New York, NY - The New York City Health and Hospitals Corporation (HHC) today announced that a pilot “Treat to Target” program, which increases the role of registered nurses and allows for more frequent and more focused clinic visits, helped patients achieve healthier blood pressure levels and reduce their risk of heart attacks and strokes. Seven HHC facilities experienced a significant improvement in the rates of patients with hypertension who were able to bring their blood pressure under control and HHC will now expand the “Treat to Target” program to all 11 public hospitals and six Diagnostic & Treatment Centers. The year-long pilot resulted in an additional 372 patients with controlled blood pressure at the seven locations. Previous clinical studies suggest that level of blood pressure control improvement, if sustained, will potentially leading to 18 fewer heart attacks and nine fewer strokes in those patients.
Traditionally, hypertension has been managed by primary care physicians who prescribe medication and lifestyle changes, a model that relies on patients to actively manage and take control of their illness. Unfortunately, a significant number of people with hypertension do not take their prescribed medications, while other patients do not receive a sufficient dose of medication to achieve their target blood pressure and would benefit from more frequent monitoring and medication adjustments.
Under HHC’s “Treat to Target” program strategy, patients with hypertension have an initial visit with a physician to set and agree upon a goal for desired blood pressure levels and a medication plan to achieve it. Patients then work closely with a nurse, who helps them take control of their illness and is empowered to closely monitor and assist with necessary medication adjustments. The nurse also direct patients to other services that may be helpful in overcoming obstacles to blood pressure management, such as lack of access to healthy food or substance abuse. Patients in the program will typically be in contact with a nurse every 2-3 weeks until the target blood pressure goal is reached.
The nurse-led “Treat to Target” hypertension pilot program was implemented at seven HHC facilities in 2012, all of which saw better blood pressure management in their hypertensive patients. In just one year the number of hypertension patients managing their high blood pressure effectively went up by over 18 percent at Harlem Hospital Center and by over 15 percent at the East New York Diagnostic & Treatment Center, the two facilities that achieved the highest improvements in the pilot program.
“This approach to hypertension management utilizes a nurse-centered model of care and engages patients as partners, providing them with frequent and ongoing education, counseling, and support,” said HHC President Alan D. Aviles. “By partnering with patients to manage their condition we’re not just helping them be healthier but are also tapping the invaluable skills of our nurses and using our resources wisely to help lower patient’s risks of heart attacks, strokes, and unnecessary hospital admissions.”
“The nurse-led visits allow for more frequent and longer visits than primary care physicians are typically able to provide. Patients have less wait time to see their nurse. And patients have told us they feel like a team is looking out for them,” said Lauren Johnston, HHC’s Chief Nursing Officer.
After each visit the nurse communicates with the patient’s primary care physician on any findings and care recommendations. Together they can stay apprised of the patient’s condition and remain active in the patient’s treatment plan.
“This offers many advantages over the traditional care model. It increases patient-caregiver interaction, and also improves the amount of buy-in that patients feel regarding their own care,” said Dr. David Stevens, Senior Director of HHC’s Office of Healthcare Improvement and HHC’s lead on the project. “They feel empowered, they see real progress in a short period of time, and they become more active participants in achieving blood pressure goals that they themselves helped to set.”
Nationwide, almost 70 million people have hypertension. Most do not have their condition under control, placing them at risk for heart disease, stroke, and other life-threatening complications. HHC’s primary care practices treat about 120,000 hypertensive patients, with 43 percent having their condition under control and able to maintain their blood pressure below thresholds considered dangerous.
It is estimated that for every one percent improvement in the rate of patients with controlled hypertension across HHC’s patient population, 60 heart attacks and 24 strokes can be prevented each year.
Six additional HHC facilities have started using the same nurse-centered care model for hypertension management. Over the next year, as part of its Patient Centered Medical Home transformation, HHC is working to implement a similar approach for patients with multiple chronic illnesses including diabetes, depression, and high cholesterol.