Improved patient health status for controlling high blood pressure augurs well for clinical laboratory testing industry

There’s a big win in the decade-long national effort to reduce high blood pressure in a large number of Americans. Researchers and health policy experts are hailing this accomplishment as proof that patients, physicians, and payers can work together and measurably improve the state of the nation’s health.

For pathologists and clinical laboratory managers, this is a significant development, because medical laboratory testing plays an essential role in diagnosing disease and monitoring the patient’s progress. Therefore, evidence that a national effort on different chronic diseases—such as high blood pressure—can measurably improve the state of health of large numbers of patients helps affirm the value of clinical lab tests in reaching these goals.

In a major study published last year by the Journal of the American Medical Association, researchers reported that 50% of Americans with high blood pressure had it under control as of 2008. This was a dramatic improvement from 2000, when the number was 31%, as well as from the early 1990s, when only 27% of patients with high blood pressure had it under control.

These results were mirrored by two regional healthcare initiatives. Each successfully lowered average blood pressure (BP) within large targeted patient populations. One initiative was in northern California and the other was in the southeastern U.S., according to studies presented at the American Society of Hypertension, Inc.’s  26th Annual Scientific Meeting and Exposition (ASH 2011).

Kaiser Initiative Nearly Doubles Control Rates

At Kaiser Permanente Northern California, study authors showed that, within a decade, the health plan nearly doubled the number of patients diagnosed with hypertension who now have the condition under control. Currently, of the 600,000 patients with high blood pressure, 80% are effectively managing the disease. This is an increase from 44% last decade.

This graph shows the incidence of hypertension (high blood pressure) for different age groups of males and females. The data was sourced from the National Center for Health Statistics and the National Heart, Lung, and Blood Institute. (Graphic copyright Wall Street Journal.)

This graph shows the incidence of hypertension (high blood pressure) for different age groups of males and females. The data was sourced from the National Center for Health Statistics and the National Heart, Lung, and Blood Institute. (Graphic copyright Wall Street Journal.)

Similar results were obtained in a study conducted by Hattiesburg Clinic, a multi-specialty medical group in Hattiesburg, Mississippi, and the Consortium for Southeastern Hypertension Control (COSEHC) Cardiovascular Center of Excellence.

The Southeast study set out to examine possible barriers to BP goal attainment, including the relationship of control rates to “clinical inertia,” which ASH defines on its website as “clinician’s failure to initiate appropriate therapeutic intensification.”

In the study population of nearly 500,000, the Hattiesburg study showed 70% of patients reduced their blood pressure to medically-recommended levels, up from 49% in 2000.

These new study results are significant for two reasons. First, hypertension is a major cause of cardiovascular disease, the leading cause of death in the U.S. Second, the study published in the Journal of American Medical Association last year indicated that, as of 2008, 50% of Americans with hypertension nationwide had reduced blood pressure to acceptable levels. However, that still leaves another 50% of Americans with this condition who need to control their blood pressure.

Simple Changes Yield Big Results in Managing High Blood Pressure

The Kaiser initiative represented a strategic commitment to launch an organization-driven large-scale, community-based hypertension program. Its dramatic success was achieved through three conceptually simple tactics:

  1. compliance with clinical guidelines;
  2. creation of a registry; and,
  3. sharing best practices.

Study data from this blood pressure management initiative confirmed that changes in algorithms as simple as lessening pill burden, with resultant reduction in co-pay, dramatically improved patient adherence to physician recommendations and, consequently, patient outcomes.

“We were encouraged by our results because they confirmed that we have many effective strategies at our disposal to make a significant improvement to patient care,” said lead study author, Marc Jaffe, M.D., Clinical Leader of the Kaiser Permanente Northern California Cardiovascular Risk Reduction Program. “We found that implementing these strategies through a systematic and comprehensive program in an integrated care delivery system did result in a significant [improvement],” Jaffe added.

Physicians with the Southeast study team were equally excited about their patients’ improvements. “The progress that’s been made nationally is really striking,” stated Brent M. Egan, M.D., a blood-pressure expert at Medical University of South Carolina, in Charleston, and Senior Medical Director of the multi-state quality-improvement network. He was quoted in a Wall Street Journal article covering the ASH conference. “It has exceeded what I thought was possible,” Egan noted.

Guideline Adherence May Change How Physicians Utilize Medical Laboratory Tests

It is not just the impressive results achieved that make these two studies interesting. It is also how those results were achieved. The improved outcomes in patients’ management of their high blood pressure did not come from advances in technology, research, or clinical insights. Rather, those improvements resulted from a fundamental, strategic shift in how medicine is practiced.

Although the application of evidence-based medicine (EBM) on such a large scale is still a fairly new practice, some pathologists and clinical laboratory directors may be surprised to learn that the roots of the concept date as far back as the 1700s. The goal of EBM is to apply the best available evidence gained from the scientific method to clinical decision making by combining the best research evidence with patient values.

Pathologists and clinical laboratory directors can view these two initiatives as examples of how the use of EBM as a strategy can dramatically improve health care outcomes. It offers credible proof that a focused, organization-wide effort can produce desired results across large populations of patients.

While hypertension does not typically involve the use of medical laboratory tests, clinical laboratory managers can expect to see similar initiatives in the future that target such diseases as diabetes and high cholesterol. The reported accomplishments in the prevention and treatment of hypertension indicate that, as outcomes-based healthcare becomes more prevalent, physicians will be motivated to pay closer attention to ordering the right clinical laboratory tests on the right patient at the right time.

–Pamela Scherer McLeod

Related Information

Can We Do Better: New Data Examines Methods to Overcome Clinical Inertia and More Effectively Treat High Blood Pressure

A Long-Awaited Advance in the War on Blood Pressure

A Very Brief History of Evidence-Based Medicine

After Taking on Jeopardy Contestants, IBM’s Watson Super Computer Might Be a Resource for Pathologists

Map of Medicine Uses Evidence-Based Medicine to Help Physicians

Evidence Based Laboratory Medicine

THE DARK REPORT: EBM Coverage