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State Program: Missouri
Basic Implementation
The Missouri Department of Health and Senior Services began receiving
funds from CDC in 1998 to support a state heart disease and stroke
prevention program. The program received increased funding for basic
implementation beginning in 2000.
Burden of Heart Disease and Stroke
- Heart disease is the leading cause of death in Missouri, accounting
for 16,708 deaths or approximately 30% of the state's deaths in 2002.
(National Vital Statistics Report 2004;53(5)).
- Stroke is the third leading cause of death, accounting for 3,885
deaths or approximately 7% of the state's deaths in 2002. (National
Vital Statistics Report 2004;53(5)).
- According to Behavioral Risk Factor Surveillance System (BRFSS)
survey results, adults in Missouri reported having the
following risk factors for heart disease and stroke:
In 2005,
- 27.3% had high blood pressure
- 38.7% of those screened reported having high blood cholesterol
In 2006,
- 7.4% had diabetes
- 23.2% were current smokers
- 62.9% were overweight or obese (Body Mass Index greater than or
equal to 25.0)
- 23.2% reported no exercise in the prior 30 days
Key Responsibilities
- Facilitate collaboration among public and private sector
partners, such as managed care organizations, health
insurers, federally funded health centers, businesses,
priority population organizations, and emergency response
agencies.
- Define the burden of heart disease and stroke and assess
existing population-based strategies for primary and
secondary prevention of heart disease and stroke within the
state.
- Develop and update a comprehensive state plan for heart
disease and stroke prevention with emphasis on heart-healthy
policies development, physical and social environments
change, and disparities elimination (e.g., based on
geography, gender, race or ethnicity, or socioeconomic
status).
- Identify culturally appropriate approaches to promote
heart disease and stroke prevention among racial, ethnic,
and other priority populations.
- Use population-based public health strategies to
increase public awareness of the heart disease and stroke
urgency, the signs and symptoms of heart disease and stroke,
and the need to call 9–1–1.
- Support health care organizations system changes to
assure quality of care and implementation of primary and
secondary prevention for heart disease and stroke.
- Monitor, implement, and evaluate prevention strategies
and programs in health care sites, work sites, and
communities.
- Provide training and technical assistance to public
health, health care professionals, and partners to support
primary and secondary prevention of heart disease and
stroke.
- Monitor quality of care for primary and secondary
prevention.
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State Highlights
- The Missouri Heart Disease and Stroke Prevention (MHDSP) program is
collaborating with Federally Qualified Health Centers (FQHC) to impact
the priority areas of controlling high blood pressure, controlling high
cholesterol, improving quality of care, and eliminating health
disparities. Currently 17 of Missouri’s 19 FQHCs are participating in a
National Health Disparity Collaborative on diabetes and/or
cardiovascular disease to strengthen the process of primary care to
improve health outcomes for chronic conditions among the medically under
and uninsured.
- As of December 2006, 21,853 Missouri patients were enrolled in the
diabetes and cardiovascular collaboratives and entered into electronic
registries for cardiovascular disease and diabetes. This represents a
dramatic increase from the number of patients enrolled in Missouri’s
collaboratives since September of 2003, when only 6,120 patients were
enrolled. The FQHCs have not only increased the number of patients
enrolled in the collaboratives but they have also been successful in
making policy and protocol changes that improved clinical outcomes with
many health centers, meeting or exceeding the measures and goals set
forth by the National Health Disparities Collaborative (HDC).
- The state medical director for the Emergency Medical System (EMS) at
the Department of Health and Human Services (DHHS) has collaborated with
MHDSP to incorporate stroke and heart attack into a comprehensive
approach to EMS, called the “Time Critical Diagnosis System.” This
system seeks to develop a statewide coordinated approach to medical
transport for ST-Segment Elevation Myocardial Infarction (STEMI), stroke, and trauma. An EMS pre-hospital stroke tool
has been drafted and approved for distribution based on recommendations
from the Statewide Stroke Committee, and collaborations with the
American Heart Association, the DHSS EMS unit, the EMS State Advisory
Council, and the Missouri Hospital Association (MHA). This is an easy
and concise tool that helps EMS quickly assist suspected stroke clients.
- The Hospital Survey Summary Report was published by MHDSP in
2006 and provides the first statewide assessment of strengths and gaps
in the current stroke system. A subsequent hospital assessment is
planned for 2009. The Missouri Acute Stroke System Development
Discussion is the companion piece and offers basic education about
concepts of acute stroke system development and the potential that
exists in Missouri due to the strong collaboration of MHDSP program and
the Statewide Stroke Committee with the EMS medical director. Both
reports were distributed as the Hospital Survey Summary Report to
all Missouri hospitals, the Statewide Stroke Committee members, and to
targeted stakeholders.
- The MHDSP and the Kansas Heart Disease and Stroke Prevention program
(KHDSP) are collaborating with the Mid-America Coalition on Health Care
(MACHC) in a unique public-private partnership to design a Community
Initiative on Cardiovascular Health (CICV). Initial efforts are focused
on a 14 county, bi-state Kansas City metropolitan area to develop a
comprehensive model that can be replicated across both states in urban
and rural areas and impact cardiovascular health and risk factors,
especially hypertension and high cholesterol. This initiative builds
upon the concepts contained in the CDC’s Successful Business
Strategies to Prevent Heart Disease and Stroke toolkit and the
MACHC’s nationally recognized Community Initiative on Depression, which
has been cited by the Institute of Medicine (IOM) as the leading
community approach to depression. The Initiative will address
cardiovascular disease from a clinical, community, and local/state
perspective. The collaboration has produced the following results:
- The Community Initiative on Cardiovascular Health steering committee
conducted a series of workshops with regional employer decision makers
to present the business case for cardiovascular health and disease
issues and to determine what extent employers were willing to
participate in the CICV Initiative.
- Fourteen employers are participating in the CICV initiative.
- Follow-up meetings were held with each of the individual employers to
design employer specific interventions that address high blood pressure,
high cholesterol, physical activity, nutrition, and smoking cessation.
- Lead Public Health Agencies (LPHA) within local public health
agencies are selected based on criteria including capacity to address
chronic disease risk factors. The LPHAs are addressing both work sites
using a Work Site Inventory program and communities using the Community
Policy and Environmental Change program. Through these
programs the LPHAs provide training and technical assistance to promote
heart disease and stroke prevention priority policy and systems
interventions.
- The Bootheel Heart Health Coalition and the Bootheel Tri-County Task
Force have partnered with the MHDSP program to implement secondary
prevention activities for heart disease and stroke in high-risk minority
communities in Southeast Missouri. The Bootheel Tri-County Diabetes,
Heart Disease and Stroke Prevention Task Force has partnered
with three home health care agencies to educate employees and agency
clients about the signs and symptoms of heart attack and stroke,
recognizing stroke as an emergency, and the importance of immediately
calling
9–1–1.
- The task force is also using local television, radio, and newspapers
(with a potential to reach 160,000 residents) to promote heart attack
signs and symptoms, and the importance of calling 9–1–1. These messages
also emphasize that heart disease is the number one killer in Missouri
and the individuals can take charge of their heart health.
For more information on heart disease and stroke prevention in the state,
visit the Missouri Heart Disease and Stroke Program Web site at
http://www.dhss.mo.gov/HeartDisease/.
To view county–level data, visit our
interactive map site at http://www.cdc.gov/dhdsp/library/maps/statemaps.htm.
Page last reviewed: October 11, 2007
Page last modified: October 11, 2007
Content source: Division for Heart Disease and Stroke
Prevention,
National Center for Chronic Disease Prevention and
Health Promotion
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