Transcript Community Health - The National Association of County and City

Million Hearts®: Local PracticeBased Successes in Addressing
Cardiovascular Health
August 21, 2013
®
Hearts :
Million
Local PracticeBased Successes in Addressing
Cardiovascular Health
Truemenda C. Green, MA
Director
Healthy Communities/Chronic Disease
National Association of County and City Health Officials (NACCHO)
1100 17th Street, NW, 7th Floor
Washington, DC 20036
(202) 507-4213 office
[email protected]
www.naccho.org
Goal and Objectives
Goal:
To help participants improve their awareness and understanding of practice-based local health
department programs that address cardiovascular health and local efforts to implement the Million
Hearts® initiative in cardiovascular disease prevention.
Objectives:
By the end of this webinar, participants will be able to:
•
Understand the purpose of Million Hearts® and how local health departments can be a part of Million
Hearts®;
•
Identify at least one cardiovascular disease prevention strategy used by a local public health
department that they can implement in their own agency;
•
Understand how policies and practices in local health departments impact cardiovascular disease
prevention; and
•
Become knowledgeable about multiple innovative strategies to transform current preventive chronic
disease efforts and programs
Speakers
• Robin Diggs Outlaw, DC Department of Health
• Rayleen Earney, Southern Nevada Health District
• Dr. Judith Shlay, Denver Public Health
• Claudia Siegel, Philadelphia Department of Health
Introduction to Million Hearts®
Goal: Prevent 1 million heart attacks
and strokes in 5 years
• National initiative co-led by CDC and CMS
• Partners across federal, state, local agencies and private
organizations
How to Get Involved with Million Hearts®
Community Participation
•
Improving care for people who do need treatment by encouraging a targeted focus on the “ABCS”
•
Empowering Americans to make healthy choices such as preventing tobacco use and reducing
sodium and trans fat consumption
Actions You Can Take
•
Align existing initiatives and programs with Million Hearts® goals
•
Convene partners, stakeholders and policy makers for Million Hearts® for planning purposes
•
Share success stories from communities on Million Hearts®
Patient Care
Coordination/
Linkage
Community
Health
Coalition
Policy, System,
Environmental
Change
Initiatives /
Healthy
Communities
NACCHO is
Committed to
Recognizing 150
Local Health
Departments
Engaged in
Million Hearts
Activities !!!
Tobacco
Control
Blood
Pressure
Monitoring/
Counseling
Sodium
Reduction/
Healthy Food
Access
Robin Diggs Outlaw
DC DEPARTMENT OF HEALTH
Million Hearts® and Local Cardiovascular
Disease Prevention Efforts
Robin Diggs Outlaw, MPH
Manager
Cardiovascular Disease and Diabetes Prevention Program
Cancer and Chronic Disease Bureau
Community Health Administration
District of Columbia Department of Health
Government of the District of Columbia
Copyright Information
All material appearing in this report is in the public domain and may be reproduced
or copied without permission; citation as to source, however, is appreciated.
Last modified: July 26, 2013
Burden of Cardiovascular Disease
in the District of Columbia
 Cardiovascular disease and stroke are the 1st and 4th
leading causes of death in the District of Columbia
 The prevalence of hypertension among African-
Americans is double the rate among Caucasian
residents at 40.4%
 In 2011, 10.1% of District residents age 65+ reported
having coronary heart disease compared to 7.3% in
2009
 The prevalence of Cardiovascular disease is highest
in Wards 4, 5, 7 and 8
Data Source: District of Columbia Behavioral Risk Factor Surveillance System (BRFSS) 2011, 2009.
Co-morbidities and the Environment
