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2019 HSR&D/QUERI National Conference Abstract

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1143 — Systems Redesign in the Development, Implementation, and Evaluation of a CAre Transitions and Hypertension (CATcH) management program for Veterans wit

Lead/Presenter: Jason Sico,  COIN - West Haven
All Authors: Sico JJ ((PRIME Center, West Haven VA)), Fenton, B. (PRIME Center, West Haven VA), , Burrone L. (PRIME Center, West Haven VA), Ellimuttil, S. (VA North Texas Health Care System, Dallas, TX), Hurd P. (VA North Texas Health Care System, Dallas, TX), Ragunton, J.M. (VA North Texas Health Care System, Dallas, TX), Jones W. (VA North Texas Health Care System, Dallas, TX), Damush, T. (Indianapolis VA)

Implementation science strategies, including Systems Redesign approaches, have the potential to develop, implement, and evaluate the implementation of interventions which treat hypertension among Veterans with stroke. We report the results of the CAre Transitions and Hypertension (CATcH) management program.

A bundled, multi-faceted, provider- and healthcare-systems level pilot-intervention designed to enhance care coordination using infrastructure routinely available within Veterans Health Administration (VHA) medical centers (VAMCs) was implemented within a large VAMC providing suboptimal post-stroke hypertension control. Two external facilitators with combined expertise in clinical stroke care, systems redesign, and implementation science conducted a rapid process improvement workshop with local personnel from internal medicine, neurology, clinical pharmacy, and the chief medical officer of the Veterans Integrated Service Network. The team process mapped out the current state of blood pressure (BP) control of post-stroke Veterans, from the hospitalization period to outpatient follow-up, and conceptualized a future state where there was enhanced care coordination between inpatient and outpatient providers, generalists and specialists, and increased engagement of underutilized talent within clinical pharmacy and telehealth. The CATcH bundle also included a Transition in Care note to improve communication between providers. The team decided to meet weekly with an external facilitator to determine newly identified and ongoing needs for patients. Chart review was conducted to determine healthcare utilization.

In the six-months prior to the implementation of CATcH, facility-level pass rate for BP control (i.e., obtaining BP < 140/90 mmHg) was 50% (18/36). Stroke survivors were neither discharged with telehealth for BP monitoring nor received clinical pharmacy appointments. In the six-months after CATcH implementation, facility-level pass rate for BP control was 69% (22/32). Nineteen percent were enrolled in telehealth whereas all patients received and attended at least two clinical pharmacy appointments post-discharge. All patients discharged during the intervention period were recipients of the CATcH program.

A systems redesign approach with external facilitation could be used to eliminate waste and minimize variability in the process of post-stroke hypertension management while improving hypertension care for stroke survivors.

As the CATcH program utilizes infrastructure available within VHA, this promising intervention could be spread to other VAMCs delivering suboptimal hypertension care.