State Program: North Dakota
Capacity Building

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The North Dakota Department of Health, Division of Chronic Disease began receiving funds from CDC in 2003 to support a state heart disease and stroke prevention program.

Burden of Heart Disease and Stroke

• More than 1 out of 4 deaths in North Dakota are due to heart disease. (National Vital Statistics Report 2009).

• 1,527 North Dakotans died from heart disease in 2006 (National Vital Statistics Report 2009).
   
• 428 North Dakotans died from stroke in 2006 (7.3 percent of tottal deaths in North Dakota). (National Vital Statistics Report 2009).

See The Burden of Cardiovascular Disease in North Dakota [PDF-321K] for more burden statistics.

• According to 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey results, adults in North Dakota reported having the following risk factors for heart disease and stroke—
   
  • 26.0% had high blood pressure
  • 37.1% of those screened reported having high blood cholesterol
  • 6.3% had diabetes
  • 20.9% were current smokers
  • 64.9% were overweight or obese (Body Mass Index greater than or equal to 25.0)
  • 47.3% reported no exercise in the prior 30 days
  • 78.1% ate fruit and vegetables less than 5 times a day

Click HERE to see a text version of this graph.

State Highlights

• The Heart Disease and Stroke Advisory Council was established by the program in January 2007. The Advisory Council is a diverse group with members from health care, insurers, government agencies, professional organizations and minority health groups. This group is charged with providing oversight and implementation of a comprehensive state plan to address heart disease and stroke prevention. The North Dakota State Plan to Reduce Heart Disease and Stroke is currently undergoing final approval for publication.
   
• The North Dakota Heart Disease and Stroke Prevention (HDSP) program published The Burden of Cardiovascular Disease in North Dakota [PDF-524K] in December 2007. This report guides the program and partners as they identify priority populations, assign resources, plan and implement strategies, and monitor trends across the State and in targeted geographic or populations disproportionately affected by heart disease and stroke.
   
• The HDSP program coordinated and supported the collection of photos and stories from the four American Indian reservations located within the state’s boundaries. These stories were collected as part of a collaborative effort between the HDSP Program and the Healthy North Dakota Health Disparities Committee. Through this project, we were able to identify partners to engage, barriers to quality health care and local champions to assist in developing culturally competent strategies and engaging their community to find solutions to the problem. Their stories identified several concerns such as long waits to see the doctor, then short visits; scarce service after hours and on weekends; manpower shortages; and lack of availability of newer drugs and/or treatments. In addition, focus groups were held on at least two reservations to develop solutions that support culturally-rooted health promotion and disease prevention activities.
   
• The HDSP program collected information relating to acute stroke treatment systems at hospitals within the state during 2007. Partners from three of the six major hospital systems (including neurosurgeons), emergency department staff, local EMS personnel and the AHA Greater Midwest Affiliate assisted the Program in the survey design.  Information was collected about emergency department protocols for acute stroke diagnosis/treatment; staffing; access to laboratory services, CT scan, neurologist consultation; telemedicine; and use of medication for treatment of stroke. In addition, data were collected on inpatient protocol for management/care for stroke patients; ability to provide coordinated stroke care beyond the emergency room; and the use of a database or system to track quality improvement activity related to stroke patients. Based on the findings, a stroke care network was established in April 2008 to assist the HDSP program in planning and implementing key strategies to improve stroke outcomes.
   
• The HDSP program is working with the Diabetes Prevention and Control Program and BlueCross BlueShield of North Dakota (BCBSND) to expand existing quality improvement collaboration.  The new initiative, MediQHome Quality Project, will implement a Web-based clinical information system. Since BCBSND insures 80 percent of covered lives in North Dakota and contracts with all but four providers in the state, this collaboration has the potential to reach most insured individuals in the state. This project, which is designed to be feasible for small practices, will address high blood pressure, coronary artery disease, diabetes, heart failure, and a few other priority conditions. The electronic system will be made available free to all primary care systems within the state and has the ability to provide comprehensive performance tracking and benchmarking for all patients seen within the provider setting. This health delivery system change will affect how providers deliver care and how patients participate in managing their own care.
   
• HB1339 (passed in 2009) established Primary Stroke Center certification in addition to a work group to address triage and transport of stroke victims. This bill has three major components that stipulates the state department of health shall designate qualified hospitals as primary stroke centers; establish a stroke system of care task force to develop recommendations for protocols for the triage, stabilization and appropriate routing of stroke patients by emergency medical services operations in rural areas; and adopt a nationally recognized standardized stroke-triage assessment tool.
   
• SB2004 (passed in 2009) appropriated funds to the state health department for a statewide stroke registry and prevention project. $472,700 was appropriated to the HDSP Program to implement Get With The Guidelines® - Stroke within local hospital systems. Funds included support for licensure fees for local hospitals; chart entry grant for populating the database; temporary regional coordinators to provide technical assistance; pre-hospital and hospital personnel training; and public education and awareness campaign to increase awareness of signs and symptoms for stroke and the need to seek help immediately. These funds are available for the 2009-2011 Biennium.
   
• The first Joint Commission Primary Stroke Center in North Dakota received certification on March 30, 2009. This center is located in Bismarck and serves the central and western part of the state. St. Alexius Medical Center has been a leader in establishing stroke systems of care within North Dakota and remains a key partner in the Stroke Network. Two additional hospital systems are exploring certification for primary stroke center designation at this time and anticipate that the certification process will be complete in early 2010.

For more information on heart disease and stroke prevention in North Dakota, visit http://www.ndhealth.gov/cvh/.

To view county–level data, visit our interactive map site at http://www.cdc.gov/dhdsp/library/maps/statemaps.htm.

Page last reviewed: November 6, 2009
Page last modified: November 6, 2009
Content source: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion