This is simply a redrawing of yesterday’s graphic, based on California population data. This site has an excellent overview of the impact to California. It understates prevalence because it speaks of patients who have had hypertension diagnosed and does not include undiagnosed Californians.

I found a more recent article and updated proportions accordingly ( see, I did find something wrong with the previous diagram )

I added a new source, #3 below, since yesterday. This paper has newer control data with a more optimistic point of view:

The prevalence of hypertension has not increased significantly since 1999. At the same time, there has been increasing control rate of hypertension, especially in Mexican American men, elderly, and obese people - Ong, et. al (see below)

(formatted for Zotero):

1. Fang J, Alderman MH, Keenan NL, Ayala C, Croft JB. Hypertension Control at Physicians’ Offices in the United States. Am J Hypertens. 2008;21(2):136-142. Available at: http://dx.doi.org/10.1038/ajh.2007.35 [Accessed May 8, 2008].

2. Rosamond W, Flegal K, Furie K, et al. Heart Disease and Stroke Statistics–2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117(4):e25-146. Available at: http://circ.ahajournals.org [Accessed May 7, 2008].

3. Ong KL, Cheung BM, Man YB, Lau CP, Lam KS. Prevalence, Awareness, Treatment, and Control of Hypertension Among United States Adults 1999-2004. Hypertension. 2007;49(1):69-75. Available at: http://hyper.ahajournals.org/cgi/content/abstract/49/1/69 [Accessed May 15, 2008].

Tomorrow, a look at costs, direct and indirect, for the nation and California.

In April of this year, I swtiched gears slightly, from spending time to discover the determinants of patient access / connectivity to their care system through personal health records, to examining the possibilities of creating connectivity with the California Healthcare Foundation.

We’ve been talking to several people and the Foundation is allowing me to present our ideas in sequence, here, for critique, improvement, and interest among potential partners. The goal is to launch a project that will connect multiple stakeholders in the health ecosystem, to improve chronic care management, in California. Timeline and details are going to be posted over time.

Let’s start with the case for hypertension as a chronic illness worthy of examination, though. Take a look at this graphic. What does it say to you about the state of high blood pressure care in the United States? What are the opportunities using HIT and Health 2.0? Are there corrections to be made?

Welcome to my PDCA cycle. Sources are underneath - feel free to ask questions about any of this data. I’ll begin posting regularly under this category.

Update: After finding an error in the image, I decided to leave it in, with this note that it’s incorrect, and a corrected version is in this post. PDCA is about iteration.

Quote: “…undiagnosed hypertension and treated but uncontrolled hypertension occur largely under the watchful eye of the healthcare system.” - Hyman and Pavlik

Sources (formatted for Zotero):

1. Fang J, Alderman MH, Keenan NL, Ayala C, Croft JB. Hypertension Control at Physicians’ Offices in the United States. Am J Hypertens. 2008;21(2):136-142. Available at: http://dx.doi.org/10.1038/ajh.2007.35 [Accessed May 8, 2008].

2. Rosamond W, Flegal K, Furie K, et al. Heart Disease and Stroke Statistics–2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117(4):e25-146. Available at: http://circ.ahajournals.org [Accessed May 7, 2008].

Tomorrow: Impact to Californians

March 28th through March 29th:

• WordPress ? Search and Replace « WordPress Plugins - Wordpress 2.5 is out. I have a feeling this plugin will be useful to have handy
• JAMA — Preserving Confidentiality in the Peer Review Process, March 24, 2008, DeAngelis and Thornton 0 (2008): 299.16.jed80000 - With tremendous respect for Catherine DeAngelis’ leadership during a tough situation. I am left wondering if the best place to hide is out in the open - if peer review became more Web2.0 like. What would happen in a situation like this?
• Findings From the 2007 EBRI/Commonwealth Fund Consumerism in Health Survey - EBRI - About 2 percent of the population is enrolled in a consumer directed health plans. Significant points for me: (1) almost half of the population with a chronic condition reports not filling medications or skipping doses or delaying care due to cost. Sobering reminder that patients can and do choose to do what we doctors prescribe. (2) “There have been no significant gains int he provision of information on provider cost and quality by any health plan type over the three years of the survey. There has been no increase in the share of CDHP or HDHP enrollees who say their health plans provide them with quality and cost information about their providers, and they remain no more likely to receive such information than enrollees in more comprehensive plans.” Okay, one more point - they did not ask about the impact of involvement in care in choosing a health plan - no mention of medical records access or involvement in information sharing at the level of the encounter.
• My Starbucks Idea - How about doing this for a health care org?
• Bronson Beta - Mail.appetizer - Nice Mail notification tool, Leopard

November 19th through November 21st:

• Analysis - health08.org - Side by side analysis of candidates’ health reform proposals. From Kaiser Family Foundation
• Technorati Weblog: Blogosphere - Important reference on the growth of blogs and splogs, from Technorati
• Pew Internet & American Life Project - Internet Typology Quiz - What are you?