CDC National Heart Disease and Stroke Prevention Program

Nebraska
Capacity Building

The Nebraska Health and Human Services System began receiving funds from CDC in 2000 to support a state heart disease and stroke prevention program. It also received CDC funding to implement a demonstration public health project that improves quality of care through the implementation of an Electronic Health Information System (EHIS) in Certified Rural Health Clinics (CRHC) in Nebraska.

Burden of Heart Disease and Stroke

• Nearly 1 out of 4 deaths in Nebraska are due to heart disease. (National Vital Statistics Report, 2009.)
• 3,445 Nebraskans died from heart disease in 2006 (23.1% of total deaths in Nebraska). (National Vital Statistics Report, 2009.)
• 922 Nebraskans died from stroke in 2006 (6.2% of total deaths in Nebraska). (National Vital Statistics Report, 2009.)

See the Nebraska Health and Human Services System report, The Impact of Cardiovascular Disease in Nebraska—December 2004, [PDF–856K] for more burden statistics.

• According to 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey results, adults in Nebraska reported having the following risk factors for heart disease and stroke:
  
  • 26.5% had high blood pressure
  • 36.6% of those screened reported having high blood cholesterol
  • 7.1% had diabetes
  • 19.9% were current smokers
  • 64.7% were overweight or obese (Body Mass Index greater than or equal to 25.0)
  • 48.0% reported no exercise in the prior 30 days
  • 75.9% 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.

State Highlights

• The Nebraska Cardiovascular Health Program collaborates with the Office of Community Health Development, Tobacco Free Nebraska, Comprehensive Cancer program, Diabetes Prevention and Control program, Injury Prevention program, and the Preventive Health and Health Services Block Grant to provide grants to local health departments to build capacity for comprehensive integrated health promotion planning and implementation. Fifteen local public health departments have been awarded funds to implement evidence-based policy or environmental interventions related to cardiovascular health, cancer, or diabetes.
• From 2007-2010, the Nebraska Registry Partnership (NRP), a collaboration between the Nebraska Cardiovascular Health Program, CIMRO of Nebraska (a Medicare quality improvement organization), Nebraska Office of Rural Health,  and the Nebraska Diabetes Prevention and Control program provided funding for a three year project for rural health clinics to establish a diabetes and cardiovascular disease (CVD) patient registry system.
• Six rural health clinics entered approximately 1,600 diabetic and CVD patients into the NRP database. In 2010, a comprehensive evaluation of the project was conducted.  Successful clinical outcomes from the electronic disease registry implementation are improvements in
  
  • Patient recall for annual examinations for patients with cardiovascular disease (13% to 20%).
  • Hypertension control (32% to 35%).
  • Total cholesterol reduction (71% to 76%).
  • LDL cholesterol reduction (53% to 58%).
  • Self-reported compliance of taking aspirin daily (35% to 44%).
  • Tobacco use detection by clinic professionals (55% to 81%).
• The Nebraska Cardiovascular Health Program, in collaboration with state partners, created the Nebraska Stroke Advisory Council. The council is a coalition of stroke experts in the state who recommend and implement key strategies to reduce the burden of stroke. Council task forces include public awareness and education, Emergency Medical Services (EMS), emergency department and hospital, rehabilitation, and policy.
• The Nebraska Cardiovascular Health Program, in collaboration with the Nebraska Stroke Advisory Council’s EMS Task Force and the Nebraska Emergency Medical Services Association, developed an EMS stroke curriculum. The EMS stroke curriculum and the Cincinnati Stroke Scale was adopted by the state EMS Board as the standardized training and pre-hospital assessment tool. To date, more than 500 EMTs have been reached through 100 trainings. An EMS assessment of pre-hospital stroke care procedures was completed.
• The Nebraska Cardiovascular Health program, in collaboration with the Nebraska Stroke Advisory Council’s EMS Task Force, conducted a survey of all Public Service Answering Points (PSAPs) to better understand the strengths and challenges PSAPs face when answering time critical diagnosis calls and to further guide training development for dispatch professionals. The Nebraska Cardiovascular Health Program coordinated the survey development, dissemination, and data analysis. Results are being analyzed and will be made available online when complete.
• The Nebraska Cardiovascular Health Program, in collaboration with the Nebraska Stroke Advisory Council’s Rehabilitation Task Force, conducted a survey of acute stroke rehabilitation in Nebraska hospitals to determine the extent to which the structure and process of acute stroke rehabilitative care is consistent with current best evidence. Conclusions from the assessment include
  
  • Hospital size and presence of a team are determinants of the structure and process of stroke rehabilitation in Nebraska hospitals.
  • Researchers and stroke specialty programs should collaborate with healthcare professionals to determine
    
    • The specialized service needs of rural stroke survivors and their caregivers.
    • How technology can increase access to standardized assessments.
    • How to use team training to create a team orientation among stroke rehabilitation professionals who are not located within the same organization or community.

For more information visit the Nebraska Cardiovascular Health Program Web site.

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