Population health management of low-density lipoprotein cholesterol via a remote, algorithmic, navigator-executed program

Plutzky, Jorge; Benson, Mark D.; Chaney, Kira; Bui, Tiffany V.; Kraft, Michael D.; Matta, Lina; McPartlin, Marian; Zelle, David; Cannon, Christopher P.; Dodek, Anton; Gaziano, Thomas A.; Desai, Akshay S.; MacRae, Calum A.; Scirica, Benjamin M.

doi:10.1016/j.ahj.2021.08.017

Cited by 8 publications

(12 citation statements)

References 23 publications

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“…Patients met criteria for cholesterol lowering based on 4 class I/level A criteria for recommended LDL-C therapy: age 26 to 80 years with LDL-C 70 mg/dL (to convert to mmol/L, multiply by 0.0259) or greater and clinical ASCVD; age 26 to 80 years with severe hypercholesterolemia (any historical LDL-C 190 mg/dL or greater); age 40 to 75 years with diabetes or hemoglobin A 1c greater than 6.5% and LDL-C 70 to 189 mg/dL; age 40 to 75 years with LDL-C 100 to 189 mg/dL and a calculated 10-year ASCVD risk of 7.5% or higher . Further details on the characteristics of this program have been published previously …”

Section: Methodsmentioning

confidence: 99%

“…The current health care delivery model exacerbates much of the heterogeneity in care, underrecognizes population risk, and permits persistent disparities in care . Over the past 5 years, our care delivery team has developed a series of remotely delivered chronic disease management programs driven by standardized medical and workflow algorithms, staffed by trained but nonlicensed navigators and licensed pharmacists, and backed by the professional staff of the Mass General Brigham (MGB) health care system . A variety of digital solutions support the clinical workflows to improve efficiency, enforce standardization, expand communication channels, and improve data collection and analysis.…”

Section: Introductionmentioning

confidence: 99%

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Results of a Remotely Delivered Hypertension and Lipid Program in More Than 10 000 Patients Across a Diverse Health Care Network

et al. 2023

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ImportanceBlood pressure (BP) and cholesterol control remain challenging. Remote care can deliver more effective care outside of traditional clinician-patient settings but scaling and ensuring access to care among diverse populations remains elusive.ObjectiveTo implement and evaluate a remote hypertension and cholesterol management program across a diverse health care network.Design, Setting, and ParticipantsBetween January 2018 and July 2021, 20 454 patients in a large integrated health network were screened; 18 444 were approached, and 10 803 were enrolled in a comprehensive remote hypertension and cholesterol program (3658 patients with hypertension, 8103 patients with cholesterol, and 958 patients with both). A total of 1266 patients requested education only without medication titration. Enrolled patients received education, home BP device integration, and medication titration. Nonlicensed navigators and pharmacists, supported by cardiovascular clinicians, coordinated care using standardized algorithms, task management and automation software, and omnichannel communication. BP and laboratory test results were actively monitored.Main Outcomes and MeasuresChanges in BP and low-density lipoprotein cholesterol (LDL-C).ResultsThe mean (SD) age among 10 803 patients was 65 (11.4) years; 6009 participants (56%) were female; 1321 (12%) identified as Black, 1190 (11%) as Hispanic, 7758 (72%) as White, and 1727 (16%) as another or multiple races (including American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, unknown, other, and declined to respond; consolidated owing to small numbers); and 142 (11%) reported a preferred language other than English. A total of 424 482 BP readings and 139 263 laboratory reports were collected. In the hypertension program, the mean (SD) office BP prior to enrollment was 150/83 (18/10) mm Hg, and the mean (SD) home BP was 145/83 (20/12) mm Hg. For those engaged in remote medication management, the mean (SD) clinic BP 6 and 12 months after enrollment decreased by 8.7/3.8 (21.4/12.4) and 9.7/5.2 (22.2/12.6) mm Hg, respectively. In the education-only cohort, BP changed by a mean (SD) −1.5/−0.7 (23.0/11.1) and by +0.2/−1.9 (30.3/11.2) mm Hg, respectively (P &lt; .001 for between cohort difference). In the lipids program, patients in remote medication management experienced a reduction in LDL-C by a mean (SD) 35.4 (43.1) and 37.5 (43.9) mg/dL at 6 and 12 months, respectively, while the education-only cohort experienced a mean (SD) reduction in LDL-C of 9.3 (34.3) and 10.2 (35.5) mg/dL at 6 and 12 months, respectively (P &lt; .001). Similar rates of enrollment and reductions in BP and lipids were observed across different racial, ethnic, and primary language groups.Conclusions and RelevanceThe results of this study indicate that a standardized remote BP and cholesterol management program may help optimize guideline-directed therapy at scale, reduce cardiovascular risk, and minimize the need for in-person visits among diverse populations.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Results of a Remotely Delivered Hypertension and Lipid Program in More Than 10 000 Patients Across a Diverse Health Care Network

et al. 2023

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“…Among all the evaluated dimensions in the included interventions, reach was documented most extensively. In total, 15 interventions reported five out of seven reach components ( 19 , 20 , 22–25 , 27–29 , 34 , 36–38 , 44 ). All interventions provided information on the target population, and 20 described the method of identifying the target population.…”

Section: Resultsmentioning

confidence: 99%

Population health interventions for cardiometabolic diseases in primary care: a scoping review and RE-AIM evaluation of current practices

Rakers,

van Hattem,

Plag

et al. 2024

Front. Med.

