Population Care Management and Team-Based Approach to Reduce Racial Disparities among African Americans/Blacks with Hypertension

Abstract

Objectives: At Kaiser Permanente, national Equitable Care Health Outcomes (ECHO) Reports with a baseline measurement of 16 Healthcare Effectiveness Data and Information Set measures stratified by race and ethnicity showed a disparity of 8.1 percentage points in blood pressure (BP) control rates between African- American/black (black) and white members. The aims of this study were to describe a population care management team-based approach to improve BP control for large populations and to explain how a culturally tailored, patient-centered approach can address this racial disparity.

Methods: These strategies were implemented through: 1) physician-led educational programs on treatment intensification, medication adherence, and consistent use of clinical practice guidelines; 2) building strong care teams by defining individual roles and responsibilities in hypertension management; 3) redesign of the care delivery system to expand access; and 4) programs on culturally tailored communication tools and self-management.

Results: At a physician practice level where 65% of patients with hypertension were black, BP control rates (< 140/90 mmHg) for blacks improved from 76.6% to 81.4%, and control rates for whites increased from 82.9% to 84.2%. The racial gap narrowed from 6.3% to 2.8%. As these successful practices continue to spread throughout the program, the health disparity gap in BP control has decreased by 50%, from 8.1% to 3.9%.

Conclusion: A sustainable program to collect self-reported race, ethnicity, and language preference data integrated with successful population care management programs provided the foundation for addressing health disparities. Cultural tailoring of a multilevel team-based approach closed the gap for blacks with hypertension.

Figure 1.

Pro-Active Health Management and Health Care Team Model. 1. Bartolome R. Equitable Care Health Outcomes: ECHO. ECHO toolkit. Hypertension management for African Americans [Internet]. Oakland, CA: Kaiser Permanente; 2012 [cited 2015 DEC 24]. Available from: https://wiki.kp.org/wiki/download/attachments/181409536/ECHO+Toolkit+020813+v7.pdf?version=3&modificationDate=1406054044814.

Figure 2.

Hypertension control for Gardena Medical Offices. Percentage of members in hypertension registry with blood pressure below 140/90 mmHg (left x-axis) and disparity between control rates for white and black members (bars), June 2011 through February 2014. 1. Tran-Nguyen J. POINT (Permanente Online Interactive Network Tool) Hypertension Disparity Report (unpublished). Pasadena, CA: Kaiser Permanente Southern California Region Hypertension Team and Pharmacy Analytical Services, 2014. Internal document available on request.

Figure 3.

Hypertension control for Kaiser Permanente programwide. Percentage of members in hypertension registry with blood pressure below 140/90 mmHg (left x-axis) and disparity between control rates for white and black members (bars), 2009 Quarter (Q) 4 through 2014 Q1. 1. Platt ST. Kaiser Permanente Programwide Quarterly ECHO (Equitable Care Health Outcomes) Report (unpublished). Oakland, CA: Center for Healthcare Analytics, Hospitals, Quality and Care Delivery Excellence; 2014.