The Million Hearts National Initiative
Preventing one million heart attacks and strokes over five years
A collaboration among the
Missouri Department of Health and Senior Services
American Heart Association
Primaris
Missouri Primary Care Association
Missouri Pharmacy Association
What the National Initiative Means in
Missouri
If successful over five years, it will mean
Million Hearts will have saved the lives
of
approximately 20,000 Missourians
enough people to fill up the Scottrade
Center in St. Louis or the Sprint Center
in Kansas City
Missouri Quick Facts
• Heart Disease continues to be the leading cause of
death.
• Stroke is now the fifth cause of death in Missouri.
• Prevalence of Hypertension is 34.3 in the general
population and over 40 in the African-American
population.
• Slightly more than half of those with hypertension are
being told to decrease their sodium intake.
• Million Hearts is described as an activity in
Missouri’s CDC 1305 Grant Domain 3
Strategy 1
Status of the ABCS
Aspirin
People at increased risk of cardiovascular disease
who are taking aspirin
47%
Blood
pressure
People with hypertension who have adequately
controlled blood pressure
46%
Cholesterol
People with high cholesterol who are effectively
managed
33%
Smoking
People trying to quit smoking who get help
23%
Source: MMWR: Million Hearts: Strategies to Reduce the Prevalence of Leading
Cardiovascular Disease Risk Factors --- United States, 2011, Early Release, Vol. 60
Key Components of Million Hearts™
• Community Prevention
– Reduce the number of people who
need treatment
• Clinical Prevention
– Optimize care for heart and stroke
patients
Health System Messages
• Clinicians
–
–
–
–
Emphasize power of prevention
Create systems to get an “A” in the ABCS
Use decision supports and registries to drive performance
Deploy teams
• Pharmacists
– Monitor and influence refill patterns
– Team up
– Teach adherence by helping patients to understand the
importance of taking their medications
– Teach patients about the ABCS through
Medication Therapy Management
Health System Messages
• Insurers
– Measure and incentivize performance on the ABCS
– Collect and share data for quality improvement
– Empower consumers
• Individuals
– Know your numbers—and goals
– Get to know the ABCS
– Take aspirin, if advised
– Take steps to lower high blood pressure and
cholesterol
– Reduce sodium and trans fats
– If you smoke, quit
– Avoid exposure to second-hand smoke
Timeline of progress in 2012
February
- Bi-weekly teleconference planning sessions began
- Press release introducing Million Hearts to public
April
- Letter to professionals released
- Webinar presented by Dr. Janet Wright, HHS/CDC and Dr.
Whaley-Connell HTN expert
- Role of Million Hearts Physician Champion defined
June
- Nine Missouri physician champions recruited
July
- Missouri Millions Hearts regions defined as BRFSS regions
August
- Missouri Department of Health and Senior Services
compiled data on Missouri cardiovascular disease
- Missouri Million Hearts committee meets to
review data
Sept –Dec - Continued to add partners, MPCA and MPA
Timeline of progress in 2013
Jan - March - Monthly teleconference planning sessions continue
April
- Presented at the MSMA meeting in KC
- Gained interest from several physicians
May
- Face to Face meeting
- Action Plan Developed for 2013/2014
- Created work groups for identified plan objectives
- Work groups convened
November - Second Face to Face meeting
October
- Started project with MO HIE as a data resource for TGA
Present
- Total Ten Missouri physician champions recruited
- 19 sites recruited to demonstrate The Guideline
Advantage
Work Groups
• Communications
(website/newsletter/media)
• Team care (Pharmacists/physicians)
• Provider Champion Recruitment and
Resources and Tools
• Data Capture and Analysis (TGA)
• Baseline Data and Success measures
• Advocacy (Gov. relations)
BRFSS Regions
Behavioral Risk Factor Surveillance System (BRFSS) is a telephone health
survey system of healthcare consumer
12
Million Hearts Provider Champion
• Serves as an expert resource for the MO Million Hearts
Collaborative
• Promotes the Million Hearts Initiative to health
professionals and patients
• Enhances knowledge on heart attack, stroke and related
modifiable risk factors
Million Hearts Provider Champion
• Supports local community-based patient-resources to
reduce smoking prevalence, improve nutrition, reduce
blood pressure
• Supports and reinforces healthy choices and healthy
behaviors: Is aware of barriers to patient access to
healthy choices and behaviors
• Promotes the use of Health Information
Technology
Champion Resources Online
Resources available on the Million
Hearts website:
www.heart.org/momillionhearts
Resource include informational articles and tools on:
• Aspirin therapy
• Blood pressure
• Cholesterol management
• Smoking cessation
• And much more.
Behavioral Risk Factor Surveillance
System (BRFSS)
• BRFSS is a state-level health survey that annually
collects information on a range of issues including
health conditions, risk behaviors, and preventive
practices.
• BRFSS is used to:
• Indentify emerging health problems;
• Establish health objectives and track
progress;
• Justify funding requests and report progress.
Behavioral Risk Factor Surveillance
System (BRFSS)
• MO Department of Health and Senior Services
(DHSS) conducts the annual BRFSS with
assistance and support of the Centers for Disease
Control and Prevention(CDC)
• How is BRFSS conducted?
• Telephone interviews with adults over 18
• Only with those not living in institutions
• How many Missourians are interviewed?
Approximately 6,360 are interviewed
throughout the year.
