Hypertension and Diabetes Initiative - Improving Hypertension Control in Individuals With Diabetes

Twelve health organizations from around the US were selected to participate in a chart review Hypertension and Diabetes Initiative with the goal of improving blood pressure control in persons with diabetes.

Hypothesis:

A three-phase quality improvement initiative facilitated and monitored through the International Diabetes Center (IDC) will result in improved population-mean systolic blood pressure in the aggregate data pool of patients from all 12 participating sites at geographically distinct health systems.

Phase 1 - Preparation: Each participating site begins to organize itself for the project. Baseline data will be collected and will be used to benchmark where each site is relative to blood pressure control/management of persons with diabetes prior to the implementation of the training programs.

Phase 2 - Implementation: Sites begin to address the gaps they have identified that affect blood pressure outcomes of patients with diabetes. IDC provides two on-site training programs for providers and support staff.

Phase 3 - Follow-up: IDC provides on-going support to each site via individual and collaborative conference calls and resources on the project Web site. Patient and visit data (audit form) will be collected six and 12 months after training. This data will be compared to the site's pre-training data.

• Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. N Engl J Med. 2000 Feb 10;342(6):381-9. Erratum in: N Engl J Med 2000 May 4;342(18):1376.
• Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003 May 21;289(19):2560-72. Epub 2003 May 14. Erratum in: JAMA. 2003 Jul 9;290(2):197.
• Saaddine JB, Cadwell B, Gregg EW, Engelgau MM, Vinicor F, Imperatore G, Narayan KM. Improvements in diabetes processes of care and intermediate outcomes: United States, 1988-2002. Ann Intern Med. 2006 Apr 4;144(7):465-74.
• Adler AI, Stratton IM, Neil HA, Yudkin JS, Matthews DR, Cull CA, Wright AD, Turner RC, Holman RR. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ. 2000 Aug 12;321(7258):412-9.
• Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). ALLHAT Collaborative Research Group. JAMA. 2000 Apr 19;283(15):1967-75. Erratum in: JAMA 2002 Dec 18;288(23):2976.

Inclusion Criteria:

• ICD-9 Code 250 (indicates type 1 or type 2 diabetes)
• ICD- Code 648.0 (indicates pregnancy with type 1 or type 2 diabetes)
• ICD-9 Code 357.2 or 362.0, indicating complications of diabetes.
• A prescription for insulin or oral hypoglycemic agents
• Include those 18-75 years

Exclusion Criteria:

• Attend a dialysis unit (if the nephrologist is primary care manager)
• Have gestational diabetes (ICD-9 Code 648.8)
• Have a terminal illness (e.g., hospice patient)
• Do not have a documented blood pressure within the past year (this is asked on the audit form)

• Advocate Medical Group
• Baystate Health
• William Beaumont Hospitals
• Columbia Park Medical Group
• Humboldt Del Norte Independent Practice Association
• Metropolitan Health
• Park Nicollet Clinic
• PeaceHealth Medical Group
• Sanford Clinic
• TriHealth Inc.
• University Hospitals Medical Practices
• Warren Clinic
• Novartis