Preventing Heart Attacks and Strokes Everyday (PHASE)

PHASE is a population health management program designed to reduce the risk of heart attacks and strokes in patients at high risk. PHASE follows Kaiser Permanente’s evidence-based protocol that has been shown to prevent one heart attack or stroke for every ten patients successfully enrolled in the program for five years. PHASE targets patients with diabetes mellitus, hypertension, and known vascular disease for a handful of interventions designed to control blood sugar, blood pressure, and weight, to prescribe cardio-protective medications, to assist in cessation of smoking, and to identify and manage patients at risk for depression.

To learn more about PHASE, check out this brief video from Kaiser Permanente!

Goal

By January 1, 2020, we will: (1) improve health outcomes, care coordination, and lifestyle indicators of PHASE patients. (2) expand the ability of care teams to make data-driven decisions; and (3) build the capacities to address health disparities by identifying and mitigating social determinants of health.

Population served

Adults 18 and over with a current or previous diagnosis of diabetes mellitus, hypertension, coronary artery disease (Heart Disease), TIA (transient ischemic attack) or Cerebrovascular Accident (Stroke).

Timeline

January 1, 2017 - January 1, 2020

Funders

Kaiser Permanente Northern California Community Benefit Programs

Partners

Data

PHASE Clinical and Quality Measures - Clinic Report Template PHASE Clinical and Quality Measures - Clinic Report Template (61 KB)

PHASE Clinical and Quality Measures - Data Definitions PHASE Clinical and Quality Measures - Data Definitions (348 KB)


2017 Q1 Consortium Baseline Results 2017 Q1 Consortium Baseline Results (32 KB)

2019 Q2 Consortium Recent Performance 2019 Q2 Consortium Recent Performance (114 KB)


Resources

Adult Diabetes Clinician Guide Adult Diabetes Clinician Guide (4962 KB)

Management of Adult Hypertension Blood Pressure Goals Management of Adult Hypertension Blood Pressure Goals (304 KB)

PHASE on a Page 03.20.2019 PHASE on a Page 03.20.2019 (339 KB)


Screening Tools

CHP PHASE Toolkit 2017 CHP PHASE Toolkit 2017 (14295 KB)

HTN_Change_Package HTN_Change_Package (625 KB)

CCI PHASE Onboarding Playbook