Prescriptions for a medication regimen to reduce heart attacks and strokes in patients with diabetes increased by nearly 40 percent after community health centers implemented Kaiser Permanente's "ALL" quality improvement protocol, according to a new study published in Implementation Science, an open access journal promoting the uptake of research findings into clinical practice.
The ALL protocol, established by Kaiser Permanente in 2003, reminds providers to prescribe blood pressure-lowering medications (ACE-inhibitors) and/or lipid-lowering medications (statins) for people with diabetes, who are often at increased risk for heart attacks and strokes.
In 2009, an observational study at Kaiser Permanente showed that patients who took the medications had a 60 percent lower chance of being hospitalized for heart attack or stroke.
The protocol was so successful in Kaiser Permanente that it has since been adopted by 55 community health centers serving approximately 80,000 patients in four states. This study included 11 clinics in Oregon.
"This is the first clinical trial to test how a care improvement program developed by a private, integrated health system can be successfully implemented in a public health system that serves millions of low-income and uninsured patients," said Rachel Gold, PhD, MPH, lead author and researcher with the Kaiser Permanente Center for Health Research in Portland, Oregon. "With more at-risk patients in these clinics on cardio-protective medications, the hope is that they will have a reduced risk for heart attacks and strokes."
The study clinics share a centralized electronic medical record through a nonprofit organization called OCHIN. For this study, OCHIN added alerts to the clinics' EMR to notify providers when patients met clinical guidelines to receive the medications, and shortcuts to expedite ordering the medications. The EMR tools were modeled after Kaiser Permanente's ALL protocol, but were adapted for the community health centers.
Before the EMR tools were added, about 45 percent of the community health center patients who met the clinical guidelines received the medications. After the tools were added, that number rose to 63 percent.
"Part of Kaiser Permanente's mission is to improve the health of the communities where we live," said Winston Wong, MD, medical director, Kaiser Permanente Community Benefit in Oakland, California. "This study shows how we are doing that, and it sets the stage for Kaiser Permanente and other private health systems to share best practices with public health systems that care for the nation's most vulnerable patients."