Addressing disparities from the heart
Maggie Wanis | April 18, 2014
April is National Minority Health Month, this year with the theme of “Prevention is Power: Taking Action for Health Equity.” Transforming our nation’s health care system needs deliberate and diligent work in addressing health inequity and disparities that persist among populations. As part of the Department of Health and Human Services’ (HHS) Action Plan to reduce Racial and Ethnic Health Disparities, the ONC is leveraging its programs to improve the quality of health care of patients and communities through strategic use of health IT.
One of the significant ways ONC is working to reduce health disparities is by supporting Million Hearts ®, a national initiative launched by HHS in September 2011 to prevent 1 million heart attacks and strokes by 2017. While all of us are at risk for heart disease and stroke, certain groups have higher risk. For example, African Americans are 40% more likely to have high blood pressure than non-Hispanic whites, and African Americans and Hispanics are more likely to die from a stroke. Million Hearts® emphasizes prevention of heart disease and stroke by improving on the ABCS: Aspirin when appropriate, Blood pressure control, Cholesterol management, and Smoking cessation.
As part of Million Hearts®, ONC is working with Regional Extension Centers (RECs) to help providers and practices improve health outcomes in underserved communities. We are doing this by encouraging the use of health IT such as clinical decision support tools, as well as team-based care and population health analytics to better understand patient health status, coordinate care and ultimately improve quality of health.
Stories from the field
In North Carolina, Karen Smith, M.D., a solo practitioner in rural Raeford, has made significant improvements in her patients’ heart health by working to improve the ABCS of Million Hearts®. Dr. Smith’s practice achieved a tobacco cessation rate of 92.7%, far exceeding the Million Hearts® goal of 70% and trended from 30% to 57.8% for LDL Cholesterol control. Dr. Smith said it is “rewarding to see our progression,” and that her EHR, patient portal and other health IT tools have helped her to implement Million Hearts®. The local REC, the North Carolina Area Health Education Center (AHEC), played a major role in helping Dr. Smith’s practice launch her Million Hearts® work.
“The REC helped us a lot with structure,” Dr. Smith said. They know our office policies and procedures really well, so they helped us develop a structure for Million Hearts®. And we rely so heavily on the REC to help us get the quality reports done. Once patients were identified, the EHR was used to categorize and communicate with them to offer three options for helping to improve their heart health:
- One-on-one meetings with a nurse or affiliated clinician to talk about the barriers standing in their way and preventing them from achieving the good health they want.
- Group visits with other patients, often using “motivational interviewing” techniques to help patients talk through their health and lifestyle challenges.
- Use of external resources already available in the community to support patients in their journey toward better health.
“The beauty of a well-functioning EHR is that it gives you access to aggregate data and individual patient data,” she said. “And you really need both.”
In New York City, the REC, NYC REACH , helped New York providers optimize their EHR systems and encourage patients to become more engaged in their health and health care. First, NYC REACH worked with providers to analyze their practice data and identify areas for improvement. “We created performance dashboards for each practice, which can be customized to fit a provider’s quality improvement priorities,” explained Rebecca Stauffer, Project Manager at NYC REACH. When one practice had low performance on smoking cessation counseling, for example, NYC REACH helped the practice implement a clinical decision support feature. Now, when a patient is identified as a smoker, a quit line number pops up on the computer screen, prompting the provider to recommend the quit line and talk to the patient about quitting smoking.
NYC REACH has had tremendous success helping providers engage patients and make progress on Million Hearts®. Practices working with NYC REACH have significantly increased blood pressure control, with an average of 68% of patients in control of their blood pressure. In fact, one of its practices, Broadway Internal Medicine, was recently named a 2013 Million Hearts® Blood Pressure Control Challenge Champion, making it among the top 10 in the nation for blood pressure control. Despite the progress to date, NYC REACH knows that there is more work to be done. “We are continuously thinking about what tools and community resources our providers need to help them improve patient care,” Ms. Stauffer said.
In Arkansas, the REC, HITArkansas , worked in tandem with its parent organization, the Arkansas Foundation for Medical Care (AFMC) and embarked on a state wide Million Hearts® campaign leveraging Health IT through a four-pronged approach:
- Providers – HITArkansas helped providers optimize their EHR system and redesign workflows to improve on the ABCS. In one practice, for example, HITArkansas helped implement an EHR alert that notifies providers during the office visit if patients are due for a cholesterol check.
- Faith-Based Organizations -AFMC encouraged churches to distribute to patients its “Bless Your Heart” Toolkit, which includes tools and resources on preventing cardiovascular disease. Furthermore, faith-based organizations have become key partners in blood pressure control. On Sundays, for instance, many churches set up blood pressure monitoring stations and encourage patients to discuss their blood pressure with providers.
- Community Hubs – HITArkansas and AFMC leveraged other community stakeholders, such as public libraries and small businesses, to help engage patients in Million Hearts®. For example, the REC distributed to providers a list of blood-pressure monitoring stations located throughout the community. Providers, in turn, referred patients to these locations and reminded them to check their blood pressure regularly—even at the local library.
- Municipalities – Finally, HITArkansas and AFMC targeted city governments to raise awareness about Million Hearts®. The organizations worked with Arkansas’s mayors to develop city-wide Million Hearts® proclamations, with the goal of designating a “Million Hearts® Day” in Arkansas’s cities and towns. The town of Lake Village, for example, recently launched its “Healing Hearts” campaign to educate community members about the threat of heart attacks and strokes.
HITArkansas’s technical assistance and outreach efforts have helped providers and patients make significant strides toward preventing cardiovascular disease. “With a simple workflow adjustment, we helped one practice increase performance on the smoking cessation CQM from 16% to 82%,” remarked Kim Miller, EHR Implementation Specialist at HITArkansas.
Addressing health disparities requires effective partnerships across communities, involving patients, providers and all those committed to helping people lead healthy, vibrant lives. Join us in our Million Hearts® Call to Action during Minority Health Month and tell us what you are doing to improve quality of health through reducing disparities. Share your story with ONC!