Discovering Healthcare Innovations to Address Disparities in Stroke

Kaiser Permanente Northern California (KPNC) serves a population of over 3 million enrollees, representative of the socio-demographic characteristics of the San Francisco Bay Area, Santa Rosa, and Sacramento except for under-representation of the very rich and very poor.78 KPNC is the largest nonprofit integrated health care organization in the country, with 22 hospitals and 44 outpatient facilities, and cares for 30% of the population in the region. The majority of Californians are managed in four large hospital networks, so the KPNC system is a model for the 167 Program Director/Principal Investigator (Last, First, Middle): Sidney, Stephen, MD, MPH PHS 398/2590 (Rev. 06/09) Page Continuation Format Page prevalent system of care in the state. An effective system-wide intervention in KPNC would likely be generalizable and feasible in the other healthcare networks in the State and, thus, could benefit the population more broadly. The project focuses on the East Bay Service Area (EBSA) because approximately one-third of African American KPNC members with HTN receive care within this geographical area. The East Bay area, home of the flagship Oakland Medical Center and Richmond Medical Center, comprises 12 cities and municipalities within the Alameda County and the western section of Contra Costa County. From Kaiser Permanente's inception in 1945, the nonprofit organization has led with innovation, beginning with its prepaid health care services offered to Richmond shipyard workers during World War II. Today, the Richmond and Oakland Medical Centers are home to about 700 physicians and 5,600 employees who serve over a quarter of a million members yearly.

Kaiser Permanente East Bay has expanded its services for West Contra Costa members. The brand new Pinole Medical Office Building, just eight miles from the Richmond Medical Center offers convenient access to members in the East Bay Area, which includes Pinole, El Sobrante, Hercules, Rodeo and Crockett.

The Pinole center provides adult medicine, family practice, pediatrics, obstetrics/gynecology, radiology, a lab, a pharmacy, and health education. For emergency services, members go to the Richmond Medical Center, and for labor and delivery services, the Oakland Medical Center. The fourth member of the EBSA is the Alameda Medical Center which offers services for internal medicine, gynecology, pediatrics, pharmacy, and members outreach. Using KPNC as a model offers several major advantages. Members generally remain in the plan for many years, with 94% retention at 1 year and 84% retention at 5 years among enrollees 65-74 years old.

Sources of electronic medical data are extensive and easy to manipulate. They will be combined to produce an electronic registry of patients with uncontrolled HTN (Figure - Electronic Registry; source of data provided in brackets). The following information is available from electronic medical record (EMR) system:

• Inpatient discharge abstracts with primary and secondary diagnoses and procedures coded by a trained medical records analyst.
• Inpatient discharge abstracts for all out-of-plan hospital admissions.
• Emergency-department and outpatient diagnoses coded by the treating physician.
• All outpatient records including BP measurements.
• All radiology reports generated by reviewing radiologists.
• Listing of all major health problems generated and frequently updated by all treating physicians.
• Cardiologist interpretations of all ECGs.
• Reports from all clinical laboratory studies.
• Listing of all outpatient filled prescriptions and completed inpatient medication orders.