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August 21, 2013 Million Hearts ® : Local Practice- Based Successesin Addressing Cardiovascular Health.

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Presentation on theme: "August 21, 2013 Million Hearts ® : Local Practice- Based Successesin Addressing Cardiovascular Health."— Presentation transcript:

1 August 21, 2013 Million Hearts ® : Local Practice- Based Successesin Addressing Cardiovascular Health

2 Truemenda C. Green, MA Director Healthy Communities/Chronic Disease National Association of County and City Health Officials (NACCHO) 1100 17th Street, NW, 7th Floor Washington, DC 20036 (202) 507-4213 office Million Hearts ® : Local Practice- Based Successesin Addressing Cardiovascular Health

3 Goal and Objectives Goal: To help participants improve their awareness and understanding of practice-based local health department programs that address cardiovascular health and local efforts to implement the Million Hearts ® initiative in cardiovascular disease prevention. Objectives: By the end of this webinar, participants will be able to: Understand the purpose of Million Hearts ® and how local health departments can be a part of Million Hearts ® ; Identify at least one cardiovascular disease prevention strategy used by a local public health department that they can implement in their own agency; Understand how policies and practices in local health departments impact cardiovascular disease prevention; and Become knowledgeable about multiple innovative strategies to transform current preventive chronic disease efforts and programs

4 Speakers Robin Diggs Outlaw, DC Department of Health Rayleen Earney, Southern Nevada Health District Dr. Judith Shlay, Denver Public Health Claudia Siegel, Philadelphia Department of Health

5 Introduction to Million Hearts ® National initiative co-led by CDC and CMS Partners across federal, state, local agencies and private organizations Goal: Prevent 1 million heart attacks and strokes in 5 years Goal: Prevent 1 million heart attacks and strokes in 5 years

6 How to Get Involved with Million Hearts ® Community Participation Improving care for people who do need treatment by encouraging a targeted focus on the ABCS Empowering Americans to make healthy choices such as preventing tobacco use and reducing sodium and trans fat consumption Actions You Can Take Align existing initiatives and programs with Million Hearts® goals Convene partners, stakeholders and policy makers for Million Hearts® for planning purposes Share success stories from communities on Million Hearts®

7 NACCHO is Committed to Recognizing 150 Local Health Departments Engaged in Million Hearts Activities !!! Patient Care Coordination/ Linkage Blood Pressure Monitoring/ Counseling Sodium Reduction/ Healthy Food Access Tobacco Control Policy, System, Environmental Change Initiatives / Healthy Communities Community Health Coalition


9 Million Hearts ® and Local Cardiovascular Disease Prevention Efforts Last modified: July 26, 2013 Copyright Information All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. Robin Diggs Outlaw, MPH Manager Cardiovascular Disease and Diabetes Prevention Program Cancer and Chronic Disease Bureau Community Health Administration District of Columbia Department of Health Government of the District of Columbia

10 Burden of Cardiovascular Disease in the District of Columbia Cardiovascular disease and stroke are the 1 st and 4 th leading causes of death in the District of Columbia The prevalence of hypertension among African- Americans is double the rate among Caucasian residents at 40.4% In 2011, 10.1% of District residents age 65+ reported having coronary heart disease compared to 7.3% in 2009 The prevalence of Cardiovascular disease is highest in Wards 4, 5, 7 and 8 Data Source: District of Columbia Behavioral Risk Factor Surveillance System (BRFSS) 2011, 2009.

11 Co-morbidities and the Environment

12 Cardiovascular Health Program Priority Areas Policy and Environmental Approaches Increase access to opportunities for physical activity Increase access to healthy food options Health System Interventions Increase utilization of health information technology (HIT) to improve disease management, quality of care, and use of preventive services. Increase engagement of non-physician team members in hypertension and diabetes management in health care systems Community-Clinical Linkages Increase access to chronic disease prevention and self- management education and support Increase use of health-care extenders in the community in support of self-management of high blood pressure and diabetes

13 Alignment with Million Hearts ® Key Partnerships Delmarva Foundation (QIO) American Heart Association Association of Black Cardiologists, Inc. Mended Hearts, Inc. Howard University YMCA District of Columbia Primary Care Association (REC) Local health systems Community-based organizations

