Strategies for Establishing Policy, Environmental, and Systems-Level Interventions for Managing High Blood Pressure and High Cholesterol in Health Care Settings: A Qualitative Case Study

Objectives: This study sought to identify promising health care practices in organizations using policy, environmental, or systems-level (PES) interventions and strategies to improve management of high blood pressure and high blood cholesterol. The objectives were to describe: (1) PES interventions and the factors influencing their adoption; (2) enabling factors and barriers that affected implementation; (3) methods for evaluating the intervention success; and (4) lessons learned.

Methods: Through literature review and expert guidance, we identified 34 practices that used PES interventions. We conducted case study interviews with key informants for nine of these practices that: (1) demonstrated improved patient outcomes for blood pressure or cholesterol; (2) implemented the interventions for at least 1 year; and (3) remained committed to sustaining interventions. Interviews were taped, transcribed, and analyzed using CDC EZ-Text software (www.cdc.gov/hiv/software/ez-text.htm).

Results: The PES interventions included specialized lipid clinics, disease management programs, collaboratives, and physician reminder systems. All practices used comprehensive systems for patient care that were measurable and linked to desirable patient outcomes. Most used data systems to identify patients for the interventions and practice areas that needed improvement and to track progress. Strategies contributing to success included leadership and staff commitment from across the organization, interventions integrated into daily work flow, legislation to support the intervention, community resources and involvement, and policies allowing staff to provide better patient care and patient self-management.

Conclusion: Interventions using comprehensive PES interventions and strategies for patient care can be effective in controlling chronic conditions such as high blood pressure and high cholesterol.