Cardiovascular Health Program
Priority Areas
 Policy and Environmental Approaches
 Increase access to opportunities for physical activity
 Increase access to healthy food options
 Health System Interventions
 Increase utilization of health information technology
(HIT) to improve disease management, quality of care,
and use of preventive services.
 Increase engagement of non-physician team members
in hypertension and diabetes management in health
care systems
 Community-Clinical Linkages
 Increase access to chronic disease prevention and selfmanagement education and support
 Increase use of health-care extenders in the community
in support of self-management of high blood pressure
and diabetes
Alignment with Million Hearts®
Key Partnerships
 Delmarva Foundation (QIO)
 American Heart Association
 Association of Black Cardiologists, Inc.
 Mended Hearts, Inc.
 Howard University
 YMCA
 District of Columbia Primary Care Association (REC)
 Local health systems
 Community-based organizations
Foster Clinical Innovations
 Quality Management of ABCs– Partner with QIO
and other cardiac stakeholders in the District to
promote team-based care, the use of HIT tools,
and other methods to improve quality of health
care delivery
 Support interventions that incorporate the use of
health care extenders to promote medication
adherence and provide education and patient
navigation services
Foster Clinical Innovations Cont’
Activities
 Leverage QIO initiatives such as Learning and
Action Networks
 Convene partners to develop webinars for
providers
 Work with your healthcare licensing department
to devise a system for communicating with health
care providers
 Focus funding efforts on interventions that are
aligned with Million Hearts® strategies
Expand Community Initiatives to
Support Healthier Behaviors
CHW Initiative
Partnership with DCPCA to enhance the CHW workforce
and increase access to cardiovascular disease and
diabetes self-management programs and support in
community settings
Hair, Heart, & Health Program
 Culturally appropriate intervention in partnership with
Medstar Health targeting African-American males
 Barbershop-based hypertension and diabetes screening,
education, and navigation to follow-up clinical care
Expand Community Initiatives to
Support Healthier Behaviors Cont’
Healthy Corners Initiative
 Partnership with DC Central Kitchen
 Delivers fresh produce and healthy snacks to corner stores in
Wards 4, 5, 7 and 8
DC Fresh Mobile Produce Carts Pilot Program
 Partnership with Daddy’s Corner, Inc (a local non-profit)
 Sells fresh produce in targeted high traffic locations within Wards
4, 5, 7 and 8
Freggie Bucks Initiative
 $3.00 vouchers to be distributed at community education and
outreach sessions in collaboration with partners
 Vouchers will be redeemable at participating corner stores and
farmer’s markets
Local Policies
 The FEED DC Act
 The Healthy Schools Act
 Workplace Wellness Act
 DC Stroke System of Care Act
 DC Telehealth Reimbursement Act
 Shared Use of School Property Bill
Contact Info
Robin Diggs Outlaw, MPH
Program Manager
Cardiovascular and Diabetes Prevention and Control Program
District of Columbia Department of Health
Community Health Administration
Bureau of Cancer and Chronic Disease
899 North Capitol Street, NE, 3rd Floor
Washington, DC 20002
p: 202-442-9130
[email protected]
Rayleen Earney
SOUTHERN NEVADA HEALTH
DISTRICT
Rayleen Earney, MEd., CHES
Health Educator II
Southern Nevada Health District, Las Vegas, NV
Office of Chronic Disease Prevention & Health Promotion
NACCHO Webinar August 21, 2013
• Prevent 1M heart
attacks & strokes
www.millionhearts.hhs.
gov
 Improving access to care
 Improving quality of care
 Focusing clinical attention on
prevention
 Promoting heart-healthy
lifestyle