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IntroductionCardiometabolic diseases (CMD) are the leading cause of death in high-income countries and are largely attributable to modifiable risk factors. Population health management (PHM) can effectively identify patient subgroups at high risk of CMD and address missed opportunities for preventive disease management. Guided by the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework, this scoping review of PHM interventions targeting patients in primary care at increased risk of CMD aims to describe the reported aspects for successful implementation.MethodsA comprehensive search was conducted across 14 databases to identify papers published between 2000 and 2023, using Arksey and O’Malley’s framework for conducting scoping reviews. The RE-AIM framework was used to assess the implementation, documentation, and the population health impact score of the PHM interventions.ResultsA total of 26 out of 1,100 studies were included, representing 21 unique PHM interventions. This review found insufficient reporting of most RE-AIM components. The RE-AIM evaluation showed that the included interventions could potentially reach a large audience and achieve their intended goals, but information on adoption and maintenance was often lacking. A population health impact score was calculated for six interventions ranging from 28 to 62%.DiscussionThis review showed the promise of PHM interventions that could reaching a substantial number of participants and reducing CMD risk factors. However, to better assess the generalizability and scalability of these interventions there is a need for an improved assessment of adoption, implementation processes, and sustainability.

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“…The structure and development of our entirely remote cardiovascular health program has been previously described. 14 , 15 , 16 Our umbrella program enrolls patients with low‐density lipoprotein cholesterol and/or BP above target identified either through direct referral or electronic health record (EHR) screening (with primary care provider assent). This study was limited to our remote hypertension management solution, where patient enrollment was predominantly through direct referral (75% during the prepandemic period and 83% during the pandemic period).…”

Section: Methodsmentioning

confidence: 99%

Remote Cardiovascular Hypertension Program Enhanced Blood Pressure Control During the COVID‐19 Pandemic

Lee

Blood

Cannon

et al. 2023

JAHA

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Background The COVID‐19 pandemic disrupted traditional health care; one fallout was a drastic decrease in blood pressure (BP) assessment. We analyzed the pandemic's impact on our existing remote hypertension management program's effectiveness and adaptability. Methods and Results This retrospective observational analysis evaluated BP control in an entirely remote management program before and during the pandemic. A team of pharmacists, nurse practitioners, physicians, and nonlicensed navigators used an evidence‐based clinical algorithm to optimize hypertensive treatment. The algorithm was adapted during the pandemic to simplify BP control. Overall, 1256 patients (605 enrolled in the 6 months before the pandemic shutdown in March 2020 and 651 in the 6 months after) were a median age of 63 years old, 57% female, and 38.2% non‐White. Among enrolled patients with sustained hypertension, 51.1% reached BP goals. Within this group, rates of achieving goal BP improved to 94.6% during the pandemic from 75.8% prepandemic ( P <0.0001). Mean baseline home BP was 141.7/81.9 mm Hg during the pandemic and 139.8/82.2 prepandemic, and fell ≈16/9 mm Hg in both periods ( P <0.0001). Maintenance during the pandemic was achieved earlier (median 11.8 versus 19.6 weeks, P <0.0001), with more frequent monthly calls (8.2 versus 3.1, P <0.0001) and more monthly home BP recordings per patient (32.4 versus 18.9, P <0.0001), compared with the prepandemic period. Conclusions A remote clinical management program was successfully adapted and delivered significant improvements in BP control and increased home BP monitoring despite a nationally observed disruption of traditional hypertension care. Such programs have the potential to transform hypertension management and care delivery.

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Population health management of low-density lipoprotein cholesterol via a remote, algorithmic, navigator-executed program

Cited by 8 publications

References 23 publications

Results of a Remotely Delivered Hypertension and Lipid Program in More Than 10 000 Patients Across a Diverse Health Care Network

Results of a Remotely Delivered Hypertension and Lipid Program in More Than 10 000 Patients Across a Diverse Health Care Network

Population health interventions for cardiometabolic diseases in primary care: a scoping review and RE-AIM evaluation of current practices

Remote Cardiovascular Hypertension Program Enhanced Blood Pressure Control During the COVID‐19 Pandemic

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Population health management of low-density lipoprotein cholesterol via a remote, algorithmic, navigator-executed program

Cited by 8 publications

References 23 publications

Results of a Remotely Delivered Hypertension and Lipid Program in More Than 10 000 Patients Across a Diverse Health Care Network

Results of a Remotely Delivered Hypertension and Lipid Program in More Than 10 000 Patients Across a Diverse Health Care Network

Population health interventions for cardiometabolic diseases in primary care: a scoping review and RE-AIM evaluation of current practices

Remote Cardiovascular Hypertension Program Enhanced Blood Pressure Control During the COVID‐19 Pandemic

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Product

Resources

About

Results of a Remotely Delivered Hypertension and Lipid Program in More Than 10 000 Patients Across a Diverse Health Care Network

Results of a Remotely Delivered Hypertension and Lipid Program in More Than 10 000 Patients Across a Diverse Health Care Network