Promise Community Health Center hypertension control program

Description

Promise Community Health Center is a Federally Qualified Health Center in rural Sioux Center, Iowa. Promise CHC, which offers medical, mental, dental, and vision care, established a quality improvement project to improve patients' hypertension.

Services offered

Promise Community Health Center formed a work group to improve hypertension control through new policies and procedures:

• Follow up with patients with uncontrolled hypertension every month instead of every 3 months
• Stay in touch with patients with controlled hypertension to help them maintain their numbers
• Use self-measured blood pressure monitoring and remote patient monitoring so patients can check their blood pressure at home
• Provide Centers for Disease Control and Prevention (CDC) handouts on taking accurate blood pressure readings and low-sodium diets
• Provide a nurse health coaching program to help patients live a heart-healthy lifestyle
• Collaborate between doctors, nurse health coaches, medical assistants, and pharmacists
• Provide scheduling services and medical services in English and Spanish to serve the local community (45% of Promise patients are not native English speakers)

Results

This program increased its hypertension control rate from 73% in 2022 to 80% in 2023 and to 84% (238 of 284 patients with hypertension) in 2024. Over 50% of hypertensive patients received health coach support, which included home blood pressure monitoring when applicable, lifestyle education and coaching, and care coordination to ensure appropriate follow-ups were scheduled and accessible.

This program was named a 2024 Hypertension Control Champion by Million Hearts®.

Challenges

Implementing the 1-month follow-up for patients with uncontrolled hypertension was a huge factor for the program's success but also its biggest challenge. Many patients face transportation and financial barriers. Many patients travel a long way for their appointments, and the rural community does not have public transportation. Promise CHC used its transportation program to help patients get to appointments. Patients also faced the barrier of cost burden with having more frequent appointments. Promise CHC adjusted the workflow to include free health coach or lab-only visits as 1-month follow-up visits. Promise CHC also loaned calibrated blood pressure cuffs for at-home monitoring, with follow-ups via secure texting tools.

Replication

Start with a clear, unifying goal and get everyone on board early. Early staff and provider buy-in was critical. Review your process against established best practices to identify real, fixable gaps. Focus on one or two key changes that will deliver big impact – like blood pressure measurement accuracy and consistent follow-up. Track progress rigorously, audit regularly, and share results transparently. Use team-based care that's responsive to different patient populations. Promise CHC's success came from small, intentional steps sustained over time, with everyone understanding the goal and moving in the same direction to get there.

Contact Information