The Million Hearts campaign was an effective way for
Southern Nevada Health District’s (SNHD) staff to cross
promote and coordinate Chronic Disease Prevention
and Health Promotion messages.
Subjects featured on our website included (ABCS,
nutrition, physical activity and tobacco/smoking
cessation):
http://www.gethealthyclarkcounty.org/spotlights/millionhearts.php
There was no specific grant funding for MH activities so
our staff took advantage of free social media tools (FB,
Twitter, Blog, and website) to promote MH messages,
resources, and activities.


SNHD News Release included local heart statistics (BRFSS)
Earned Media Interviews:
◦ Healthier Tomorrow Radio Program (African American listenership),
◦ Channel 8 TV news physical activity segment

Utilized free Social Media Outlets (FB, Twitter, Blogs,
website) & earned media
◦ Weekly interactive posts per topic
 Risk tests, links to videos, MH resources

2 Community Presentations
◦ Nevada Parks & Recreation Department Staff
◦ Body & Soul Program staff (faith based initiative)
◦ Staff also printed/distributed MH handouts to community/staff at
SNHD and participated in Go Red for Women activities coordinated
by the American Heart & Stroke Association

ABCS: National and local resources on our home page:
http://www.gethealthyclarkcounty.org/spotlights/million-hearts.php

Promoted SNHD’s free online programs (Walk Around Nevada and
Nutrition Challenge): www.gethealthyclarkcounty.org

Consumer Tools: sodium calculator, BP basics video, AHA Heart
360 program Nevada, blood pressure journal, medication wallet
cards, guides to lowering blood pressure, risk tests, places to check
blood pressure
Healthcare Provider Tools :
• Rx pads linking patients to free online programs Nutrition
Challenge and Walk Around Nevada, and the Nevada Tobacco
Users’ quitline
• MH fact sheets, BP toolkit, and the national Million Hearts link

English Blog:
 http://blogs.gethealthyclarkcounty.org/blog/gethealthyclarkcounty/2013/02/
FB:
 How has heart disease and stroke affected you and your family? Take the
Million Hearts Pledge: http://millionhearts.hhs.gov/index.html
Twitter: GetHealthyCC@GetHealthyCC7 Feb
◦ Aspirin may be able 2 reduce ur risk 4 heart attacks, ask ur doctor about
aspirin therapy.


GetHealthyCC@GetHealthyCC11 Feb
Check out these blood pressure basics you can do to help lower your blood pressure.
http://bit.ly/TAuPu2
Spanish Blog:
 http://www.vivasaludable.org/blog/index.php/page/5/
Twitter:
TuSNHD@TuSNHD21 Feb

¿Tiene el colesterol alto? Lea nuestros “tips” consejitos para reducirlo en
http://www.vivasaludable.org/blog/index.php/tag/corazon/
Blog Views:


2400 blog viewers (English)
315 blog viewers (Spanish)
Earned Media:


1 live radio interview (KCEP Healthier Tomorrow Radio Program)
1 TV interview channel 8
Website Views & Downloads:
 153 spotlight website views:
http://www.gethealthyclarkcounty.org/spotlights/million-hearts.php
 30 web downloads
 324 heart related materials disseminated at worksite (FDA provided
free Heart Disease handouts and also printed some from MH Toolkit)
Community Presentations (2):
◦ Henderson Parks & Recreation
◦ Body & Soul Church Program

Successes
◦ Leveraging community, clinical and faith-based partnerships
through coalitions
◦ Coordinated approach for CD messages
◦ Reached low SES diverse communities (African
Americans/Latinos)
◦ Earned media opportunities generated through press
releases

