AMA's MAP BP Program improves blood pressure control by 12% at select Trinity Health locations

medical team gettyTrinity Health, in collaboration with the American Medical Association (AMA), is prioritizing the prevention of cardiovascular disease with a strategy to implement the MAP BP Program in the majority of its primary care practices. 

"The quality improvement program aims to effectively manage blood pressure, which in turn can reduce patient morbidity and mortality rates," Jennifer Bailey, MSN, RN, CMCN, and Trinity Health's director of ambulatory clinical operations, said. 

During a Jan. 28 webinar hosted by Becker's Hospital Review, and sponsored by the AMA Health System Program, Bailey and other leaders from Livonia, Mich.-based Trinity Health discussed how they are implementing the MAP BP Program nationally in the system's primary care medical group practices. To illustrate the program's effectiveness, they presented results from Trinity Health Of New England's MAP BP Program implementation at 13 Springfield, Mass. offices. Around a year after implementing the program, patient blood pressure control rates at select Trinity Health Of New England Medical Group locations increased by 12 percentage points.

The MAP BP Program

The three-step program works to diagnose and manage patients with hypertension. In opening remarks, Daniel Weiswasser, MD, quality and clinical informatics director at Trinity Health Of New England, highlighted the program's importance with a startling statistic: Only half of U.S. adults with hypertension have adequate blood pressure control. 

The program's first step — Measure Accurately — focuses on all practice team members obtaining accurate, representative blood pressure readings. Steps to achieving accuracy include establishing a blood pressure measurement protocol, calibrating sphygmomanometers, and reconfiguring exam rooms to engage and inform staff and patients about correct blood pressure measurement. To help ensure measurement accuracy, the team displayed patient positioning posters which illustrate seven simple tips to accurate blood pressure measurement.

"I really derive some degree of pleasure when I hear that our patients insist that their specialists, who they see after being seen in our primary care office, use proper blood pressure techniques that they've learned in their PCP's office as a result of this poster," Dr. Weiswasser said.

Practices should also purchase enough automated office blood pressure machines to ensure consistent use —Trinity Health Of New England bought one device for every two providers which enabled them to take unattended BP measurements, consistent with best practices. The pilot practices document confirmatory blood pressure readings using this methodology and followed up on staff utilization to ensure the protocol is being followed. 

The second step — Act Rapidly — focuses on provider behavior. The program guidelines urge providers to respond to uncontrolled blood pressure by conducting rapid follow-up visits, changing medication regimes or referring patients to hypertension specialists. When treating patients with hypertension, the pilot locations found lower doses of two medications were more effective than a higher single dose, and that patients on such a treatment protocol stopped the medication less frequently, as confirmed in the Journal of Hypertension. 

The MAP BP Program's final step – Partner with Patients – provides education about the impact lifestyle choices can have on blood pressure. The hope is to empower patients to take more ownership of hypertension by monitoring blood pressure at home, Dr. Weiswasser said. For patients who can afford it, self-measured blood pressure (SMBP) devices cost about $40, and Trinity Health Of New England locations developed a device-loaner program for those who cannot buy their own. 

The results 

Of 2,000 Springfield patients with hypertension, 72 percent had controlled blood pressure in November 2018. A year after the MAP BP Program was implemented, blood pressure control improved by about 12 percentage points, at 84 percent in November 2019. This gave Trinity Health Of New England all the evidence needed to spread the program across its other locations. 

In 2019, Trinity Health Of New England received Gold Status recognition from the AMA/AHA's Target: BP™ initiative, which is the highest level of recognition awarded for achieving blood pressure control rates at or above 70 percent.

"Since implementing MAP BP across the Trinity Health nation, the team is identifying additional patients with hypertension, all of whom are at varying degrees of risk for cardiovascular disease or stroke. We are currently managing nearly 500,000 individuals with hypertension," Ms. Bailey said.

Conclusion

"The MAP BP Program is structured yet flexible, and the framework can be applied to drive improvement," Dr. Weiswasser said. The program is cost effective, with no additional hiring required and the AMA training support is provided at no charge.

"The program's methods are designed to reduce diagnostic uncertainty, clinical inertia and medication nonadherence," Ms. Bailey said.

For more information on the MAP BP Program, click here.

Drive the future of medicine

The AMA Health System Program (more information) provides enterprise solutions that equip your leadership, physicians and care teams with the resources needed to advance your programs while also being recognized as a leader. The combination of recognition opportunities, invites to healthcare leadership summits and prioritization in AMA mission based resources will help your health system drive the future of medicine.

To request information on the Health System Program, click here. To view this webinar, click here.

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