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State Heart Disease and Stroke Prevention Program in Health Care Settings to Prevent Heart Disease and Stroke

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Heart disease and stroke, the principal components of cardiovascular disease (CVD), are the first and third leading causes of death in the United States, accounting for nearly 40 percent of all deaths.1 Several organizations including the American Heart Association and the American College of Cardiology have developed clinical practice guidelines to assist in the diagnosis and management of patients with CVD.2,3 Scientific studies have demonstrated that adherence to these clinical guidelines is associated with decreases in CVD mortality and morbidity as well as cost savings to society through reductions in productivity losses at work and home.4,5 Yet, a significant proportion of patients do not receive the recommended health care to prevent and control heart disease and stroke.6-8 To address this problem, these and other organizations have developed guideline-based tools for heart disease and stroke care and prevention that have demonstrated health care quality improvement.5,9,10 Additionally, federally funded community health centers have adopted the Chronic Care Model to produce system changes that have been effective in reducing health care costs and improving quality care.11

State Heart Disease and Stroke Prevention Programs Take Action

State Health Departments work with their partners, such as primary care associations, managed care, clinics, and quality improvement organizations to improve the quality of care provided in healthcare settings in two ways:

  1. Promoting the use of guidelines for primary and secondary prevention of heart disease and stroke.
  2. Increasing access to quality care in federally funded community health centers to eliminate CVD disparities among priority populations with higher rates of disease.

Implications

Because of the complexity and diversity of the health care system, there are no easy solutions to improving patient quality of care. However, state heart disease and stroke prevention programs provide examples of how health care setting environment and policy strategies can be implemented to improve quality of care.

Examples of CDC–Funded State Program Activities Addressing CVD Disparities in Health Care Settings

  • To address CVD disparities and to improve the functional and clinical outcomes of patients served in federally funded community health centers, the Bureau of Primary Health Care of the Health Resources and Services Administration (HRSA), the Centers for Disease Control and Prevention (CDC) and the Institute for Health Improvement (IHI) began the Cardiovascular Health Disparity Collaborative in 2001. State cardiovascular programs have several key roles in the collaborative including implementing environmental strategies and policy changes for cardiovascular health, establishing linkages, sharing resources, and partnering to reduce CVD risk factors.
  • Programs in the District of Columbia, Connecticut, Arkansas, Missouri, Washington, and Georgia have assisted community health centers to establish and use patient registry systems to enhance the provision of patient follow–up to screenings of CVD and related risk factors and to track patient improvement.
  • Several state programs including Virginia, Colorado, District of Columbia, Georgia, Utah, and Ohio have facilitated training sessions for federally funded health center providers on how to implement clinical practice guidelines.
  • Programs in Arkansas, Wisconsin, and North Carolina have assisted community health centers to adopt the Chronic Care Model, which provides an organizational approach to care for people with CVD and other chronic disease in a primary care setting. For more information see http://www.improvingchroniccare.org/change/index.html.
  • The North Carolina state program has developed partnerships with its State Primary Health Care Association and the federally funded health centers that are participating in the collaborative. The program has developed a mapping process linking patients treated in hospital emergency rooms with federally funded health centers to improve the continuum of care, standardized procedures, and facilitate correct blood pressure measurement techniques.1

Examples of CDC-funded State Program Activities to Improve Guideline Adherence in Health Care Settings

Programs in Alaska, Alabama, Colorado, Connecticut, Georgia, Illinois, Kentucky, Montana, New York, North Carolina, and Wisconsin are addressing hospital system quality of care through the introduction and promotion of the American Heart Association (AHA) and the American Stroke Association's (ASA) Get With the GuidelinesSM program. For information on the program, please see the AHA's Web site (http://www.americanheart.org).

Programs in Arkansas, Florida, Louisiana, Maine, Minnesota, Missouri, Oklahoma, and Utah are promoting health system supports such as reminders of care, development of clinical performance measures, and the use of case management services to increase health care providers' adherence to recommended heart disease an stroke prevention and treatment guidelines.

