Improving cardiovascular outcomes by using team-supported, EHR-leveraged, active management: Disseminating a successful quality improvement project

Allison A Lewinski, Hayden B Bosworth, Karen M Goldstein, Jennifer M Gierisch, Shelley Jazowski, Felicia McCant, Courtney White-Clark, Valerie A Smith, Leah L Zullig, Allison A Lewinski, Hayden B Bosworth, Karen M Goldstein, Jennifer M Gierisch, Shelley Jazowski, Felicia McCant, Courtney White-Clark, Valerie A Smith, Leah L Zullig

Abstract

Background: Uncontrolled blood pressure (BP) is common among Veterans. Rural Veterans are at risk for suboptimal care coordination as successful programs may be implemented at lower rates due to individual- and system-level factors. There is strong evidence to support the use of remotely delivered support and patient-generated data from home BP monitors and virtual BP visits to manage BP.

Objective: The purpose of this project is to augment the current approach to addressing uncontrolled BP so that existing clinical staff can reach a larger patient population.

Methods: Our project will address uncontrolled BP by leveraging team-based care, the Veteran's Health Administration Electronic Health Record, and patient-centered medical home data to address patient, provider, and system barriers to cardiovascular disease (CVD) preventive care. We will implement this project in cardiovascular disease practices in three rural Veterans Health Administration clinics. We will evaluate implementation processes as well as patient-level (e.g., clinical outcomes, referrals to specialty services) outcomes in a one-arm, pre-post design.

Discussion: This manuscript describes our process in expanding the implementation of a successful project to improve BP control in high-risk, rural Veterans. Findings from our study will inform an understanding of both implementation and clinical effectiveness outcomes of a potentially scalable BP intervention in rural, community-based clinics. Appropriate management of Veterans with uncontrolled BP can reduce morbidity and mortality related to CVD. In turn, improvements in BP, can lead to improved quality metrics and potentially decrease costs for a healthcare system.

Keywords: Cardiovascular diseases; Implementation science; Population health management; Quality improvement; Veterans.

Conflict of interest statement

Dr. Bosworth reports receiving research funds from 10.13039/100004339Sanofi, Otsuka, 10.13039/100004331Johnson and Johnson, Improved Patient Outcomes, 10.13039/501100004191Novo Nordisk, 10.13039/100001797PhRMA Foundation as well as consulting funds from 10.13039/100004339Sanofi, Otsuka, Abbott, and 10.13039/100004336Novartis. Dr. Zullig reports receiving funding from the 10.13039/100001797PhRMA Foundation and Proteus Digital Health as well as consulting funds from 10.13039/100004336Novartis. The remaining authors have no competing interests to declare. The findings and conclusions in this document are those of the author(s) who are responsible for its contents and do not represent the views of the Department of Veterans Affairs, the US Government, or Duke University. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs or Duke University.

Published by Elsevier Inc.

Figures

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Fig. 1
Team-supported, Electronic Health Record (EHR)-leveraged, Active Management (TEAM) components. CVD, cardiovascular disease.
Fig. 2
Fig. 2
Heart health Handout.
Fig. 2
Fig. 2
Heart health Handout.
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Fig. 2
Heart health Handout.
Fig. 3
Fig. 3
Flow of activities in TEAM.

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