A few years ago, a colleague and I asked ourselves the question, “How can the health care system save the most lives?” Surely the answer was well known.
A literature search turned up virtually nothing. As it turns out, the question had not been widely studied. When we did our own analysis we found a simple answer.
We can save the most lives in health care by tackling heart disease.
More than 83 million U.S. adults live with one or more types of heart disease, and an estimated 935,000 heart attacks and 795,000 strokes occur each year.
High blood pressure, high cholesterol, and smoking continue to be the major risk factors. Among those factors, improving blood pressure control will have the most impact.
We know this can be done. Across the nation, health care systems are achieving control rates of 70% and higher. Identifying these high performers, learning from them, and scaling up their practices are key components of the Million Hearts focus on helping 10 million more Americans get their blood pressure under control and help prevent 1 million heart attacks and strokes in the next three years.
Early in February we recognized nine public and private practices and health systems across the country that have control rates of 70% or more.
Let me tell you about two of them.
Almost 85 percent of the patients at Cheshire Medical Center/Dartmouth-Hitchcock community hospital and clinic in southwestern New Hampshire have their blood pressure under control.
The practice accomplished this remarkable feat by having their health care teams and all 107 doctors in the practice use an evidence-based hypertension treatment protocol to assess patients’ control, recheck it at regular intervals, adjust medications, and reinforce healthy behaviors such as physical activity and lower-sodium foods.
Patients can come in any time to have their blood pressure checked in a no-cost nurse clinic setting. To be sure blood pressure screening is standardized across the community, the practice partnered with state public health programs, the local YMCA, home health care agencies, and others to make sure everyone is taking blood pressure in the same way.
To help their patients track important health markers, they gave out more than 12,000 blood pressure wallet cards. No matter where the patient got their blood pressure checked, they could record the results to share with the practice.
Dr. Rudolph Fedrizzi told us the cards were so popular the state medical association printed 40,000 more to distribute to the 2,000 doctors in New Hampshire.
Broadway Internal Medicine in Queens, New York was recognized for achieving an 81% blood pressure control rate among a vulnerable, urban population at considerable risk for heart attack and stroke.
Dr. Luz Ares told us one of the reasons for their success is that they help their patients develop a sense of ownership of their blood pressure. Patients receive equipment to check their blood pressure at home, and they’re expected to come in with their readings and discuss how they’re doing.
Dr. Ares’ laughingly reports that not only do the patients “own” their blood pressure, they also feel they “own” the practice. “Our patients have ‘stock’ in this office! They tell us which nurses are ‘keepers’ and which plants should be in which spots in the waiting room,” she told us.
Her story reminds us that giving patients control of their own health is empowering in many ways.
These two examples demonstrate that tackling heart disease, and preventing a million heart attacks and strokes, can be done. It takes a commitment to involving patients in their own care, use of the entire health care team, and the adoption and use of an evidence-based high blood pressure treatment protocol.
With those steps, we’ll see blood pressure control in our nation increase, saving lives and preventing disability.