The Massachusetts State Program partners with Southcoast Hospital Group to establish leadership and education for heart disease prevention requirements for hospitals that are licensed to perform open-heart surgeries.

The Montana and West Virginia programs partner with the states' Quality Improvement Organizations, the American College of Cardiology (ACC), physicians, nurses, and hospital administrators to implement quality of care improvement projects to increase adherence to the ACC/AHA practice guidelines for Acute Myocardial Infarction (AMI) patients. Participating hospitals receive a Guidelines Applied into Practice (GAP) tool kit containing background literature, sample AMI orders for admission, sample patient information form, sample heart attack discharge form, chart stickers, and hospital–specific data reports, which serve as prompts for the practice of evidence–based therapies and treatments. Each hospital has a team lead by a physician and a project leader who adapts, implements, and monitors the use of the tool kit within the team. For more information on the program, please see the ACC's Web site (http://www.acc.org).

References

  1. Preventing Heart Disease and Stroke: Addressing the Nation’s Leading Killers—2003. Centers for Disease Control and Prevention.
  2. Smith SC, Blair SN, Bonow RO, Brass LM, Cerqueira MD, Dracup K, Fuster V, Gotto A, Grundy SM, Miller NH, Jacobs A, Jones D, Krauss RM, Mosca L, Ockene I, Pasternak RC, Pearson T, Pfeffer MA, Starke RD, Taubert KA. AHA/ACC Scientific Statement: AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 Update: A statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Circulation 2001;104:1577–1579.
  3. Pearson TA, Blair SN, Daniels SR, Eckel RH, Fair JM, Fortmann SP, Franklin BA, Goldstein LB, Greenland P, Grundy SM, Hong Y, Miller NH, Lauer RM, Ockene IS, Sacco RL, Sallis JF, Smith SC, Stone NJ, Taubert KA. AHA Scientific Statement: AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 Update: Consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases. Circulation 2002;106:388–391.
  4. Grover SA, Ho V, Lavoie F, Coupal L, Zowall H, Pilote L. The importance of indirect costs in primary cardiovascular disease prevention. Archives of Internal Medicine 2003;163:333–339.
  5. Fonarow GC, Gawlinski A, Moughrabi S, Tillisch JH. Improved treatment of coronary heart disease by implementation of a cardiac hospitalization atherosclerosis management program (CHAMP). The American Journal of Cardiology 2001;87:819–822.
  6. McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. The New England Journal of Medicine 2003;348:2635–2645.
  7. Burwen DR, Galusha DH, Lewis JM, Bedinger, MR, Radford, MJ, Krumholz, HM, Foody JM. National and state trends in quality of care for acute myocardial infarction between 1994–1995 and 1998–1999: The Medicare health care quality improvement program. Archives of Internal Medicine 2003;163:1430–1439.
  8. Asch SM, Kerr EA, Lapuerta P, Law A, McGlynn EA. A new approach for measuring quality of care for women with hypertension. Archives of Internal Medicine 2001;161:1329–35.
  9. Mehta RH, Montoye CK, Gallogly M, Baker P, Blount A, Faul J, Roychoudhury C, Borzak S, Fox S, Franklin M, Freundl M, Kline-Rogers E, LaLonde T, Orza M, Parrish R, Satwicz M, Smith MJ, Sobotka P, Winston S, Riba AA, Eagle KA. Improving quality of care for acute myocardial infarction: The Guidelines Applied in Practice (GAP) Initiative. Journal of the American Medical Association 2002;287:1269–1276.
  10. Marciniak TA, Ellerbeck EF, Radford MJ, Kresowik TF, gold JA, Krumholz HM, Kiefe CI, Allman RM, Vogel RA, Jencks SF. Improving the quality of care for Medicare patients with acute myocardial infarction: Results from the Cooperative Cardiovascular Project. Journal of the American Medical Association 1998;279:1351–1357.
  11. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: The chronic care model, part 2. Journal of the American Medical Association 2002;288:1775–1779.
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