Integrating Primary Care and Public Health to Prevent and Control Cardiovascular Disease

Transcription

1 Integrating Primary Care and Public Health to Prevent and Control Cardiovascular Disease Michael Schooley, MPH Branch Chief, Applied Research and Evaluation Branch Division for Heart Disease and Stroke Prevention, CDC IOM Committee on Integrating Primary Care and Public Health June 27, 2011 National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention

2 Overview q Background q DHDSP Overview q Opportunities q New Directions

3 Cardiovascular Disease: The Leading Cause of Death q Leading cause of preventable early death and of disparities in life expectancy q More than a million heart attacks and 700,000 strokes every year q Where the money is Direct medical costs ~$300 billion expected to triple in the next 20 years ~17% of all health spending

4 Aspirin Blood pressure Cholesterol Smoking On ABCS, U.S. gets an F People at increased risk of cardiovascular disease who are taking aspirin People with hypertension who have adequately controlled blood pressure People with high cholesterol who have adequately controlled hyperlipidemia People trying to quit smoking who get help 33% 46% 33% 20% Despite spending nearly $1 out of every $6 on health care

5 The Health Impact Pyramid Frieden, TR. A Framework for Public Health Action: The Health Impact Pyramid. Am J Public Health. 2010;100:590-5.

6 Division Overview ABCS Initiative High Blood Pressure Control/Sodium Reduction Low CVD Risk Increased CVD Risk Acute CVD Events Disability & Risk of Recurrent CVD Mississippi Delta Initiative

7 2010 Division Funded Programs

8 National Heart Disease and Stroke Prevention Program q Started in 1998; 41 states and District of Columbia currently funded q Program Goals: Increase state capacity by planning, implementing, tracking, and sustaining population-based interventions that address heart disease, stroke, and related risk factors. Conduct surveillance of heart disease and stroke and related risk factors and assess policy and environmental support for heart disease and stroke prevention. Identify promising strategies for promoting heart-healthy interventions. Promote cardiovascular health in a variety of settings through education and policy and environmental changes.

9 Examples of Heart Disease and Stroke Prevention Programs Working with Primary Care q Kansas Quality of Care Project: improving care of patients through Planned Care Model. q Rhode Island Cardiovascular Chronic Care Collaborative: improve disease management through FQHC s. q Nebraska Registry Partnership: implement chronic disease registry in health clinics. q Washington State : collaboration to train providers and share lessons learned. q West Virginia: install and train FQHC s on use of registry.

10 WISEWOMAN Program q Started in 1995; 19 states and 2 tribal organizations funded. q Provides screening for heart disease and stroke risk factors and lifestyle interventions for many lowincome, uninsured, or under-insured women aged years. q Have numerous WISEWOMAN programs working with CHC s and FQHC s to provide clinical services. Massachusetts: Improve BP measurement to meet JNC -7 guidelines.

11 Paul Coverdell National Acute Stroke Registry q Started in 2001; 6 states currently funded. q Near term goals: Develop and disseminate best practices in hospital recruitment and training, data collection, and quality improvement based on lessons learned. Encourage the development of statewide systems of care for stroke patients through coordination with emergency medical services and collaboration among statewide partners. Communicate with major stakeholders in stroke care to ensure ongoing improvement in the quality of that care.

12 Sodium Reduction Communities Program q Started in 2010; five sites funded. q Short-Term Goals (2 3 years): Increase policies and programs that support reducing sodium intake in communities. Expand public health efforts to implement sodium-related policies, surveillance, and evaluation. q Long-Term Goals: Reduce sodium intake to within the recommended levels in the 2010 Dietary Guidelines for Americans. Decrease average blood pressure level and improve blood pressure control in the general population.

13 Mississippi Delta Health Collaborative Goals: q Increase capacity to implement evidence-based and population-based strategies for ABCS. q Increase capacity to plan/implement strategies that improve heart disease and stroke outcomes. q Increase access to care for treatment of heart disease, stroke, and related risk factors. q Increase access to treatment and diagnostic screening for heart disease, stroke, and related risk factors in 7 counties. q Reduce risk factors for heart disease and stroke at policy, environmental, and systems change level. q Determine impact of interventions implemented. q Increase coordination of state /local chronic disease and prevention control efforts.

14 Surveillance Activities q National Cardiovascular Disease Surveillance System Data Trends and Maps q Heart Disease and Stroke Atlases q Chronic Disease Geographic Information System Exchange

15 OPPORTUNITIES His mother had often said, When you choose an action, you choose the consequences of that action. She had emphasized the corollary of this axiom even more vehemently: when you desired a consequence you had damned well better take the action that would create it. Lois McMaster Bujold

16 q Affordable Care Act Emerging Opportunities q National Prevention Strategy q National Strategy for Quality Improvement in Health Care (National Quality Strategy)

17 Opportunities for Primary Care and Public Health q Quality measurement and improvement Make hypertension control, high cholesterol control & smoking cessation core reporting requirements q New health care delivery and payment models q Medicare annual wellness visit CVD risk assessment & personalized prevention plan q Medicare Part D improvements Hypertension & cholesterol in plan ratings criteria Medication management services

18 Opportunities for Primary Care and Public Health q Campaigns to increase CVD prevention focus among individuals, health care providers, and communities q Community Transformation Grants q Enhance systems to provide information that is more Locally relevant Timely Focused on key subgroups

19 Opportunities for Public Health and Primary Care q Align policies to encourage use of recommended guidelines (JNC7, JNC8, ATPIII, USPSTF). q Integrate and expand the role of Community Health Workers. q Require and pay for chronic disease management. q Promote reduction in co-pays and incentives for quality improvements.

20 Opportunities for Primary Care and Public Health q WISEWOMAN: potential model to improve patient adherence to blood pressure medications and diabetic management. q National Heart Disease and Stroke Prevention Programs work with CHC s/fqhc s on systems change. q Surveillance data and a uniform data system q Health Care Systems Survey

21 NEW DIRECTIONS The greatest obstacle to discovery is not ignorance -- it is the illusion of knowledge. Daniel J. Boorstin

22 Potential Opportunities q Establishing Community Health Teams to Support Patient-Centered Medical Home ( 3502) q Medication Management Services in Treatment of Chronic Diseases ( 3503) q Incentives for Prevention of Chronic Diseases in Medicaid ( 4108)

23 Potential Areas of Collaboration q Patient Safety and Clinical Pharmacy Services Collaborative q 340B Drug Pricing Program q National Health Service Corps

24 Thank You For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone: CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention