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We Are Public Health, September 2014.

We Are Public Health 2014-07

This story features the work of the Montana Cardiovascular Health Program.

We are public health.
We harness health information systems to combat high blood pressure.

In the state of Montana, over 30 percent of adults have high blood pressure, one of the major risk factors for heart disease, stroke, and kidney failure. While there are proven methods for keeping blood pressure levels at healthy ranges—through medication, diet, daily physical activity, and smoking cessation—the proportion of people with high blood pressure has steadily increased in Montana since 1995.

To combat this trend and improve the health of its residents, the Montana Department of Public Health and Human Services’ Cardiovascular Health Program was created in 2000 to lead systems-level change efforts in healthcare settings. In 2011, the state health department was awarded a Community Transformation Grant from the Centers for Disease Control and Prevention (CDC) to expand clinical and preventative services. In particular, these funds served as a catalyst for hospitals, community health centers, and rural health clinics in Montana to work on their health information systems to address high blood pressure control.

In an ideal world, the widespread adoption of electronic health records (EHRs) would enable health care organizations to improve high blood pressure care through registries, decision support systems, and outreach capabilities for self-care education and follow-up. In Montana, program staff found that these capabilities differed greatly from organization to organization.

“Some organizations had low information technology staffing resources or had little knowledge on how to develop or pull such reports,” said Crystelle Fogle, MBA, MS, RD, Program Manager of the Montana Cardiovascular Health Program.

Combating these differences would have been difficult if not for funding flexibility.

“The funding really allowed organizations to choose a project that related to their electronic health records (EHRs), and then tailor their approach and quality improvement objectives according to their resources and needs,” said Marilyn McLaury, MS, RD, Quality Improvement Coordinator of the Montana Cardiovascular Health Program.

To date, the funding has supported the efforts of seven hospitals, thirteen community health centers, and five rural health clinics, with many showing promising and sustainable results. Though results vary from site to site, many of the participating partners have developed registries, improved reporting capabilities, and used EHRs to identify patients with uncontrolled high blood pressure or high cholesterol. Others worked on patient and staff education, trained staff on accurate blood pressure measurement, and enabled alerts and decision support tools.

For example, when Benefis Hospital, in Great Falls, Montana, reviewed their efforts 10 months into the program they found impressive results. Not only were patients with high blood pressure formally identified (the first step in determining a baseline number), but patients with blood pressure at target improved by more than 20 percent. The hospital also adopted changes in their reporting systems, including registries and follow-up. Going forward, Benefis Hospital plans to sustain and expand its efforts by improving the registry functions, expanding the capability of automated blood pressure data entry, adding blood pressure competency training requirements for staff, and developing physician champions for blood pressure in each department.

Jonathan Griffin, MD, has seen how the funding has greatly augmented quality improvement systems and operations at St. Peter’s Medical Group, in Helena, Montana. “Major transformative efforts are underway in the realm of information systems and operations,” said Griffin. “The grant is helping us restructure our primary care teams and work together better to serve our patients.”

“As we complete the final year in the grant, we’re excited to see what our primary care partners have accomplished,” said Fogle.