Challenges
◦ Funding
◦ Infrastructure
◦ Priorities
◦ Local level data
www.gethealthyclarkcounty.org
www.vivasaludable.org
Rayleen Earney, MEd., CHES
Health Educator II
Email: [email protected]; [email protected]
Phone: 702-759-1271
Dr. Judith Shlay
DENVER PUBLIC HEALTH
Reducing Cardiovascular Disease
Risk Using Patient Navigators
Judith C. Shlay, MD, MSPH
Denver Public Health
Original Project 2007-2009
• Objective of study: To determine whether
enhanced counseling, and using patient
navigators to counsel patients on CVD riskreduction strategies and facilitate patient
access to community-based lifestyle-change
services reduced CVD risk among at-risk
patients in a low-income population
• Conducted by Denver Public Health; funded
through a state CVD prevention grant
Shlay et al. Prev Chronic Dis 2011;8(6):A143
Method
• Compared clinical characteristics at baseline and
12-month follow-up for 340 intervention and 340
comparison patients
• All patients had FRS >10% at baseline
• Intervention: patient-centered counseling by
bilingual patient navigators
– One hour counseling session at baseline, plus followup calls at 1-4 weeks and 6-10 weeks; additional calls
made within 6 months of enrollment
• Assessed health behaviors of intervention
participants at baseline and 12-month follow-up
Results
• At follow-up, clinical differences identified between
intervention and control group
– Change in mean FRS (baseline to follow-up):
intervention 15.5% to 14.8% vs. control 15.0% to
15.8%
– At goal (FRS <10%): intervention 11.8% vs. control 3.5%
– Total cholesterol: intervention 183mg/dL vs. control
197mg/dL
• Intervention group reported significant
improvements in some health behaviors at 12month follow-up
– Nutrition-related behaviors improved
– Tobacco use and cessation attempts did not change
Conclusions
• Using patient navigators to provide
individualized counseling, assist in goal
setting, and link to community resources
seemed to help intervention participants
achieve positive behavioral changes and
improve several clinical outcomes
• Simple intervention for enhancing traditional
clinical CVD risk-reduction services
• Large scale programming and evaluations
needed
Ongoing CVD Prevention Work
using Patient Navigators and
Coordinated Care in Colorado
Denver’s Community
Transformation Grant
Cardiovascular disease
Reduction: A Focused
Transformation (CRAFT)
Funded for 2011-2016
Denver CTG Partners by Program Area
Smoke Free Living
Healthy Eating
Active Living
Clinical Preventive
Services
Healthy & Safe
Environment
• Group to Alleviate Smoking Pollution (GASP)
• Denver Housing Authority (DHA)
• Denver Environmental Health (DEH)
• Denver Public Schools (DPS)
• Denver Health & Hospital Authority Community Health
Services (CHS)
• Kaiser Permanente
• Colorado Alliance for Health Equity and Practice
(CAHEP)
• EMC
• The Trust for Public Land (TPL)
• Denver Parks & Recreation (DPR)
Denver CRAFT (Cardiovascular disease
Reduction: A Focused Transformation)
Denver Cardiovascular Disease Registry
Improved public health surveillance
Patient
Navigation
Services
Public
Health
Detailing
Increased
retention in care
of patients
diagnosed with
HTN
Improved quality
of care provided
by clinic
physicians on
CVD
↑ in clinic
control of
HTN patients
in safety net
clinics in
Denver
Program Goal
Improve cardiovascular health of
adults in Colorado communities
2009-2016
Current CHHS Communities
CHHS Numbers
CHHS by the Numbers
Among the 1,200 participants with elevated risk factors retested
at 12 months, decreases seen in a number of risk factors
Baseline
levels for atrisk
population
Change in
risk factor
Baseline
levels for
those with
abnormal
risk factor
Change in
risk factor
Total
cholesterol
215mg/dL
↓ 15
240mg/dL
↓ 24
LDL
cholesterol
139mg/dL
↓ 18
164mg/dL
↓ 30
Systolic Blood
Pressure
131mmHg
↓4
155mmHg
↓ 18
11.3
↓ 0.8
20.8
↓ 2.4
Framingham
Risk Score
Improvements in Framingham
Risk Scores
Claudia Siegel
PHILADELPHIA DEPARTMENT
OF HEALTH
Philadelphia
and Heart
Health:
Common
Goals with
Million
Hearts
Cardiovascular Disease Mortality,
United States and Philadelphia, 2000 - 2010
Age-Adjusted Rate per 100,000 Population
450
400
Philadelphia
350
300
U.S.
250
200
150
100
50
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Based on data from Centers for Disease Control and Philadelphia Department of Public Health
Adult Hypertension in Philadelphia, 2000 - 2012
Source: PHMC Household Health Survey, 2000-2012
Philadelphia’s Challenges
• Health care environment dominated by larger players,
