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Discussion
Changes in health care delivery improved hypertension control in a large and diverse population throughout all demographic subgroups, including Hispanic and non-Hispanic black patients and patients receiving Medicaid. The Kaiser health plan encompasses Los Angeles County, where 48% of residents are Hispanic compared with 38% in California overall and 17% in the United States. Nationally, there are significant gaps in awareness, treatment, and control of hypertension between the non-Hispanic white and Hispanic populations. However, there is no difference in hypertension control between these populations in the Kaiser population. Our results demonstrate that system-wide changes can affect all subpopulations of patients.
This study has several limitations. First, we described a continuous quality improvement process over time with many changes occurring simultaneously. The relative contribution of any of the individual best practices could not be quantified. Second, the hypertension registry may have included patients without hypertension. Finally, the importance of the context of a fully integrated health care delivery system cannot be estimated and probably magnified overall success. Therefore, these results may not be transferable to a system lacking integrated health care delivery.
Increasing hypertension control in the United States by 2017 to the Million Hearts population goal of 70%, including people with and without a usual source of care, would substantially reduce heart attacks and strokes. Treatment and control of hypertension has a greater impact in patients with other cardiovascular risk factors, such as age, black race, and additional comorbidities, such as diabetes. Through the implementation of a series of health care delivery changes, Kaiser improved hypertension control from 54% to 86% in its patient population. The systematic use of a collection of basic implementation tools and protocols is associated with significant success in hypertension control across a large multiethnic population.
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