The CDC and CMS added four NYC Health + Hospitals' facilities to the Million Hearts Hypertension Control Champion list in 2024, which recognizes hospitals who have achieved blood pressure control for at least 80% of adult hypertension patients.
Only six hospitals in New York State achieved the recognition in 2024, according to a Nov. 27 news release from NYC Health + Hospitals.
With the 2024 additions, NYC Health + Hospitals now has five facilities on the Hypertension Control Champion list: NYC Health + Hospitals/Elmhurst; NYC Health + Hospitals/South Brooklyn Health; NYC Health + Hospitals/Gotham Health, Belvis; NYC Health + Hospitals/Gotham Health, Cumberland; and NYC Health + Hospitals/Gotham Health, Morrisania, which earned the distinction in 2023.
According to the Million Hearts' website, there are 199 Hypertension Champions in the U.S., caring for 16 million adults across 44 states.
Karyn Singer, MD, physician and assistant vice president of chronic disease and prevention at NYC Health + Hospitals spoke with Becker's about how the system was able to achieve hypertension control across four sites in one year.
Editor's note: Responses have been lightly edited for clarity and length.
Question: Was there a coordinated, systemwide effort to get patient blood pressure under control?
Dr. Karyn Singer: This initiative has been years in the making. Blood pressure control is one of the most important and prevalent chronic conditions we face, with potentially severe outcomes if unmanaged. Clinical teams take it very seriously. Over the years, our clinical toolkit has grown to support frontline efforts. Clinical pharmacists, introduced about five to six years ago, are now present in all major hospitals and clinics. Chronic disease nurses have been integral to the program for even longer, with each site having one or two dedicated nurses. We’ve also improved our data capabilities with the integration of Epic, allowing us to track prescribing patterns, identify uncontrolled patients and differentiate between true hypertension and white coat hypertension. These advancements, combined with the hard work of our nurses, pharmacists, PCPs and other frontline staff, have driven significant progress.
We are incredibly proud of this team effort. The collaboration and dedication of everyone involved, especially those on the frontlines, have been key to improving patient outcomes. We’re excited about what we’ve achieved and are committed to continuing these efforts to benefit our patients.
Q: What advice would you give to other health systems aiming to replicate these results?
KS: The first thing is just making sure blood pressure is being taken correctly. From a system standpoint, one of the things that we've been able to do is have accurate data to focus on the folks who need the most support to get their blood pressure under control.
We have reports that are available to any frontline staff that will tell them, within a clinic, which have diagnosed high blood pressure, are they controlled or not and when is their next appointment. We also have a specific outreach report, which identifies patients who have a diagnosis of hypertension, have had a recent visit, but don't have a subsequent visit scheduled.
The intent here is to catch patients before they fall for the cracks. We want to be sure that if you have a chronic condition like hypertension, we're getting you into the system. That's a really useful tool, because it means the frontlines don't have to go through the data one by one. It can identify those patients easily for the front lines to focus their efforts on getting those folks in.
Q: What care strategies were most effective in helping 80% of adult hypertension patients reach blood pressure control?
KS: We have a comprehensive team of people that can support patients between visits with the PCP. Coming in to see the PCP once every three to four months is great, but that's not going to get your blood pressure under control for folks who need more support.
We have chronic disease nurses who are nurses trained in helping to coach patients through adhering to a healthy diet and exercise, and also doing outreach for patients.
We have clinical pharmacists at all of our large clinics and hospital outpatient sites who can help prescribe medication and have more capacity to see patients more frequently.
We have another program with nurses — not just chronic disease nurses, but all staff nurses — called "Treat to Target." This initiative allows nurses to follow up with patients every two weeks to assess their adherence to blood pressure medication. This includes identifying whether patients are experiencing side effects, encountering barriers such as insurance issues, being unable to afford medications or receiving incorrect pharmacy instructions.
Q: A lot of the programs seem focused on patient engagement. What insights can you share on the best ways to invest in patient engagement or encourage providers to effectively engage patients?
KS: Patients tend to take their doctor's advice seriously. While there are many priorities in patient visits, hypertension is one that warrants dedicated time. PCPs should emphasize to patients that high blood pressure needs attention, even if they feel fine. Providing home blood pressure cuffs for those not meeting their target is vital so they can monitor their progress. Telehealth, including video visits and phone calls, has been incredibly effective in reaching these patients. When combined with home blood pressure monitoring, it allows for meaningful medical adjustments without requiring office visits.
During the pandemic, our blood pressure control rates plummeted because we couldn’t measure it without in-person visits. To address this, we implemented a system-wide effort to supply blood pressure cuffs. Our office distributes about 10,000 blood pressure cuffs annually to patients for whom the cost is prohibitive so they can monitor their blood pressure at home. This approach enables telehealth visits where we can gather accurate measurements, track home blood pressure data in a discrete field within the electronic health record and ensure that every provider or clinical team member can access the data easily. Additionally, we provide high-quality, validated blood pressure cuffs to ensure accurate readings.
Q: There are a few different types of devices marketed for measuring blood pressure, but it seems like the cuffs are the most reliable?
KS: One critical issue is the availability of validated blood pressure cuffs. Many on the market are approved for safety but not validated for accuracy. We ensure that the cuffs we distribute are validated, and we educate patients about choosing reliable devices. While the list of validated cuffs changes frequently, staying informed is essential to ensure accuracy in readings.