intense competition, and fragmented health information
sources
• Multiple factors in the mix
– 5 academic health centers, each with its own health system,
clinics, hospitals, and EHR systems
– Several large insurers dominate the market
– Medicaid population under managed care and split among 5
different companies that provide services (under contract with
the state Department of Public Welfare)
– Uninsured, many of whom find care at the city’s 30+ federally
qualified health centers
– Substantial lifestyle and environmental challenges, health
disparities
EHR, Electronic health record
Impact Pyramid
Factors that Affect Health
Smallest impact
Counseling
and Education
Health care services
Clinical
Interventions
Potential common ground
Public health
Long-lasting Protective
Interventions
Changing the Context
to make individual’s default
decisions healthier
Largest impact
Frieden TR. Am J Public Health 2010;100 (4): 590–5
Get Healthy Philly: Multi-sector initiative
How can we make it easier for Philadelphians
to engage in healthy behaviors?
RETAIL ENVIRONMENT
MEDIA
MEDIA
Legislation and
Regulation
Schools and Universities
Health
Insurers and
Providers
WORKPLACES
Nutrition
• Develops and implements nutrition standards
• All City-funded food procurement contracts (20 million
meals annually)
• Supports 630 corner stores in selling produce and low-salt
items
Sodium Reduction
• Training 221 Chinese take-out restaurants to reduce the
sodium content of meals
• Sodium reduction mass media campaign, Spring 2014
• Evaluates impact of sodium labeling in chain restaurants
(Philadelphia’s menu labeling law)
Hypertension Prevention
• Reduce medication copays for hypertension, high
cholesterol, and smoking cessation
• Employer-focused effort
• Promotes policies and programs to reduce tobacco use
Philadelphia Department of Public Health
Heart Health Data Gathering and Sharing
• Convening working groups with key players (insurers, health systems,
providers, etc.) to get better data and to share data on hypertension and
cardiovascular disease in the city (CDC NPHII)—de-identified, aggregated data
• 100 percent response rate--all partners responded
• First city-wide estimate of hypertension based on
clinical data
• New initiative: “Know your numbers” –PDPH is publishing location and hours
of free health screenings throughout the city:
http://www.phila.gov/health/Commissioner/HealthInfoandImprovement.html
• Million Hearts partnership for mobile app launch
• National and local partnerships for screening event and dialogue—American
Kidney Fund Kidney Action Day, Friday, May 3, 2013
PDPH Data-Sharing Initiative Initial Results:
Success with Gaps
• Insurer data: 585,922 of adults ≥18 years old (~50%)
– Overall population
• 24.2%: Hypertension prevalence
• Blood pressure controlled: 35.4–62.5% (including Medicare)
– Medicare population alone
• 79.5%: Hypertension prevalence
• Blood pressure controlled: 62.5%
• Provider data: 355,057 adults ≥18 years old (~30%)
• 17.1%: Hypertension prevalence
• Blood pressure controlled: 42.1–65.7%
• For target zip codes, zip code-level information from some
insurers and providers was available
Next Steps
• Sustain, promote and expand Get Healthy
Philly
• Continue data-sharing and analysis
• Bring additional partners to the table
• Change the environment around data:
– Shared perspectives
action plan
collaborative
• Maintain emphasis on heart health alongside
Million Hearts
Q&A
Contact Information for Speakers
• Robin Diggs Outlaw, DC Department of Health:
[email protected], (202-442-9130)
• Rayleen Earney, Southern Nevada Health District:
[email protected] (702-759-1271)
• Dr. Judith Shlay, Denver Public Health:
[email protected] (303-602-3714)
• Claudia Siegel, Philadelphia Department of Health:
[email protected] (215-686-5263)
Additional Resources and Contact Information
For more information on Million Hearts®, visit:
http://www.naccho.org/topics/HPDP/chronicdisease/million-hearts/index.cfm
For additional resources on Million Hearts®, visit the Million Hearts® Toolkit:
http://www.naccho.org/toolbox/index.cfm?v=4&id=266&topicname=Million%20Hearts
For technical assistance with Million Hearts®, contact:
[email protected]
NACCHO Million Hearts® Contacts:
Truemenda Green, Director: [email protected], 202-507-4213
Iris Tiongco, Program Associate: [email protected], 202-507-4232
Coming Soon!
Keep a lookout for a soon-to-be-released NACCHO Million Hearts® resource:
Million Hearts®
Local Engagement Guide
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