Impacting population cardiovascular health through a community-based practice network: update on an ASH-supported collaborative

Abstract

The Hypertension Initiative began in 1999 to help transition South Carolina from a leader in cardiovascular disease (CVD) to a model of heart and vascular health. Goals were to reduce heart disease and stroke by 50% by promoting healthy lifestyles and access to effective care and medications. Continuing medical education was used to train providers, encourage physicians to become American Society of Hypertension (ASH)-certified hypertension specialists and recruit practices into the community-based practice network (CBPN). Practice data audit with provider specific feedback is a key quality improvement tool. With ASH support, the CBPN has grown to 197 practices with approximately 1.6 million patients (approximately 700,000 hypertensives). Clinical data are obtained from electronic health records and quarterly provider feedback reports are generated. Hypertension, hypercholesterolemia, and diabetes control rose and South Carolina's ranking improved from 51st to 35th in CVD mortality from 1995 to 2006. The Hypertension Initiative expanded to the Outpatient Quality Improvement Network (O'QUIN) to encompass comparative effectiveness research and other chronic diseases. Lessons learned include: trust enables success, addressing practice priorities powers participation, infrastructure support must be multilateral, and strategic planning identifies opportunities and pitfalls. A collaborative practice network is attainable that produces positive, sustainable, and growing impacts on cardiovascular and other chronic diseases.

Figure 1

The Outpatient Quality Improvement Network (O’QUIN) logo was designed to capture the twin strategies: namely, healthy lifestyle, ie, physical activity and good nutrition, and access to effective health care and essential medications. These two strategies were designed to address the goals and realize the mission. CVD indicates cardiovascular disease.

Figure 2

The initial set of tactics were designed to implement and grow the community‐based practice network beginning with continuing medical education (CME) program that could enhance the practice of evidence‐based medicine, prepare interested providers for the American Society of Hypertension Clinical Specialists Examination, and to develop the relationships and trust required to build a sustainable practice‐based network focused on quality improvement in CVD risk management. The subsequent tactics expanded the reach and scope of Outpatient Quality Improvement Network (O’QUIN) to effect improvements in both lifestyle and medical approaches to CVD prevention and health promotion.

Figure 3

Geographic location of American Society of Hypertension (ASH)–certified clinical hypertension specialists in the Carolinas‐Georgia‐Florida chapter. The area of the black circles is proportional to the number of hypertension specialists in a city/town.