14 Foster Clinical Innovations Quality Management of ABCs– Partner with QIO and other cardiac stakeholders in the District to promote team-based care, the use of HIT tools, and other methods to improve quality of health care delivery Support interventions that incorporate the use of health care extenders to promote medication adherence and provide education and patient navigation services

15 Foster Clinical Innovations Cont Activities Leverage QIO initiatives such as Learning and Action Networks Convene partners to develop webinars for providers Work with your healthcare licensing department to devise a system for communicating with health care providers Focus funding efforts on interventions that are aligned with Million Hearts ® strategies

16 Expand Community Initiatives to Support Healthier Behaviors CHW Initiative Partnership with DCPCA to enhance the CHW workforce and increase access to cardiovascular disease and diabetes self-management programs and support in community settings Hair, Heart, & Health Program Culturally appropriate intervention in partnership with Medstar Health targeting African-American males Barbershop-based hypertension and diabetes screening, education, and navigation to follow-up clinical care

17 Expand Community Initiatives to Support Healthier Behaviors Cont Healthy Corners Initiative Partnership with DC Central Kitchen Delivers fresh produce and healthy snacks to corner stores in Wards 4, 5, 7 and 8 DC Fresh Mobile Produce Carts Pilot Program Partnership with Daddys Corner, Inc (a local non-profit) Sells fresh produce in targeted high traffic locations within Wards 4, 5, 7 and 8 Freggie Bucks Initiative $3.00 vouchers to be distributed at community education and outreach sessions in collaboration with partners Vouchers will be redeemable at participating corner stores and farmers markets

18 Local Policies The FEED DC Act The Healthy Schools Act Workplace Wellness Act DC Stroke System of Care Act DC Telehealth Reimbursement Act Shared Use of School Property Bill

19 Contact Info Robin Diggs Outlaw, MPH Program Manager Cardiovascular and Diabetes Prevention and Control Program District of Columbia Department of Health Community Health Administration Bureau of Cancer and Chronic Disease 899 North Capitol Street, NE, 3 rd Floor Washington, DC 20002 p: 202-442-9130


21 Rayleen Earney, MEd., CHES Health Educator II Southern Nevada Health District, Las Vegas, NV Office of Chronic Disease Prevention & Health Promotion NACCHO Webinar August 21, 2013

22 Prevent 1M heart attacks & strokes Improving access to care Improving quality of care Focusing clinical attention on prevention Promoting heart-healthy lifestyle www.millionhearts.hhs. gov

23 The Million Hearts campaign was an effective way for Southern Nevada Health Districts (SNHD) staff to cross promote and coordinate Chronic Disease Prevention and Health Promotion messages. Subjects featured on our website included (ABCS, nutrition, physical activity and tobacco/smoking cessation): hearts.php hearts.php There was no specific grant funding for MH activities so our staff took advantage of free social media tools (FB, Twitter, Blog, and website) to promote MH messages, resources, and activities.

24 SNHD News Release included local heart statistics (BRFSS) Earned Media Interviews: Healthier Tomorrow Radio Program (African American listenership), Channel 8 TV news physical activity segment Utilized free Social Media Outlets (FB, Twitter, Blogs, website) & earned media Weekly interactive posts per topic Risk tests, links to videos, MH resources 2 Community Presentations Nevada Parks & Recreation Department Staff Body & Soul Program staff (faith based initiative) Staff also printed/distributed MH handouts to community/staff at SNHD and participated in Go Red for Women activities coordinated by the American Heart & Stroke Association

25 ABCS: National and local resources on our home page: Promoted SNHDs free online programs (Walk Around Nevada and Nutrition Challenge): Consumer Tools: sodium calculator, BP basics video, AHA Heart 360 program Nevada, blood pressure journal, medication wallet cards, guides to lowering blood pressure, risk tests, places to check blood pressure Healthcare Provider Tools : Rx pads linking patients to free online programs Nutrition Challenge and Walk Around Nevada, and the Nevada Tobacco Users quitline MH fact sheets, BP toolkit, and the national Million Hearts link


27 English Blog: FB: How has heart disease and stroke affected you and your family? Take the Million Hearts Pledge: Twitter Twitter : GetHealthyCC@GetHealthyCC7 FebGetHealthyCC@GetHealthyCC7 Feb Aspirin may be able 2 reduce ur risk 4 heart attacks, ask ur doctor about aspirin therapy. GetHealthyCC@GetHealthyCC11 Feb GetHealthyCC@GetHealthyCC11 Feb Check out these blood pressure basics you can do to help lower your blood pressure. Spanish Blog: Twitter: TuSNHD@TuSNHD21 Feb ¿Tiene el colesterol alto? Lea nuestros tips consejitos para reducirlo en

