)Family Doctors Office Walk-In Clinic, Phoenix, AZ
(4)WCA Hospital, Jamestown, NY
(5)Carilion Clinic, Roanoke, VA
(6)West Virginia School of Osteopathic Medicine, Lewisburg, WV

Learning Objective 1: The learner will be able to describe how true collaboration results from interdisciplinary teamwork and can improve patient outcomes measurably.

Learning Objective 2: The learner will be able to list 3 steps in effective decision making: 1) authentic leadership; 2) appropriate staffing; and 3) skilled communication.

Background:  Nurses, residents and faculty physicians at a residency clinic determined through a chart review that compliance of 884 patients diagnosed with hypertension and blood pressure (BP) of 140/90 or less was 35%, while the national standard is 65% (NCQA). The interdisciplinary clinic team employed true collaboration and appropriate staffing to design a quality initiative using evidence-based medicine to increase patient compliance.   Review of 2010 data revealed that of 7,509 patient visits, only 1,899 visits were covered by private insurance, while 75% were uninsured, underinsured or indigent. Patient interviews indicated that BP medications were unaffordable for many, hampering compliance. Objective: To see 45% of patients achieve a measured BP of 140/90 or less over 6 months. Outcome: Preliminary data shows project is on track to achieve goal.  Hypertension compliance increased 10% over 6 months.  Over 12 months, 50% of patients attained the pre-defined BP goal. Conclusions: Effective decision-making/authentic leadership undertaken by staff to improve compliance included: 1) accurate baseline recording of BP; 2) patients with a BP greater than 140/90, medication compliance reviewed by a physician during follow-up appointment; and 3) meaningful recognition/skilled communication: the patient’s BP was recorded in the electronic medical record, those greater than 140/90 flagged with standardized documentation. Interventions included inquiry into patient’s finances, establishing medication regimen targeting affordability, patient and staff education involving a BP control algorithm. By introducing this quality initiative using an evidence-based, effective decision-making, interdisciplinary collaborative process, the team achieved quality patient outcomes.