Improving Hypertension _ Diabetes Control and Prevention
An e-NEWSLETTER from Quality Insights                                                                                  January 5, 2017
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don't miss the upcoming Blood Pressure Quality Improvement Initiatives webinar from acmq

register now button Wednesday, January 17, 2018
12:00 p.m. to 1:00 p.m.

The American College of Medical Quality's (ACMQ) Education Committee invites you to its next complimentary Ask the Expert webinar, "Blood Pressure Quality Improvement Initiatives." 

College President-Elect Donald E. Casey, Jr., MD, MPH, MBA, DFACMQ, Principal of IPO4Health, will dialogue with Michael Rakotz, MD, FAHA, FAAFP, Vice President of Improving Health Outcomes, at the American Medical Association. Once you register to attend this webinar, please send Drs. Casey and Rakotz your questions in advance (by January 13) by completing this short online form.

Session Agenda:
  • Review the major key points of the new 2017 AHA/ACC High Blood Pressure Clinical Practice Guidelines
  • Identify some key implications for quality improvement of care for patients with high blood pressure
  • Examine implementation and preliminary results of a national Hypertension quality improvement initiative -- Target: BP
keep in mind these key points regarding screening and follow-up for High Blood Pressure in Adults

FREE Over t he next few weeks, Quality Insights will be highlighting several suggestions for screening and follow-up of high blood pressure in adults from the American College of Cardiology in our weekly e-newsletters.  

The following are a few key points to keep in mind based on the new blood pressure (BP) guidelines that were released in November of 2017:
  • It is critical that healthcare providers follow the standards for accurate BP measurement. BP should be categorized as normal, elevated, or stages 1 or 2 hypertension to prevent and treat high BP. Normal BP is defined as <120/<80 mm Hg; elevated BP 120-129/<80 mm Hg; hypertension stage 1 is 130-139 or 80-89 mm Hg, and hypertension stage 2 is ≥140 or ≥90 mm Hg.
  • Prior to labeling a person with hypertension, it is important to use an average based on ≥2 readings obtained on ≥2 occasions to estimate the individual's level of BP. Out-of-office and self-monitoring of BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication, in conjunction with clinical interventions and telehealth counseling.
  • It is important to screen for and manage other cardiovascular disease risk factors in adults with hypertension: smoking, diabetes, dyslipidemia, excessive weight, low fitness, unhealthy diet, psychosocial stress, and sleep apnea. Basic testing for primary hypertension includes fasting blood glucose, complete blood cell count, lipids, basic metabolic panel, thyroid stimulating hormone, urinalysis, electrocardiogram with optional echocardiogram, uric acid, and urinary albumin-to-creatinine ratio.
Click here to view more key points to remember from the 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.
American Diabetes Association Releases 2018 Standards of Medical Care in Diabetes 

diabetes graphic In a press release issued by the American Diabetes Association (ADA) on December 8, 2017, the Association announced the release of its 2018 edition of the  Standards of Medical Care in Diabetes (Standards of Care) which includes comprehensive recommendations that reflect the latest advances in evidence-based research to improve care for millions of people with diabetes. Some of these recommendations focus on:
  • Advances in cardiovascular disease risk management, including hypertension; an updated care algorithm that is patient-focused
  • The integration of new technology into diabetes management
  • Routine screening for type 2 diabetes in high-risk youth (BMI >85th percentile plus at least one additional risk factor)
The Standards of Care provides the latest in comprehensive, evidence-based recommendations for the diagnosis and treatment of children and adults with type 1, type 2 or gestational diabetes, strategies to improve the prevention or delay of  type 2 diabetes, and therapeutic approaches that reduce complications and positively affect health outcomes. 

The Standards of Care is published annually and is now available here.
Prediabetes Prevention: Patient vs. Provider Perspective

doc with patient Patient Perspective
Prediabetes can often be prevented and reversed with moderate exercise, weight loss and change in diet. There are millions of reasons why people don't find the time to make healthy lifestyle choices, but whatever the reason, prediabetes is real. 

The first important step a person can take to determine their prediabetes risk level is to take a quick online test, Do I Have Prediabetes. Healthcare providers  can distribute this test to patients and make them available in the waiting room areas, and/or make a link available on their website or patient portal. The hard copy tests are available for  download in both English  and Spanish.

In addition to focusing on the person with prediabetes, it is also important to engage the systems and communities where people live, work and play. We can all act - today. For tips and tools, visit the  Prevent Diabetes STAT website.  

Provider Perspective
A recent Diabetes in Control article, Prediabetes Risk Unrecognized by Most PCPs , reviewed a study that was conducted to assess primary care providers (PCP) on the following:
  • Knowledge of risk factors that should prompt prediabetes screening, laboratory criteria for diagnosing prediabetes and guidelines for management of prediabetes
  • Management practices around prediabetes
  • Attitudes and beliefs about prediabetes
According to the article, researchers surveyed 140 PCPs associated with Johns Hopkins in Baltimore and found the ADA guidelines were helpful for 42 percent of respondents, while 30 percent were unfamiliar with these guidelines.
Some key takeaways from the article include:
  • Only six percent of PCPs were able to identify 11 prediabetes risk factors that would prompt them to screen patients under the ADA guidelines
  • Any patient with just one of the risk factors for prediabetes should be followed up with and an A1C test should be done
  • Addressing gaps in knowledge and the underutilization of behavioral weight loss programs in prediabetes are two essential areas where PCPs could take a lead in curbing the diabetes epidemic
reminder about program year 2017 meaningful use applications 

Please remember that the Pennsylvania Medical Assistance (MA) EHR Incentive Program continues to process Program Year (PY) 2016 applications and that you cannot begin PY 2017 applications until your PY 2016 applications have been processed. 
contact information

For more details about the Improving Hypertension and Diabetes Care & Prevention project, please contact Rhonda Dodson.
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Funding provided by the Pennsylvania Department of Health through the State Public Health Actions to Prevent and Control 
Diabetes,  Heart Disease, Obesity and Associated Risk Factors and Promote School Health federal grant from the Centers for 
Disease Control  and Prevention. Publication number: PADOH-HD-010518