1. Cardiovascular Disease (CVD) in Texas Philip Huang, MD, MPH Texas Department of State Health Services

2. Overview Burden of CVD Mortality Morbidity Economic Cost Risk Factors Quality/Performance HEDIS EMS Strategies to Address

3. Burden of CVD Leading cause of death in Texas and in the United States 34% of all deaths in Texas 1,422,000 Texas adults reported that they have had heart disease or stroke in 2005

4. MORTALITY DATA

5. Mortality Data Death certificate data were compiled and tabulated by the Statistical Services Division of the Texas Vital Statistical Unit (VSU) All death rates are age-adjusted using the 2000 US standard population

6. Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 2004

10. Trends of Heart Disease Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 1969-2004

11. Trends of Stroke Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 1969-2004

12. Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 1990-2004

13. Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 1999-2004

14. Mortality Data-Ischemic Heart Disease Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 1999-2004 Ischemic Heart Disease 6 Year Average Age-Adjusted Mortality Rates, 1999-2004

15. Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 1999-2004

16. Mortality Data-Stroke Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 1999-2004 Stroke 6-Year Average Age-Adjusted Mortality Rates,1999-2004

17. Hospital Discharge Data 2000 - 2004

18. Hospital Discharge Data Data Source: Texas Health Care Information Collection (THCIC), Department of State Health Services, 2005

19. Data Source: Texas Health Care Information Collection (THCIC), Department of State Health Services, 2000-2003

20. Estimated Hospital Charges

21. Data Source: Texas Health Care Information Collection (THCIC), Department of State Health Services, 2000-2003

23. Medicaid Claims Data for Cardiovascular Disease Texas, 2005 The data is based on paid Medicaid claims for Fee-For- Service (FFS) and Patient Care Case Management (PCCM) clients. It does not include information on individuals served by Medicaid HMOs or those served by STAR+PLUS. This information is derived from paid or partially paid Medicaid claims and does not include data on denied or pending claims.

24. Primary CVD Diagnoses, Inpatient Cost, Texas, 2005 Source: Fee for Service (FFS) and Patient Care Case Management (PCCM) clients Hypertension$2,132,630 Hypertensive heart disease$1,655,524 Ischemic Heart Disease$47,697,130 Stroke$20,071,425 Congestive Heart Failure$30,885,743

25. Primary CVD Diagnoses, Outpatient Cost, Texas, 2005 Hypertension$1,640,395 Hypertensive heart disease$1,061,310 Ischemic Heart Disease$18,415,949 Stroke$9,944,830 Congestive Heart Failure$11,801,680 Source: Fee for Service (FFS) and Patient Care Case Management (PCCM) clients

26. Primary CVD Diagnoses, Emergency Department Cost Texas, 2005 Source: Fee for Service (FFS) and Patient Care Case Management (PCCM) clients Hypertension$6,561,670 Ischemic Heart Disease$7,348,006 Stroke$3,248,339 Congestive Heart Failure$3,762,690

27. Total Medicaid Paid Claims Due to CVD, Texas, 2005 InpatientEmergency Department Outpatient Medicaid Paid Amount for CVD $182,524,852.67$42,641,919.19$103,351,622.91 Source: Fee for Service (FFS) and Patient Care Case Management (PCCM) clients

28. Risk Factor Surveillance

29. BRFSS Ongoing telephone survey sponsored by DSHS in partnership with CDC Conducted on a monthly basis of 500 randomly selected Texans 18 years or older are asked questions about their health habits

30. BRFSS Behavioral Risk Factors Medical Risk Factors Preventive Health Practices

32. Adult Cigarette Smoking Prevalence – 2006 Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006

33. Adult Cigarette Smoking Health Service Region – 2006 Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006

34. Cigarette Smoking Among Youth – 2001 & 2005 Data Source: Texas Youth Risk Behavior Surveys (YRBS), Texas Department of State Health Services, 2001, 2005 (Excluding Houston ISD) High School Survey

35. Overweight/Obesity

36. Overweight or Obesity Texas and US Adults, 1995-2006 Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 1995-2006

37. Overweight or Obesity Texas, BRFSS,- 2006 Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006

38. Overweight or Obesity Health Service Region-2006 Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006

39. Overweight among Youth Prevalence – 2001 & 2005 Data Source: Texas Youth Risk Behavior Surveys (YRBS), Texas Department of State Health Services, 2001, 2005 (Excluding Houston ISD) High School Survey

40. Lack of Physical Activity

41. Lack of Physical Activity* Texas & US Adults, 1995-2006 * During the past 30 days, did you participate in any physical activities or exercise? % of adults who did not participate in any physical activities during the past 30 days Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 1995-2006

42. Lack of Physical Activity* Adults, Prevalence – 2006 * During the past 30 days, did you participate in any physical activities or exercise? % of adults who did not participate in any physical activities during the past 30 days Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006

43. Lack of Physical Activity* Adults, Prevalence – 2006 * During the past 30 days, did you participate in any physical activities or exercise? % of adults who did not participate in any physical activities during the past 30 days Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006

44. Poor Nutrition

45. Poor Nutrition* Adults, Prevalence – 2005 *% of adults who reported eating fewer than 5 servings of fruits and vegetables per day Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005

46. Poor Nutrition* Health Service Region – 2005 *% of adults who reported eating fewer than 5 servings of fruits and vegetables per day Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005

47. *% of students who reported eating 5 or more servings of fruits and vegetables per day Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005 Nutrition* Public High School Students – 2001,2005

48. Medical Risk Factors Diabetes High Cholesterol High Blood Pressure

49. Diabetes Texas and U.S Adult - 1995-2006 Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 1995-2006

50. Diabetes Prevalence - 2006 Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006

51. Diabetes Prevalence Health Service Region– 2006 Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006

52. High Cholesterol Texas and U.S Adult-1995-2005 Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 1995-2005

53. High Cholesterol Prevalence - 2005 Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005

54. High Cholesterol Health Service Region– 2005 Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005

55. High Blood Pressure Texas and U.S Adult -1995-2005 Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 1995-2005

56. High Blood Pressure Prevalence - 2005 Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005

57. High Blood Pressure Health Service Region--- 2005 Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005

58. HEDIS Health Plan Employer Data and Information Set

59. HEDIS Standardized performance measures designed for comparing the quality of care of managed care organizations

60. Result from HEDIS. Texas, 2001-2006 Measures200120022003200420052006 Controlling High BP 1 47.850.957.959.264.5 Beta Blocker Treatment After a Heart Attack 2 NA90.386.985.283.384.3 LDL-C Screening after acute CV event 3 72.476.277.177.979.475.6 LDL-C Level < 130 mg/dL 4 42.657.756.355.846.8 Data Source: http://www.opic.state.tx.us/page.php?p_sub_page_id=582001-2006

61. STRATEGIES Surveillance, Data and Outcome Management Health Education and Outreach Clinical Prevention and Treatment Services Community Policy and Environmental Changes