Preventing heart attacks by bringing the care team into home care

Hypertension, or high blood pressure, is a major factor in heart attacks, strokes, kidney disease and other conditions. It affects almost half of all adults in the United States and is the primary diagnosis in 33.6 million visits to physician offices each year.

Read the Agency for Healthcare Research and Quality’s grantee profile of Dorr.

Empowering people to have much better control of their blood pressure and reducing the likelihood that they have a heart attack or stroke has been an aim of David Dorr, M.D., professor and vice chair of medical informatics and clinical epidemiology at the OHSU School of Medicine, for more than 15 years.

In Enhancing Complex Care through an Integrated Care Coordination Information System, Dorr first demonstrated that a system of integrated care coordination could be successfully implemented in a diverse set of clinics using certified electronic health records. The 2008 project was supported by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality, or AHRQ, which has been a major funder of Dorr’s work.

Now, Dorr and a multi-institutional research team are in the testing phase of a tool called COACH, or Collaboration-Oriented Approach for Controlling High Blood Pressure, that aims to bring the care team into home care through connecting information that the patients provide with data the care team has about them — and then empowering the patient with easy-to-understand recommendations about what they can do to improve their current health themselves.

“People are interested in using these kinds of tools that can monitor their condition, provide information on how to perform the home tests, count steps, send reminders,” said Dorr, who is also chief research information officer at OHSU.

Building a successful COACH

In order to understand how best to implement these kinds of tools sustainably — both in clinics and at people’s homes — Dorr knows it’s essential to talk with patients living with high blood pressure in addition to the medical care teams.

The researchers recently completed site visits with medical assistants, pharmacists, nurse providers, medical directors and clinic managers. Each group had insight into how to make the system work more effectively; they share the research team’s interest in better engaging people to manage their own health at home.

People living with high blood pressure and their families were able to help investigators understand what barriers they face in their home care and what features might help them achieve their goals.

“Importantly, effective home-based care addresses the worry or discomfort many people experience trying to manage their blood pressure at home,” said Dorr. “Individuals often don’t know what the pressures mean and they don’t know whether there is any action they can take — and what that action could be.”

Science-based care: Common and individual

To control high blood pressure, many of the most effective recommendations will be the same regardless of the individual: Increase physical activity, watch nutrition, stop tobacco use, reduce alcohol content and improve sleep. Individuals may also have unique needs, depending on their conditions.

“We look at what actions are more universal and what are more specific to an individual’s needs,” said Dorr. “How you can take a system like this that can exchange information readily between electronic health records and a phone or computer in the Coach application?”

The next steps to improve efficacy and quality are implementing the COACH tool at two other institutions, revising the tool, and then conducting a trial with people at home to determine the best ways to successfully engage them in the process successfully and accurately. Testing at the University of Missouri at Columbia and at Vanderbilt University Medical Center will provide crucial information into what adjustments need to be made before beginning tests in people’s home settings.

Selected AHQR-funded research and reports