PROVIDENCE – A new pilot program to reduce uncontrolled hypertension, or high blood pressure, among Rhode Island residents will soon be launched, deploying an innovative system of digital blood pressure self-monitoring by patients at home. The program will target medically underserved communities as a way to decrease the incidence of stroke, heart attack and other related health problems.

The new pilot program will be managed by Healthcentric Advisors, which won a highly competitive Special Innovation Project award from the Center for Medicare and Medicaid Services to undertake the initiative.

Under the program, some 150 patients will be able to use an at-home Omron blood pressure monitoring system, and then have the data shared securely, in real time, with providers, allowing both patients and caregivers to better manage any potential dangerous spike in blood pressure.

The pilot program is slated to run for six months, with a one-month evaluation period, before potentially scaling up the program to become a nationwide initiative.

A serious, pervasive condition
High blood pressure is a serious condition that affects about one-third of U.S. adults, and Rhode Island has the highest rate in New England, making the disease a critical public health concern for the state, according to Healthcentric Advisors, a Rhode Island-based national health care quality improvement authority.

About half of those diagnosed with hypertension do not have their blood pressure under control, according to the Centers for Disease Control and Prevention. Barriers to better management of high blood pressure include limited access to primary health care, a lack of transportation, unaffordable medications and difficulty in accessing healthy food.

The goal of the pilot program is to build a system of patient engagement, working with patients where they live, building upon the mobile blood pressure monitoring system with additional training and social supports.

“Using an Application Program Interface (API) like ours,” explained Lauren Capizzo, director of Practice Transformation at Healthcentric Advisors, “allows for secure and automated data sharing between at-home blood pressure cuffs and Healthcentric Advisors’ data portal.”

The technology will enable patients to monitor their blood pressure between office visits, and then share it back to their provider, with a real-time alert to follow up on any high blood pressure reading, Capizzo continued. “Instead of waiting for the three-month follow-up visit,” she said, “the care team will know right away if a patient should be seen sooner.”

Preventive tactics against the number-one killer
ConvergenceRI recently sat down with the team at Healthcentric Advisors to learn more about the pilot program – and to observe a demonstration of the mobile blood pressure monitoring system, with ConvergenceRI serving as the “volunteer” to test the system.

Brenda Jenkins, a senior program administrator at Healthcentric Advisors, framed the purpose of the pilot program succinctly.

“Cardiovascular disease is the number-one killer in the United States,” she said. “There are many ways that it can be prevented. One out of three people in the U.S. has hypertension, and half of those people are not in control of their high blood pressure, which leaves them at risk for cardiac mortality and lots of complications and chronic diseases that go along with that.”

The national statistics for heart disease underscored what Jenkins said.

• Heart disease is still the number one killer of men and women, the underlying cause of death for some 800,000 Americans each year, accounting for a third of all deaths in the U.S., according to the American Heart Association.

• In turn, the health insurance industry and the health care delivery system spend hundreds of billions a year in treatment for coronary heart disease, stroke, and high blood pressure.

• The annual cost of treating heart disease in the U.S. is estimated to be approximately $300 billion a year. Heart attacks [$11.5 billion] and coronary heart disease [$10.4 billion] were two of the 10 most expensive hospital discharge diagnoses a year, according to American Heart Association statistics.

• The usual suspects in the risk factors attributed to the high incidence of heart disease are: smoking, physical inactivity, nutrition, obesity, cholesterol, high blood pressure [emphasis added], and diabetes, with clinical treatments targeting care interventions around reducing these risk factors.

Targeting those at the highest risk
Under the new pilot program being launched by Healthcentric Advisors, Jenkins explained, the goal is to identify and target those patients with uncontrolled high blood pressure, and in a six-month time frame, work directly with the patients and the practices caring for them to better manage their condition.

In particular, in partnership with the R.I. Department of Health, Progreso Latino and the African Alliance of Rhode Island, and Health Equity Zones, the target audience for the pilot program will seek to include populations where health disparities are most prevalent.

The approach being taken by Healthcentric Advisors, Jenkins continued, was “multi-pronged.”

“We will be giving the patients a state-of-the-art, Omron Series 10, wireless blue-tooth enabled, blood pressure monitoring system,” Jenkins said.

And, then, Jenkins said, utilizing the technology developed by Bryan Los at Healthcentric Advisors, “We will be able to get those blood pressure readings in real time.” If the readings are higher than the prescribed range by the provider, an alert will be sent to both the provider and the patient.

In addition to empowering the patient to become involved in monitoring his or her high blood pressure at home and, at the same time, creating a real-time feedback mechanism with the care provider, the pilot program will also be emphasizing education.

“We are going to be providing education to the patients on the proper technique of taking a blood pressure,” Jenkins said, “because studies show that up to 60 percent of health care workers do not use the proper technique when taking a blood pressure.” As a result, Jenkins continued, inaccurate readings can lead to either over-treatment or under-treatment of high blood pressure.

Patient engagement
One of the immediate goals of the pilot program is change the trajectory of how changes can be made in managing a patient’s high blood pressure – without having to wait until the next appointment that may months away.

As part of the pilot program, Healthcentric Advisors and its team will be providing a mini-course for patients and their families about high blood pressure, its complications, and the ways in which they can have control over some of the contributing factors – such as smoking, dietary habits and physical activity, according to Jenkins.

“We are going to be starting with a minimum of 150 patients,” Jenkins said. “We are going to be targeting seniors, because this is a Medicare-funded project. But we are opening the program to everyone who could be in need.”

At least 40 percent of the target population, Jenkins continued, “is going to be coming from a disparate population, so that ethnicity, race, socio-economic status, and educational status will all be taken into consideration.”

Enrollment in the pilot program, Jenkins said, would be finalized by the middle of September.

Broader collaborations
Moving forward, the Healthcentric Advisors team expressed interest in potential collaborations working with Erick Loucks, the director of the Mindfulness Center at Brown University, utilizing mindfulness stress reduction techniques related to cardiovascular health.

Also, the team expressed curiosity about the findings by researcher Dr. Bruce Lanphear about the relationship between elevated blood lead levels and cardiovascular disease.

But, according to Jenkins, the short-term, rapid cycle of the grant, focused on improvement for uncontrolled hypertension, limited the kinds of exploration that could be undertaken as part of the pilot program.

“While I appreciate all those potential contributing factors, which are very important and need to be researched,” Jenkins said, “for this particular project, it’s a very targeted short-term effort focused on [managing] uncontrolled hypertension.”

Jenkins indicated that the project would be looking at some contributing factors, including race, ethnicity, the social determinants of health and the support systems that people have, adding: “I think that mindfulness is something that we’d like to explore.”