2017 Southern California Dissemination, Implementation and Improvement (DII) Science Symposium Be There San Diego: Improving Cardiovascular Disease Prevention through a Regional Quality Collaborative Christine Thorne, MD, MPH - University of California, San Diego Allen Fremont, MD, PhD - RAND Corporation; UCLA; VA Greater Los Angeles HealthCare System For more information on DII, go to: https://ctsi.ucla.edu/patients-community/pages/dissemination_implementation_improvement

1. Improving Cardiovascular Disease Prevention
through a Regional Quality Collaborative
Southern California Dissemination Implementation and Improvement Science
Symposium
Christine Thorne, MD, MPH
May 3, 2017

2. Be There San Diego
§ A quality collaborative in San Diego
County focused on preventing heart
attacks and strokes through improved
management of cardiovascular disease risk
factors.
o Spread best practices
o Scale up evidence based
approaches
o Use data to motivate and
evaluate progress

3. Health Care Organizations
Kaiser-Permanente
La Maestra Community Health Center*
Mountain Health and Community Health Services
Multicultural IPA
Neighborhood Healthcare*
North County Health Services*
San Diego Family Care*
Scripps Clinic
Scripps Coastal Medical Center
Sharp Rees-Stealy Medical Group
UCSD Medical Group
Vista Community Clinic*
*Federal Qualified Health Clinic
Data Quality Collaborative Participants
§ Quality Measures Tracked
• Hypertensives with BP <140/90
• Diabetics with BP <140/90
• Diabetics with HbA1c <8
• Diabetics with HbA1c >9
• 209,688 patients with
hypertension
• Approximately 1 in 3
hypertensives in the County are
included in our data
• For every 2 % gain another 4200
patients have their hypertension
under control

4. BTSD: BP Control Rate among Hypertension Patients
by Year (all payers)
4
83% 84% 82%
72%
74%
76%
79%
50%
60%
70%
80%
90%
100%
Weighted average across groups reported in a given year
CA Avg (2015)
Nat 90th (2015)

5. Changing size and Mix of Data Group HTN population
as DFQ Matured
5
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
200000
2010 2011 2012 2013 2014
Number of HTN reported on by year and group
UCSD
Sharp-RS
Scripps Coastal
Scripps Clinic
MultiCultural IPA
Kaiser
CCC
Arch

8. Comprehensive Approach to Cardiovascular Disease
across the Determinants of Health
8
Clinical – Community Linkages Interventions
• Engage community pharmacists
• Engage community health workers
• Develop bi-directional referral
recommendations
• Promote partnerships between
faith-based organizations and clinicians
Clinical Interventions
• Promote use of the ASCVD Risk
Calculator
• Promote the use of the CVD Risk
Medication Bundle
• Promote team based care, including
pharmacists on the care team and
health coaches
• Test innovative technologies for CVD
risk
• Promote sharing of best practices
Community Interventions
• Engage faith-based organizations
in creating heart health PSEs
• Promote use of community blood
pressure screenings
• Promote home blood pressure
monitoring
• Raise awareness of CVD risk
factors
• Partner with community
leadership groups
Health Care System Transformation
Interventions
• Share intermediate outcome data
between medical groups
• Assess and promote the use of
clinical decision support tools
• Promote pharmacist integration
across the health care system
• Support linkages between clinical
and public health community
• Develop payment model to support
population health
We are a regional integrator with a commitment to increasing health equity, working collaboratively across sectors, and creating sustainable
change. Our infrastructure is built on strategic planning, coalition building, data management and analytics, outcome evaluation, and
developing financial sustainability.

9. Influences from Outside of Be there San Diego
9

10. What has been the progress towards the goal of BP
control in 80% of hypertension patients?
10
71
89
69 71
58
70
66 67
75
69
80
87
80
79
58
71
74
59
64
79
76
63
0
10
20
30
40
50
60
70
80
90
100
Percentage of Hypertension Patients with Controlled Blood Pressure (BP <
140/90) in Q1 2015 and Q4 2016
Q1 2015
Q4 2016
80% Goal
* Combined percentage is weighted and accounts for patients within groups shown in figure only (i.e., excludes Groups A, I, K which
lacked validated 2015 data).
At or above goal Within 5% of goal

11. Outcomes: Comparison of Two Divergent Groups
11
50%
55%
60%
65%
70%
75%
80%
85%
Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016
Trend in Hypertension Control Rate Q1 2015 - Q4 2016
Group 2 Group 7 All Groups Combined

12. Outcomes: High Achieving Group
12
Attendance – University of Best Practices 2014-2016
Total Attendance (All Persons) 31
Total Medical Director 20
• Measure Up/Pressure Down Collaborative
2013
• Heart Attack and Stroke Free Zone Project
Participant 2015-Present
0.64
0.66
0.68
0.7
0.72
0.74
0.76
0.78
0.8
0.82
Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016
Trend in Hypertension Control Rate Q1 2015 - Q4 2016
Group 2 All Groups Combined
Adopted BTSD
Simplified Approach to
Hypertension
Treatment Algorithm
Hypertension
Workflow
Toolkit Rolled
Out
Standardized
training and toolkit
implementation

13. Outcomes
13
UCSD
Hypertension treatment
approach 2017
Health Coach Project
2015-2017
Attendance – University of Best Practices 2014-2016
Total Attendance (All Persons) 16
Medical Director 0
0.5
0.55
0.6
0.65
0.7
0.75
0.8
0.85
Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016
Trend in Hypertension Control Rate Q1 2015 - Q4 2016
Group 7 All Groups Combined
Heart Attack and Stroke Free Zone
Project Participant 2015-Present
Roll-Out of System
Wide Hypertension
Treatment
Approach - 2017

14. Feedback from Teams
§ “We talk to our physicians and we tell them,
’the community clinics can do this with their
patients. If they can do that, why are your
patients not at goal?’”
§ “When a doctor/medical director starts to
question if they can do it, [you realize] you can
too.”
§ “It allows other benchmarks [of peers in the
community]”
§ “Always stay focused on the ultimate goal of
improving the health of the community in which
the groups practice, rather than the performance
results of any individual group.” —Dan
Dworsky, MD, Vice President of Quality and
Value, Scripps Clinic Medical Group
14

15. Be There San Diego: Quality Improvement Next steps
§ Recommendations:
• Undiagnosed Hypertension
• Team-Based Care
• Self-Management of Blood
Pressure
§ Improving data quality and
expanding measures
§ Considering next steps in looking at
tackling another chronic disease
with more complex quality
measures, such as diabetes
15

16. Thank you