PHASE programme helps diabetes patients reduce cardiovascular risk

Kaiser Permanente's integrated programme (PHASE), implemented between 2004-2013 in Northern California, has been effective in helping diabetes patients control three key cardiovascular risk factors, according to research published in the American Journal of Medicine.

This study marks the first investigation to systematically assess the effects of Preventing Heart Attacks and Strokes Everyday (or PHASE) programme on multiple risk factors. The study reviewed annual blood pressure, blood sugar and blood lipid levels in approximately 100,000 PHASE patients with diabetes in Northern California, and compared them with data on commercial enrolees from the National Committee for Quality Assurance's Healthcare Effectiveness Data and Information Set (HEDIS).

Bringing blood pressure, blood sugar and blood lipid levels under control is a major focus of the PHASE programme at Kaiser Permanente, which uses lifestyle changes and medications to improve patients' heart health. PHASE was designed for members with an elevated risk of cardiovascular disease, including people who have had a heart attack, stroke or diabetes. The use of a patient registry identifies these patients who might benefit from intensive risk-factor control, and each patient is treated by a comprehensive care management team according to a continually updated treatment algorithm.

"Our encouraging findings speak to the strength of the PHASE programme," said lead author Jamal S. Rana, MD, PhD, cardiologist at Kaiser Permanente Oakland Medical Center. "This study shows that the PHASE programme addresses the daunting challenge of controlling risk factors in a high-risk population consistently and over an extended period of time, by the systematic application of a simple treatment protocol, a comprehensive registry, performance metrics, and task sharing with care managers."
      
PHASE has been particularly successful for diabetes patients, who make up two thirds of the programme's participants. Key findings of the study include:

- The proportion of diabetes patients with better blood pressure control consistently remained 20 percentage points higher at Kaiser Permanente than among U.S. health systems reporting performance to HEDIS.
- From 2004 through 2013, the percentage of people with diabetes who had poor blood sugar control fell both nationally and for Kaiser Permanente patients, but only the Kaiser Permanente group's decline was statistically significant.
- During the same period, the proportion of individuals with diabetes with good lipid control rose from 47 to 71 percent for the Kaiser Permanente patients, but there was no significant change seen in the national HEDIS reports.  

The study's senior author Marc G. Jaffe, MD, of Kaiser Permanente's South San Francisco Medical Center and the Resolve to Save Lives Cardiovascular Health Initiative, is leading efforts to spread a similar approach worldwide to help low- and middle-income countries implement proven strategies to prevent cardiovascular disease.

"We are excited to share our experiences with others who treat high-risk individuals, not only in California, but also across the world," Dr. Jaffe said.                                        

Source: Kaiser Permanente
Image Credit: Bill Branson