Wisconsin Collaborative for Quality Healthcare

WCHQ Membership Achieves Impressive Gains in Hypertension Control

Every WCHQ member organization improved hypertension control among its patients, when comparing the current performance data on WCHQ’s website to that reported a year earlier.

Hypertension is a major risk factor for heart disease and stroke, the first and fourth leading causes of death for Americans. One in three adults have hypertension, resulting in an estimated $51 billion cost for our nation annually.1

Recognizing the importance of controlling hypertension for both health and economic reasons, WCHQ formed a Hypertension Quality Improvement Steering Team composed of clinical, quality, and operational leaders from its member organizations, as well as subject-matter experts from other key stakeholders. The team took action, establishing an improvement goal, recommending strategies to help achieve that goal, and compiling a variety of resources into a toolkit to support implementation of the strategies.

A call to action – WCHQ’s improvement goal

WCHQ member organizations will improve their performance as follows on the WCHQ hypertension measure “Controlling High Blood Pressure: Blood Pressure Control” by December 31, 2016:2

  • 1.0 - 3.0% for high performing members (with baseline scores of ≥80% of patients in control)
  • 3.1 – 5.0% for medium performing members (with baseline scores of 72%-79%)
  • Greater than 5.0% for low performing members (with baseline scores of <72%)

Impressively, almost all WCHQ members have already achieved their improvement targets within this goal, well before its conclusion date. WCHQ will continue to encourage and support these advances by disseminating “best practice” strategies and tools.

Improvement strategies and toolkit

The WCHQ Hypertension QI Steering Team reviewed a number of best practices for hypertension control before recommending three strategies that offer the combined advantage of being evidence based and effective, without requiring the purchase of expensive new technology or the hiring of additional staff.

Check out the WCHQ Toolkit for Improving Hypertension Care & Outcomes, which presents evidence-based, effective strategies and tools for improving hypertension control.

Download this toolkit for free on the HIPxChange website.

Rapidly improving organizations share their best practices

Several WCHQ member organizations have dramatically improved their hypertension control rates by 10 percent or more.3 Here, we showcase the best practices of two such rapid improvers: Agnesian HealthCare and Marshfield Clinic.

Agnesian HealthCare, a three-hospital system with a 104-multispecialty physician clinic, has improved its hypertension control rate by a stellar 12 percent. Sue Gullickson, MPA, BS, NHA – project manager leading ambulatory quality improvement activities – related several of their keys to success:

  • Transparent reporting: Since 2013, Agnesian HealthCare has distributed non-blinded, individual-level performance reports with its providers as a means to identify high performers, encourage sharing of best practices, and motivate improvement across the board.
  • Standard documentation: In 2014, Agnesian HealthCare created a standardized workflow for documenting blood pressure (BP) readings in its electronic medical record. This improved the accuracy of data extraction for performance reporting and analysis.
  • Recheck reminder: In 2015, Agnesian HealthCare implemented a simple yet effective tool – a bright colored notepad – to help providers and their care teams remember to recheck a patient’s BP, if the first reading was elevated. In such cases, rooming staff leave the notepad where it will catch the attention of providers during office visits.

While reporting, documentation, and tools have spurred improvement in Agnesian HealthCare’s hypertension control rate, Sue also credits teamwork – the enthusiasm and commitment of providers, clinic leadership, and staff alike to “do the right thing” for the benefit of patient care and outcomes.

Marshfield Clinic has improved its hypertension control by 10 percent. Caroline Fender, RN – clinical coordinator with Marshfield Clinic’s Institute for Quality, Innovation and Patient Safety (IQIPS) – described multiple strategies and tools that drove this improvement:

  • Provider goal and reporting: Starting in 2015, Marshfield Clinic challenged its primary care providers to achieve a hypertension control rate of at least 82 percent for their patients, or to close the gap by 25 percent between the provider’s baseline and that goal – with 3 percent of their salary tied to the outcome. In order to support providers, clinic leadership and IQIPS staff distributed monthly performance reports. Additionally, IQIPS team members performed annual reviews with individual providers, along with their medical support staff and manager, to discuss progress and share best practices from high performing colleagues.
  • Staff education: Marshfield Clinic trains patient care staff annually on proper technique for measuring BP, using computer-based modules that are reinforced through competency testing. Marshfield Clinic created a toolkit, drawing from resources in WCHQ’s hypertension toolkit and its own customized tutorials.
  • Patient outreach: Marshfield Clinic uses a population health management application to analyze performance data at multiple levels and to print lists of patients who are “not at goal” for BP control. Staff then contact those patients to schedule a visit with their provider for treatment.
  • Engaging specialists: Marshfield Clinic involves specialty providers in improving hypertension control. When patients receive specialty care – whether or not in connection to cardiovascular disease – the specialist’s care team measures and records the BP. If that BP is elevated, they perform a second reading to ensure accuracy. Should that BP also be high, the patient receives a referral to his/her primary care provider for follow up.

We congratulate Agnesian HealthCare and Marshfield Clinic on their rapid improvement and thank them for sharing their strategies to advance hypertension control. Just as we applaud the entire WCHQ membership for its across-the-board gains in this critical area of health care.

Million Hearts Wisconsin BP Improvement Challenge

The Million Hearts Wisconsin Leadership Team is kicking off a BP Improvement Challenge to recognize clinical and community efforts promoting hypertension control and heart-healthy lifestyles. We encourage WCHQ member organizations to submit their stories of success in one or more of these challenge categories:

  • Interventions in a clinical setting and related outcomes
  • Interventions in a community setting and related outcomes
  • Innovative BP control activities
  • Unique and effective outreach strategies
  • Informative BP control education

Entries, in written or video format, will be accepted at the Million Hearts Wisconsin BP Improvement Challenge website until November 30.


1 These statistics are taken from the Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention infographic at http://www.cdc.gov/bloodpressure/infographic.htm.

2 WCHQ hypertension improvement goal:

  • The improvement rates specified in this goal are relative, rather than absolute.
  • The baseline performance ranges – high, medium, and low – were calculated using data from the measurement period of 7/1/13 to 6/30/14, as published in the WCHQ Member Scorecard from November 2014:
    • High performers scored greater than or equal to 80%, which is 1.5 standard deviations below the benchmark of 88% (the top performer’s score).
    • Medium performers scored between 72% and 79%, corresponding to the range between 1.5 and 3.0 standard deviations below the benchmark.
    • Low performers scored less than 72%, which is 3.0 standard deviations below the benchmark.

3 The improvement rates referenced here are relative, rather than absolute.