Addressing Health Disparity in Hypertension Control
Submission Date: June 2017
Entry Type: Case Study
State/Territory Submitted on the Behalf of: South Carolina
States/Territories Involved: South Carolina
Funding Source: CDC
CDC Funding:Yes
CDC Funding (Specified):(DP14-1422) State and Local Public Health Actions to Prevent Obesity, Diabetes and Heart Disease
Domain Addressed:Health Systems Strategies
Public Health Issue:Disparity in hypertension control contributes to disparity in deaths from heart disease and stroke.
The collaboration and engagement of diverse partners is essential for promoting health equity, according to the Institute of Medicine which recommends increasing health care providers’ awareness about health disparities and better adherence to evidence-based quality guidelines as important ways to address the issue of health inequity.
Many health practitioners struggle with cultural competence and applying a health equity lens to their work with patients.
Program Action:The South Carolina Department of Health and Environmental Control (DHEC) makes health disparities a priority in their work to identify and control hypertension, using cultural competence education as the mode for spreading the message and practice improvement as a method for reducing disparitiesy. They call their program SC PHASE: Prevention and Health across Systems and Environment.
DHEC created a self-guided cultural competence training which local/regional health department (LHD) staff promotes to providers in medical practices.
The DHEC chronic disease epidemiology team identified areas for intervention using data on mortality, prevalence, inpatient hospitalization, and emergency department visits for chronic disease as well as Medicaid data on diabetes and hypertension medication adherence. Grouping contiguous counties with high prevalence rates helped them arrive at their intervention counties.
SC PHASE team leads and clinical coordinators, who work at the local level, recruit clinical practices in the identified counties to engage in practice improvement using a readiness assessment and signed contract agreements to make practice improvement more likely to occur.
Once engaged, medical practices work with SC PHASE team leads and clinical coordinators along with physician champion Dr. Brent Egan, Senior Medical Director of the Care Coordination Institute (CCI), to focus on team-based care and undiagnosed hypertension; to modify their electronic health records; and to use real-time information based on quality improvement strategies such as registries and protocols. CCI gives practices monthly and quarterly disparities reports along with dashboard measure reports that compare individual providers to the practice as a whole on selected measures. CCI helps practices apply the M.A.P. framework developed by the American Medical Association. A daily âhuddleâ report displays information on the patientâs theyâll see that day to help practices adjust their work flow to best serve their patientsâ needs.
Impact/Accomplishments:DHECâs health disparity focus and coordinated work with CCI helps medical practices engage with patients in meaningful ways to improve hypertension control and help prevent heart attack and stroke.
Applying the MAP framework helped one pilot practice site with a vulnerable patient population obtain âKaiser-likeâ numbers for hypertension control. The hypertension control rate jumped from 61% to 88% in just six months. In 16 practice sites across 4 counties, the average control rate increased from 65% to 75% in six months for patients seen at least twice.
All 16 contracted medical practice sites have participated or will participate in cultural competence training. By linking training to practice requirements such as patient-centered medical home standards and providing CME credit, DHEC encourages participation and adds value.
Medical practices are maintaining their hypertension control improvement and 17 new sites are implementing hypertension control strategies in 2017 based on lessons learned from the initial practice improvement work.
DHEC and CCI combined action builds a sustainable foundation to support best practice in hypertension control in the face of ever-evolving clinical guidelines.
Next Steps:Working with the South Carolina Office of Rural Health, SC PHASE is creating a change packet that any medical practice can use to engage disparate populations.
Program Areas:Health Equity and Cultural Competency, Heart Disease and Stroke
State Contact Information:
SC
Jacqlyn Atkins, MPH
South Carolina Department of Health and Environmental Control
803-898-7867
baylisjr@dhec.sc.gov