28 Blog Views: 2400 blog viewers (English) 315 blog viewers (Spanish) Earned Media: 1 live radio interview (KCEP Healthier Tomorrow Radio Program) 1 TV interview channel 8 Website Views & Downloads: 153 spotlight website views: 30 web downloads 324 heart related materials disseminated at worksite (FDA provided free Heart Disease handouts and also printed some from MH Toolkit) Community Presentations (2): Henderson Parks & Recreation Body & Soul Church Program

29 Successes Leveraging community, clinical and faith-based partnerships through coalitions Coordinated approach for CD messages Reached low SES diverse communities (African Americans/Latinos) Earned media opportunities generated through press releases Challenges Funding Infrastructure Priorities Local level data

30 Rayleen Earney, MEd., CHES Health Educator II Email:; Phone: 702-759-1271


32 Reducing Cardiovascular Disease Risk Using Patient Navigators Judith C. Shlay, MD, MSPH Denver Public Health

33 Original Project 2007-2009 Objective of study: To determine whether enhanced counseling, and using patient navigators to counsel patients on CVD risk- reduction strategies and facilitate patient access to community-based lifestyle-change services reduced CVD risk among at-risk patients in a low-income population Conducted by Denver Public Health; funded through a state CVD prevention grant Shlay et al. Prev Chronic Dis 2011;8(6):A143

34 Method Compared clinical characteristics at baseline and 12-month follow-up for 340 intervention and 340 comparison patients All patients had FRS >10% at baseline Intervention: patient-centered counseling by bilingual patient navigators –One hour counseling session at baseline, plus follow- up calls at 1-4 weeks and 6-10 weeks; additional calls made within 6 months of enrollment Assessed health behaviors of intervention participants at baseline and 12-month follow-up

35 Results At follow-up, clinical differences identified between intervention and control group –Change in mean FRS (baseline to follow-up): intervention 15.5% to 14.8% vs. control 15.0% to 15.8% –At goal (FRS <10%): intervention 11.8% vs. control 3.5% –Total cholesterol: intervention 183mg/dL vs. control 197mg/dL Intervention group reported significant improvements in some health behaviors at 12- month follow-up –Nutrition-related behaviors improved –Tobacco use and cessation attempts did not change

36 Conclusions Using patient navigators to provide individualized counseling, assist in goal setting, and link to community resources seemed to help intervention participants achieve positive behavioral changes and improve several clinical outcomes Simple intervention for enhancing traditional clinical CVD risk-reduction services Large scale programming and evaluations needed

37 Ongoing CVD Prevention Work using Patient Navigators and Coordinated Care in Colorado

38 Denvers Community Transformation Grant Cardiovascular disease Reduction: A Focused Transformation (CRAFT) Funded for 2011-2016

39 Denver CTG Partners by Program Area Group to Alleviate Smoking Pollution (GASP) Denver Housing Authority (DHA) Smoke Free Living Denver Environmental Health (DEH) Healthy Eating Denver Public Schools (DPS) Active Living Denver Health & Hospital Authority Community Health Services (CHS) Kaiser Permanente Colorado Alliance for Health Equity and Practice (CAHEP) EMC Clinical Preventive Services The Trust for Public Land (TPL) Denver Parks & Recreation (DPR) Healthy & Safe Environment

40 Patient Navigation Services Public Health Detailing in clinic control of HTN patients in safety net clinics in Denver Increased retention in care of patients diagnosed with HTN Improved quality of care provided by clinic physicians on CVD Denver CRAFT (Cardiovascular disease Reduction: A Focused Transformation) Denver Cardiovascular Disease Registry Improved public health surveillance

41 Program Goal Improve cardiovascular health of adults in Colorado communities 2009-2016

42 Current CHHS Communities

43 CHHS Numbers

44 CHHS by the Numbers Baseline levels for at- risk population Change in risk factor Baseline levels for those with abnormal risk factor Change in risk factor Total cholesterol 215mg/dL 15240mg/dL 24 LDL cholesterol 139mg/dL 18164mg/dL 30 Systolic Blood Pressure 131mmHg 4155mmHg 18 Framingham Risk Score 11.3 0.820.8 2.4 Among the 1,200 participants with elevated risk factors retested at 12 months, decreases seen in a number of risk factors