MISSOURI MILLION HEARTS 2012 BASELINE MEASURES
Population Heart attack
Stroke
Hypertension
Region
(≥ 18 years) Percent Number Percent Number
Percent Number
US (median, 2010)
4.1
−
2.6
− 28.7 (2009)
−
Missouri
4,598,567
5.6 257,520
3.6 165,548
34.3 1,577,308
Central
551,603
4.9
27,029
2.9
15,996
36.9 203,542
Kansas City Metro
900,062
5.4
48,603
3.5
31,502
33.3 299,721
Northeastern
196,020
6.0
11,761
4.2
8,233
35.1
68,803
Northwestern
188,083
5.0
9,404
4.0
7,523
32.5
61,127
Southeastern
444,483
8.5
37,781
5.2
23,113
38.0 168,904
Southwestern
701,379
6.2
43,485
4.6
32,263
35.1 246,184
St. Louis Metro
1,616,937
4.8
77,613
3.0
48,508
32.9 531,972
Data source: adult population, MICA; prevalence, BRFSS.
4/8/2015
1
MISSOURI MILLION HEARTS 2012 BASELINE MEASURES
Population High cholesterol
Current smoker
Region
(≥ 18 years) Percent
Number Percent
Number
US (median, 2010)
37.4 (2009)
−
17.3
−
Missouri
4,598,567
40.4 1,857,821
25.0 1,149,642
Central
551,603
41.8
230,570
28.0
154,449
Kansas City Metro
900,062
42.3
380,726
24.9
224,115
Northeastern
196,020
37.1
72,723
22.3
43,712
Northwestern
188,083
35.3
66,393
24.2
45,516
Southeastern
444,483
47.4
210,685
28.9
128,456
Southwestern
701,379
39.5
277,045
26.1
183,060
St. Louis Metro
1,616,937
38.3
619,287
23.0
371,896
Data source: adult population, MICA; prevalence, BRFSS.
Role of Missouri Dept. of Health and
Senior Services
• Produce data from available sources such
as BRFSS for Million Hearts.
• Provide Strategic Doing Expertise which
enabled Missouri to establish strategic
focus areas and workgroups for
implementation.
Role of Missouri Dept. of Health and
Senior Services
• Partner with organizations representing
disparate populations. (Missouri Primary Care
Association for quality improvement initiatives on related
measures e.g. high blood pressure, A1c, cholesterol.
• Initiate implementation of evidence based
initiatives for quality improvement focusing
on medication adherence. (e.g. add
pharmacists to team based care)
Role of Missouri Dept. of Health and
Senior Services
• Promote Missouri Tobacco Quitline for
quitting smoking, smoke-free policies, safe
walking areas, and access to healthy food.
• Serve as the key leader in establishing the
Sodium in Knowledge in Practice which is
enabling Missourians to make better lower
sodium food choices by focusing on
education, policy change and
environmental interventions.
Role of Health Depts. and
Community Organizations
• Work with health care systems to monitor
national quality indicators, including
“controlling high blood pressure,” and
carry out quality improvements.
• Encourage health systems to use health
information technology to identify patients
who have high blood pressure and
establish follow up systems to
monitor those patients.
Role of Health Depts. and
Community Organizations
• Promote Missouri Tobacco Quitline for
quitting smoking, smoke-free policies,
safe walking areas, and access to healthy
food.
Role of American Heart Association
• Provide evidence based guidelines for the
treatment and prevention of stroke and
heart disease
• Provide a multitude of resources for both
consumers and providers
– Educational materials
– Health tracking tools
– Tools for professionals
– Quality improvement programs
Role of American Heart Association
• Provide link to physicians for support and
expert opinion
• Utilize connections with the community to
disseminate information
• Gain interest and support due to AHA
brand name and credibility
Role of Primaris
• Pilot Project with physician practices
– Develop a systems-level, data-driven
approach to quality improvement
• Promote reporting and use of metrics to
identify areas for clinical improvement
• Advance Patient-Centered Medical Home
efforts with emphasis on care
management & transitions of care
Role of Missouri Pharmacy
Association
• Pilot Project with pharmacists
• Inform the public of the benefits of
pharmacists as members of the health
care team
• Promote medication adherence as a key
factor in health.
Role of Missouri Primary Care
Association
One of our functions is assisting Federally
Qualified Health Centers (a.k.a Community
Health Centers) with quality enhancement
and networking support of efforts to develop,
implement, and sustain community health
improvements.
Role of Missouri Primary Care
Association
•
•
•
•
•
•
•
Quality Improvement/Performance Improvement
Best Practices
Data Collection
Research and Analysis
Technical Assistance
Network Development
Patient Centered Medical Home efforts with
emphasis on population health and individual
care management and care
• coordination
Program Model
31
Tool for Population Health
Management
• On-demand access to quality improvement
data using a web-based tool
• Available physician-level reporting
• Clinic and system aggregation
• Tools for creating action lists
32
Tool for Population Health
Management
• Alignment with key national initiatives
• National and State benchmarking
• Practice network opportunities, including
virtual workshops and national recognition
33
Contacts
• Robin Hamann
American Heart Association
Phone: (618) 402-5393
robin.hamann@heart.org
• Kris Kummerfeld
Heart Disease and Stroke Prevention
Phone: (573) 522-2879
Kris.Kummerfeld@health.mo.gov
• Abhi Ray
Primaris
• Phone: (816) 588 1848
aray@primaris.org
Thank You for Your
Attention!
Questions?