Prescriptions for a medication regimen to reduce heart attacks and strokes in patients with diabetes increased by nearly 40 percent after community health centers implemented Kaiser Permanente’s “ALL” quality improvement protocol, according to a new study published today in Implementation Science, an open access journal promoting the uptake of research findings into clinical practice.
The ALL protocol, established by Kaiser Permanente in 2003, reminds providers to prescribe blood pressure-lowering medications (ACE-inhibitors) and/or lipid-lowering medications (statins) for people with diabetes, who are often at increased risk for heart attacks and strokes.
In 2009, an observational study at Kaiser Permanente showed that patients who took the medications had a 60 percent lower chance of being hospitalized for heart attack or stroke.
The protocol was so successful in Kaiser Permanente that it has since been adopted by 55 community health centers serving approximately 80,000 patients in four states. This study included 11 clinics in Oregon.
“This is the first clinical trial to test how a care improvement program developed by a private, integrated health system can be successfully implemented in a public health system that serves millions of low-income and uninsured patients,” said Rachel Gold, PhD, MPH, lead author and researcher with the Kaiser Permanente Center for Health Research in Portland, Oregon. “With more at-risk patients in these clinics on cardio-protective medications, the hope is that they will have a reduced risk for heart attacks and strokes.”
The study clinics share a centralized electronic medical record through a nonprofit organization called OCHIN. For this study, OCHIN added alerts to the clinics’ EMR to notify providers when patients met clinical guidelines to receive the medications, and shortcuts to expedite ordering the medications. The EMR tools were modeled after Kaiser Permanente’s ALL protocol, but were adapted for the community health centers.
Before the EMR tools were added, about 45 percent of the community health center patients who met the clinical guidelines received the medications. After the tools were added, that number rose to 63 percent.
“Part of Kaiser Permanente’s mission is to improve the health of the communities where we live,” said Winston Wong, MD, medical director, Kaiser Permanente Community Benefit in Oakland, California. “This study shows how we are doing that, and it sets the stage for Kaiser Permanente and other private health systems to share best practices with public health systems that care for the nation’s most vulnerable patients.”
Additional study authors include Arwen Bunce, Celine Hollombe, MPH, James Davis, Nancy Perrin, PhD, and Greg Nichols, PhD, of the Kaiser Permanente Center for Health Research in Portland, Oregon; Christine Nelson, PhD, RN, Stuart Cowburn, MPH, and Jon Puro, MPA, of OCHIN in Portland, Oregon; John Muench, MD, Oregon Health & Sciences University in Portland, Oregon; Christian Hill, MD, of the Virginia Garcia Memorial Health Center in Beaverton, Oregon; and Meena Mital, MD, formerly of the Multnomah County Health Department in Portland, Oregon.
Collaborators on the implementation include: Wiley Chan, MD, and James Dudl, MD, of Kaiser Permanente; Ann Turner, MD, and MaryBeth Mercer of the Virginia Garcia Memorial Health Center; Victoria Jaworski, RN, of the Multnomah County Health Department; Colleen Howard, RN, Emma Abiles, and Jennifer DeVoe, PhD, MD, of Oregon Health & Science University; and Amit Shah, MD, of CareOregon.
The study was funded by grant 1R18HL095481-01A1 from the National Heart, Lung and Blood Institute at the National Institutes of Health.
About the Kaiser Permanente Center for Health Research
The Kaiser Permanente Center for Health Research, founded in 1964, is a nonprofit research institution dedicated to advancing knowledge to improve health. It has research sites in Portland, Oregon, and Honolulu. Visit kpchr.org for more information.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 9.1 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.
About OCHIN
OCHIN is one of the nation’s largest Health Information Networks and is recognized for its innovative use of Health IT to improve the integration and delivery of health care services across a wide variety of practices. OCHIN operates in 19 states and supports over 4,500 medical providers who serve over 2.5 million patients. Visit www.ochin.org for more information.