45 Improvements in Framingham Risk Scores


47 Philadelphia and Heart Health: Common Goals with Million Hearts

48 Based on data from Centers for Disease Control and Philadelphia Department of Public Health

49 Adult Hypertension in Philadelphia, 2000 - 2012 Source: PHMC Household Health Survey, 2000-2012

50 Health care environment dominated by larger players, intense competition, and fragmented health information sources Multiple factors in the mix –5 academic health centers, each with its own health system, clinics, hospitals, and EHR systems –Several large insurers dominate the market –Medicaid population under managed care and split among 5 different companies that provide services (under contract with the state Department of Public Welfare) –Uninsured, many of whom find care at the citys 30+ federally qualified health centers –Substantial lifestyle and environmental challenges, health disparities EHR, Electronic health record Philadelphias Challenges

51 Clinical Interventions Long-lasting Protective Interventions Changing the Context t o make individuals default decisions healthier Smallest impact Largest impact Frieden TR. Am J Public Health 2010;100 (4): 590–5 Impact Pyramid Factors that Affect Health Counseling and Education Health care services Public health Potential common ground

52 Schools and Universities RETAIL ENVIRONMENT MEDIA WORKPLACES Health Insurers and Providers Legislation and Regulation Get Healthy Philly: Multi-sector initiative How can we make it easier for Philadelphians to engage in healthy behaviors? MEDIA

53 Nutrition Develops and implements nutrition standards All City-funded food procurement contracts (20 million meals annually) Supports 630 corner stores in selling produce and low-salt items Sodium Reduction Training 221 Chinese take-out restaurants to reduce the sodium content of meals Sodium reduction mass media campaign, Spring 2014 Evaluates impact of sodium labeling in chain restaurants (Philadelphias menu labeling law) Hypertension Prevention Reduce medication copays for hypertension, high cholesterol, and smoking cessation Employer-focused effort Promotes policies and programs to reduce tobacco use



56 Convening working groups with key players (insurers, health systems, providers, etc.) to get better data and to share data on hypertension and cardiovascular disease in the city (CDC NPHII)de-identified, aggregated data 100 percent response rate--all partners responded First city-wide estimate of hypertension based on clinical data New initiative: Know your numbers –PDPH is publishing location and hours of free health screenings throughout the city: Million Hearts partnership for mobile app launch National and local partnerships for screening event and dialogueAmerican Kidney Fund Kidney Action Day, Friday, May 3, 2013 Philadelphia Department of Public Health Heart Health Data Gathering and Sharing

57 PDPH Data-Sharing Initiative Initial Results: Success with Gaps Insurer data: 585,922 of adults 18 years old (~50%) –Overall population 24.2%: Hypertension prevalence Blood pressure controlled: 35.4–62.5% (including Medicare) –Medicare population alone 79.5%: Hypertension prevalence Blood pressure controlled: 62.5% Provider data: 355,057 adults 18 years old (~30%) 17.1%: Hypertension prevalence Blood pressure controlled: 42.1–65.7% For target zip codes, zip code-level information from some insurers and providers was available

58 Next Steps Sustain, promote and expand Get Healthy Philly Continue data-sharing and analysis Bring additional partners to the table Change the environment around data: –Shared perspectives collaborative action plan Maintain emphasis on heart health alongside Million Hearts

59 Q&A

60 Contact Information for Speakers Robin Diggs Outlaw, DC Department of Health:, (202-442-9130) Rayleen Earney, Southern Nevada Health District: (702-759-1271) Dr. Judith Shlay, Denver Public Health: (303-602-3714) Claudia Siegel, Philadelphia Department of Health: (215-686-5263)

61 Additional Resources and Contact Information For more information on Million Hearts ®, visit: For additional resources on Million Hearts ®, visit the Million Hearts ® Toolkit: For technical assistance with Million Hearts ®, contact: NACCHO Million Hearts ® Contacts: Truemenda Green, Director:, Iris Tiongco, Program Associate:,

62 Coming Soon! Keep a lookout for a soon-to-be-released NACCHO Million Hearts ® resource: Million Hearts ® Local Engagement Guide

63 Thank you! Thank you for attending our webinar! Please complete the online evaluation for this webinar.

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