CDC National Heart Disease and Stroke Prevention Program

Missouri
Basic Implementation

The Missouri Department of Health and Senior Services began receiving funds from CDC in 1998 to support a state heart disease and stroke prevention program. The program received increased funding for basic implementation beginning in 2000.

Burden of Heart Disease and Stroke

• More than 1 out of 4 deaths in Missouri are due to heart disease. (National Vital Statistics Report, 2009.)
• 14,749 Missourians died from heart disease in 2006 (27% of total deaths in Missouri). (National Vital Statistics Report, 2009.)
• 3,247 Missourians died from stroke in 2006 (5.9% of total deaths in Missouri). (National Vital Statistics Report, 2009.)

See the Missouri Department of Health and Senior Services report, Highlights: The Burden of Heart Disease and Stroke in Missouri—March 2009 Update, [PDF–2.04M] for more burden statistics.

• According to 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey results, adults in Missouri reported having the following risk factors for heart disease and stroke:
  
  • 29.4% had high blood pressure 
  • 39.5% of those screened reported having high blood cholesterol
  • 8.0% had diabetes 
  • 24.5% were current smokers 
  • 63.3% were overweight or obese (Body Mass Index greater than or equal to 25.0)
  • 51.2% reported no exercise in the prior 30 days
  • 79.8% ate fruit and vegetables less than 5 times a day

Key Responsibilities

• Facilitate collaboration among public and private sector partners, such as managed care organizations, health insurers, federally funded health centers, businesses, priority population organizations, and emergency response agencies.
• Define the burden of heart disease and stroke and assess existing population-based strategies for primary and secondary prevention of heart disease and stroke within the state.
• Develop and update a comprehensive state plan for heart disease and stroke prevention with emphasis on heart-healthy policies development, physical and social environments change, and disparities elimination (e.g., based on geography, gender, race or ethnicity, or socioeconomic status).
• Identify culturally appropriate approaches to promote heart disease and stroke prevention among racial, ethnic, and other priority populations.
• Use population-based public health strategies to increase public awareness of the heart disease and stroke urgency, the signs and symptoms of heart disease and stroke, and the need to call 9–1–1.
• Support health care organizations system changes to assure quality of care and implementation of primary and secondary prevention for heart disease and stroke.
• Monitor, implement, and evaluate prevention strategies and programs in health care sites, work sites, and communities.
• Provide training and technical assistance to public health, health care professionals, and partners to support primary and secondary prevention of heart disease and stroke.
• Monitor quality of care for primary and secondary prevention.

State Highlights

• The Missouri Heart Disease and Stroke Prevention (MHDSP) Program, the Missouri Diabetes Prevention and Control Program (MDPCP) and the Missouri Primary Care Association (MPCA) are collaborating on controlling high blood pressure and high cholesterol, improving quality of care, and eliminating health disparities in 16 of 21 Federally Qualified Health Centers (FQHCs). The FQHCs receive a monthly scorecard measuring progress on goals for control of blood pressure and hyperlipidemia, technical assistance with quality improvement plans, and mentorship opportunities with experienced center leaders. The FQHCs protocol changes have led to improved clinical outcomes, which include: educating patients about high blood pressure, coaching all patients with a diagnosis of hypertension, diabetes or cardiovascular disease on lifestyle changes that lower blood pressure, and discussing medications for lowering blood pressure. Interventions in the 16 FQHCs have reached approximately 40,000 patients. One FQHC increased blood pressure control in patients from 12% to 65% in six months, and maintained nearly the same level 12 months later.
• MHDSP has formed a new partnership incorporating the WISEWOMAN Program. This collaboration enables the programs to use staff and resources more effectively and to maximize partner participation. For example, the partnership’s Quality Health Care workgroup serves as the WISEWOMAN program’s medical advisory board and participates in advising MHDSP on health care-related interventions. The programs are collaborating on an initiative to improve medical care for WISEWOMAN clients with a previous diagnosis of high blood pressure (HBP) and/or high cholesterol (HC). The goal is to identify barriers to follow-up care for WISEWOMAN clients with HBP and/or HC, develop an enhanced referral system for these clients to improve follow-up care, and apply lessons learned to other health care providers of high-risk, low income Missourians.
• MHDSP, in partnership with the Healthy Communities Program, is promoting disease prevention efforts in work sites. Both programs are administering pilot programs that use the Mid-America Coalition on Health Care’s (MACHC) toolkit. This initiative builds upon concepts in the CDC’s Successful Business Strategies to Prevent Heart Disease and Stroke toolkit and MACHC’s Community Initiative on Depression.
• MDHSP serves on the core team that planned and is now implementing a statewide Time Critical Diagnosis (TCD) system for stroke and acute cardiac events. In 2008, legislation passed that authorizes Missouri’s Department of Health and Senior Services (DHSS) to publish rules and regulations for stroke and acute cardiac event centers. The core team completed draft regulations for center designations and is now developing data indicators for the data collection system.
• Missouri DHSS recognized the need to develop a more comprehensive and integrated approach to address chronic disease. In the fall of 2009, a DHSS team was established to produce a framework for developing chronic disease prevention and management strategic plans. This framework, intended to reduce chronic disease morbidity and mortality statewide, is a useful tool for DHSS programs and may be helpful to local and state stakeholders in planning chronic disease prevention and management activities.

For more information on heart disease and stroke prevention in the state, visit the Missouri Heart Disease and Stroke Program Web site.

To view county-level data, visit our interactive map site.