Improving Chronic Hypertension Among Underserved Ambulatory Patients
Julia Childress, Brooke Myers, Sydney Muller, Stephanie Mwesigwa, & Morgan Tyner
Bon Secours Memorial College of Nursing
Description of the Issue
❖ Macro: Healthcare systems are financially impacted by
the improper use of resources due to repeat patient visits
with uncontrolled medical conditions, such as
hypertension.
➢ “This is the level where overall values, principles, and
strategies for health care develop, and where decisions
concerning resource allocation occur. Without overall
coordination at this level, health services are likely to be
wasteful and fragmented” (WHO, 2018).
➢ Government policies
➢ Medicaid reimbursement/ Expansion of resources
❖ Micro: On a micro-level, the issue is broken down into
points such as, health behaviors, like diet, exercise,
smoking, alcohol use, drug use, and stress levels.
➢ Access
➢ Socioeconomic status
➢ Patient-Provider relationship
➢ Health literacy
Root Cause
Ineffective teaching due to
❖ time restraints
❖ consistency/continuity of care
❖ literacy level of teaching materials & content
❖ culture
According to Marcus (2014), communication is often
misunderstood when considering the factors that may
affect patient comprehension. The Joint Commission
identified the root cause of sentinel events and poor
patient outcomes to be related to inadequate
patient-provider communication.
Analysis of the Issue
❖ Time Restraint
➢ Per Care-A-Van, MDs & NPs are allotted a certain
number of patients to see in a day’s time but the
number of patients waiting exceeds the provider’s
capacity to care
➢ Chronic care clinic only offers 30 minute
appointments one day a month for specialty and
complicated cases
❖ Consistency/Continuity of Care
➢ No stability in patient-provider relationship
➢ Ineffective documentation of discharge teaching
➢ Lack of review of self-management education
❖ Literacy Level & Content of Teaching Materials
➢ Materials are provided at a sixth grade reading level
when most of the population reads at a lower level
➢ No standardization of the teaching content
❖ Culture
➢ Physical activity and cost are not the primary barriers
in self-management
➢ Diet and the types of food eaten are directly linked to
a person’s culture (i.e., highly processed, canned
food)
References
Epping-Jordan, J. (2002). Innovative care for chronic conditions: Building
blocks for action (pp. 35-40). Geneva, Switzerland: World Health
Organization.
Gunter, K., Weyer, G., Vinci, L., Chin, M., & Peek, M. (2017).
Hypertension control in the University of Chicago Primary
Care Group. Clinical Diabetes Journals, 35(3).
Marcus, C. (2014). Strategies for improving the quality of
verbal patient and family education: a review of the literature
and creation of the EDUCATE model. Health Psychology & Behavioral
Medicine, 2(1), 482-495.
Solution
Hypothesis: Implementation of a standardized education flow sheet that is
disease/condition specific will improve the continuity and quality of
patient education.
Evidence: According to Care-A-Van representatives:
➢ No method used to determine what education has been implemented in
past visits.
➢ No time effective method to determine the number of patient visits.
➢ Progress notes searching is ineffective time management.
➢ Patients cannot properly absorb all information for their chronic
condition in one visit.
Evidence of research to support the hypothesis:
➢ Chicago Primary Care Group- 15 month quality improvement study
○ Their goal was to increase the amount of patients with controlled HTN.
○ 64% of the patients had controlled HTN compared to only 34% before
the project was conducted (Gunter, 2017).
❖ Staff training on new ConnectCare flowsheet
Logistics ❖ New flowsheet
❖ New education fact sheet for handout to patients
❖ IT specialist--assist with new addition to software and
technical assistance
❖ Care-A-Van-- potential to deliver more care to more
Stakeholders patients through effective time management
❖ Care-A-Van administration--to ensure implementation
❖ Medical staff-- provide direct implementation of care
❖ Patient-- help improve self management of their chronic
condition
❖ Training of staff
Cost ❖ Creation of flowsheet by IT
❖ New printed education material
Estimated implementation time: 18 months
❖ 0-6 months: Design and build
Timeline ❖ 6-12 months: Implementation
❖ 13-18 months: Continuous monitoring to include
outcomes evaluation
❖ Objective data collection of blood pressure
Data Collection ❖ Baseline/final assessment questionnaire