Examples of Health Care Leaders Promoting Heart–Healthy and Stroke–Free Communities for Health Care Leaders

Institute standardized treatment and prevention protocols that are consistent with national evidence–based guidelines to prevent heart disease, stroke, and related risk factors. Track changes in health outcomes and cost.

In South Carolina, many collaborators—including the Medical University of South Carolina, the Duke Foundation, the Agency for Healthcare Research and Quality, and the pharmaceutical industry—are working together to support the Hypertension Initiative, which aims to improve blood pressure control, especially among people in underserved, high–risk populations. The South Carolina Cardiovascular Health Program provides support to increase hypertension expertise among primary care providers statewide, particularly providers in rural areas and those with substantial numbers of Medicaid patients. Strategies include peer–led training on best practices for providers, quality–of–care monitoring, and feedback. The Carolina Medical Review, the state's quality improvement organization, is analyzing the South Carolina Medicaid database to determine how these strategies are affecting quality of care. About 50% of hypertensive patients have controlled blood pressure, according to baseline data from participating providers who are reporting on patients under active care. The Hypertension Initiative's goal is to increase this proportion to 70% of hypertensive patients. More than 300 participating providers from 38 of the state's 46 counties are involved in these quality improvement efforts, which will affect about 70,000 hypertensive patients statewide. This approach for improving quality of care has been adopted by the American Society of Hypertension.

Institute clinical information systems to reinforce guidelines (e.g., Get with the Guidelines, Guidelines Applied in Practice) in your hospital setting and track changes in health outcomes and cost.

The Kentucky Department of Public Health's Cardiovascular Health Program partnered with the American Heart Association Kentucky affiliate, the Kentucky Hospital Association, Healthcare Excel, and the American College of Cardiology to improve quality of care and care management for patients hospitalized with cardiovascular disease. The partners used the American Heart Association's Get with the Guidelines—Coronary Artery Disease to improve patient outcomes in acute care settings. Twenty–five hospitals in major metropolitan and rural areas in all five regions of Kentucky are conducting this secondary prevention program. Regular technical assistance is provided by the American Heart Association, the state Cardiovascular Health Program, and the project's information technology manager. By combining their strengths and resources, participating organizations have contributed to the development of a hospital–based quality improvement infrastructure that ensures appropriate medications during treatment and risk counseling before discharge. As more acute care hospitals across the state launch quality improvement programs, reductions in illness and death from heart disease and stroke are expected.

Encourage your hospitals to ensure that your health care providers are up–to–date on the latest emergency heart disease and stroke training and treatment guidelines. Consider seeking recognition of your facility's stroke care capabilities from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

The Utah Cardiovascular Health program collected data on the public's general awareness of the signs and symptoms of stroke, the readiness of emergency medical centers to treat stroke patients, and EMS systems' use of protocols for stroke care. The data showed that the majority of people from Utah understood the signs and symptoms and called 9–1–1. However, the study found barriers to effective stroke care, including lack of an updated protocol among EMS systems, lack of coordination between centers accepting stroke victims, and a shortage of on–call neurologists. This effort acted as a catalyst for partnerships with Operation Stroke, the initiation of the American Heart Association's Get with the Guidelines—Stroke in two hospital stroke centers in Salt Lake, and the development of a stroke center work group to write an action plan and explore the use of funding for first-responders to enhance 9–1–1 services.

The New York State Department of Health participated in a stroke demonstration project partnership in New York City to improve the standard of care for acute stroke patients, determine if compliance with the Brain Attack Coalition (BAC) guidelines results in quality care, and explore the possibilities for administering tPA to a greater number of eligible stroke patients. Partners included the American Heart Association, the Fire Department of New York EMS, IPRO (NY's Quality Improvement Organization), a panel of experts in stroke care, and an influential assemblywoman. Hospitals in Kings County, Brooklyn and Queens County, Queens that met the core set of BAC–based criteria participated in the project. These hospitals decreased the amount of time that stroke patients had to wait before being evaluated and increased the number of patients who received tPA. Essential to the success of the demonstration project was the close collaboration with the EMS system and the improved adherence to guidelines.
 

Date last reviewed: 05/12/2006
Content source: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion