| Training | Continuously increase the knowledge and skills of health providers at the MFMC | 94% (61 of 65) doctors and 97% (152 of 156) nurses trained and demonstrating competency for blood pressure measurement and HTN management, including patient education Ongoing monthly CPD programs led by and for staff doctors and nurses; clinical topics selected by group consensus
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| Patient flow | To have most functional flow of patients through the MFMC | Redesigned use of space with clearly designated areas for registration, patient waiting, screening, clinical care, and medical records Increased patient satisfaction from March through October 2003
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| CPG | Develop, adapt, and use guidelines for doctors and nurse to identify and manage HTN in patients at the MFMC | CPG for HTN created by and for team of doctors and nurses (baseline, no HTN CPG) HTN CPG used at MFMC 144 hypertensive patients identified and followed with new protocol including medical record HTN CPG adopted by MoH for use throughout Kosovo
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| Data | Design and use data forms and databases in order to improve the care of patients with HTN | Forms created and in use: medical record for HTN; patient HTN “passport”; daily patient registration datasheets, patient and staff surveys (baseline, 0 medical records or passports) Registration data collected for more than 40,000 patient visits during year 1 (baseline, 0) Data shared and used to inform and improve care via data display in patient areas and routine reporting to leadership group
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| Patient education | Provide the best health education (about HTN) for the population of Gjilan | Nurses provide patient education for all patients found at screening to have high blood pressure or be at risk for HTN (baseline, no nurse-led patient education) Patient education brochures created and distributed at individual appointments and in waiting area (baseline, no available materials) Patient education videotapes available for various health topics
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| LRC | Increase knowledge and skills of the MFMC staff through better use of information systems (computer, Internet, library resources) | 5 computers with Internet connection available at MFMC for medically related use by staff and interested community members (baseline, no LRC) Doctors and nurses trained by LRC staff: 117 in computer use, 56 in basic Internet searching, 15 in evidence-based medical searching 1 Clinical Practice Standard Review completed on hypertensive crisis (baseline, 0)
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| Patient access | Improve quality of care by having patients get their care at the MFMC in their own community | Increase in Monday staffing in response to higher volume 24% decrease (31% in November 2002 to 7% in October 2003) of patients seen at MFMC rather than family medicine center in their own community 52% decrease in visits resulting in antibiotic injection (average of 268 per week in November 2002 to 139 per week in March 2003)
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| Community outreach | Use hypertension screening as a vehicle to build a good relationship between the MFMC and the community | 10 community screenings for HTN held in 8 months; provided screening for 860 individuals; counseling and referral for appropriately identified patients Ongoing patient education radio and TV spots for various common health topics, including HTN Patient education posters for HTN in community settings
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