Yes, that is a 90% Hypertension Control Rate

The results are in from what is considered the report card for health plans in the United States, and these results are kind of amazing.

I was reminded of this when I was at the #DesignForAction conference in Washington, DC, where in one of the sessions about health, the current United States’ rate of blood pressure control was bemoaned to be around 50%. This figure is sadly true.

Except at Kaiser Permanente.

Like I said, amazing. The number is 86% across Kaiser Permanente, 91% for the number one health plan in the nation, Kaiser Permanente Mid-Atlantic States, which is also number one in 7 other measures.

In the Medicare population, it’s even higher, 94% across Kaiser Permanente, 95% in Kaiser Permanente Mid-Atlantic States.

-> 95% <-

That means that 5% of Medicare members do not have their hypertension under control. Unheard of.

The 50th, 75th, 90th, and 95th percentiles for blood pressure control are


Every Kaiser Permanente region is above the 95th percentile.

Breast cancer screening, similar story

Kaiser Permanente Mid-Atlantic States is #1 in the nation at 90%, every Kaiser Permanente region is number one in the state it operates, except for Kaiser Permanente Northern California (88%). It’s #2 to Kaiser Permanente Southern California (88%) 🙂 .

Overall, Kaiser Permanente is number 1 in 21 measures, out of 83 total measures, across 5 domains of care.

News, Views and Moves from Kaiser Permanente

Source: Kaiser Permanente Share | Being the Best Saves Lives: Kaiser Permanente Leads the Nation in 21 Quality Measures

Data Graphic: Patient-Physician E-mail improves care

When I decided to toss most of the slides I was going to show at the Consumer Health Congress in Washington, DC, I knew that I would be able to share that information here, in the social media world, where the conversation never ends.

Here is some impressive data regarding the impact of patient-physician e-mail.


Technology does not replace us…

We use it to improve the care we provide

Key points:

  • People ultimately rely on health professionals as their primary source of health information. Therefore, “getting information online” and “getting information from your doctor” should not be considered mutually exclusive (and surveys should not present this dichotomy – I have good information that @SusannahFox is totally on top of this :))
  • At a place where patients get information from their doctor AND online, Kaiser Permanente, you can see a significant improvement in blood pressure control on the part of patients who did e-mail their doctor versus those that didn’t.

This data comes from the online appendix to this study published in Health Affairs in July. I decided to pull out blood pressure specifically, but you can see from the article that overall this was the case with all of the quality measures studied (with a nod to the nice people at Health Affairs who allowed me to leave the table in after I published it before checking with them – at least I am easy to train).

All of this put together is, kind of huge. A condition that affects 1/3 of American adults, is accountable for 27 % of CVD events in women, 37 % of CVD events in men, is the #1 reason for physician office visits in the United States, can be managed by patients and physicians together, with the help of electronic systems that provide information online WITH (not instead of) from doctors and nurses.

At this point in the presentation, when the audience might be thinking, “Kaiser Permanente can do that, I can’t,” I would show this slide. And I believe it. Enjoy.

And you will, too.

Now Reading: Improved Quality At Kaiser Permanente Through E-Mail Between Physicians And Patients

This article, published in Health Affairs today, adds to the body of information we already have about patients and physicians enjoying the benefits of secure e-mail access to each other, with information about impacts on health care quality.

Thanks to the scale of Kaiser Permanente (and even in just one region of Kaiser Permanente), it is possible to look at the use of secure e-mail between patients and the 3,092 primary care physicians (there are 6,000 total in this multi-specialty group) who had used it with at least one patient, by December, 2008.

And…in a comparison between patients with diabetes and/or hypertension who did and did not exchange e-mail with their physicians two months after the service was available, there was a statistically significant (better) improvement of all of the Healthcare Effectiveness Data and Information Set (HEDIS) measures for this population.

Not just one of the measures analyzed, all of them.

In addition, the more messages sent resulted in more improvement for four measures (HbA1c and cholesterol screening, HbA1c control, and nephropathy screening).

The patients with e-mail use were compared to patients similar to them based on baseline measures (where they started disease-wise), age, sex, and primary care provider. In other words, this takes care of differences between doctors who may practice differently in terms of working with patients to improve health.

What this matching does not take care of, as the authors point out, are patients that are more likely to use secure e-mail in the first place, because they have more resources, they are more engaged, etc.

On this note, I have been having conversations of late about the “engaged in their health” person. I know that a lot of people are taught to promote the idea that many patients don’t want to be engaged in their health, but really, this is an idea whose origin is not clear to me. How many people do we know that want to be engaged in being sick? Comment from the patient community?

One thing to notice – look at the rate of blood pressure control across all the patients – 90%. This is unheard of in most of health care, where the average control rate is less than 40%, in a condition (high blood pressure) that accounts for 27% of total CVD events (stroke, heart attack) in women and 37% in men. That by itself is huge, and it actually makes a study like this very difficult, because unlike the rest of health care, in this system there is almost nowhere to go but down.

One note from the authors that I agree is worth considering, an unintended consequence of a system that still thinks “in person” is more important than “accessible”:

Nonfinancial barriers to the use of e-mail should also be addressed. Current quality measures, such as those used by HEDIS and the National Committee for Quality Assurance, rely on face-to-face visits as the standard of care. For example, an office visit is now required to document the ongoing presence of hypertension.

These are impressive findings, and I think ready (and useful) to be replicated in health environments where the quality numbers are not as good to begin with. I do not say this pejoratively, all health systems can be this good for their patients, and every tool helps. If you are a health care provider or patient using an online system to communicate, please post your experiences in your perceived quality of care since you began, even anecdotally, what do you think?

I feel the need to paste in Exhibit 1, showing the p values of improvement for each measure checked. Looks good.

courtesy Health Affairs