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Michigan dept of Health and Human Services, Million Hearts® 2-Year Summary: Muskegon County, 11.3.2016

Introduction:  Michigan began as a Million Hearts® State in 2013 with the award of an unfunded National Association of Chronic Disease Directors Million Hearts® Stakeholder Workshop Technical Assistance grant. In fall 2014, the Michigan Department of Health and Human Services accepted an Association of State and Territorial Health Officials (ASTHO) Million Hearts® State Learning Collaborative grant. Using a cross-sector collaborative method, we engaged local health agencies and implemented systems that encouraged a multifaceted approach to improving gaps in blood pressure (BP) control.

Methods:  Aim Statement:  By June 30, 2015, increase hypertension (HTN) control (<140/90) among residents aged 18-85 in Muskegon County zip codes by 5% over baseline.

The 9-month project focused on patients in Muskegon County, Michigan.  The core planning team members included the State Deputy Director of Population Health and Community Services, Sue Moran; Heart Disease and Stroke Prevention Unit leadership; representatives from the health network; local public health; Information Systems analysts of the local physician organization and clinics; state Regional Extension Center (REC); state Quality Improvement Organization (QIO); our state public health institute; community health worker HUB Director; and Medicaid Quality Analyst.

We engaged in on-site visits, monthly updates with the core planning team, utilized census data to map the sample population, and created data sharing agreements.  We established quality improvement processes using Plan-Do-Study-Act cycles to improve identification of undiagnosed patients, improve treatment and follow-up of diagnosed patients, and to increase reporting of NQF 0018 (measurement of patients 18-85 years of age with a diagnosis of hypertension and whose BP was controlled).

With support from the Canadian Cardiovascular Health Awareness Program, their framework and adapted forms were used to establish the community based chronic condition Management and Referral Assistance Program (MRAP) using Muskegon Medical Reserve Corps as site volunteers. The Hypertension Treat to Target Algorithm was chosen as the evidence-based standard treatment algorithm to implement in primary care clinics.

Results:  Representation from a variety of organizations allowed us to harness the wisdom of many experts.  Practitioners in the Mercy Health/Lakeshore Health Network developed a hypertension treatment algorithm using evidence-based guidelines for lifestyle modifications and medication therapy management which was easily adapted to the network’s current practices.

In the health system’s clinical settings, a second BP measurement should follow an initial high measurement. A review of this data in two clinics indicated that this was only being done 48.15% of the time. After providing education and data feedback to the staff at the clinic, follow-up data indicated rechecks being performed 63.44% of the time. 

Discussion:  This collaborative method consisting of state and local partners may be a useful model for improving HTN screening, diagnoses, and treatment among disparate populations.

The project benefited from having one large hospital and physician organization serving the target community. This made it easier to reach the entire community and achieve consensus for protocol implementation, data collection, and data sharing. The technical assistance and training available from ASTHO, our QIO, and our REC were also essential pieces to assist with developing and executing the model.

Conclusion:  While our interventions were a bit delayed, local members of the team continue these efforts without the assistance of MDHHS.  Local public health continues to participate in statewide meetings and present on the project. The health system is sustaining its efforts to spread the HTN Treat to Target Algorithm throughout the health network as well as reflect on individual practice data.  Additionally, MRAP continues to provide community screenings and feedback to providers.