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Fact Sheets and At–a–Glance Reports
State Heart Disease and Stroke Prevention Program in Health Care Settings
to Prevent Heart Disease and Stroke
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Examples of CDC-funded State Program Activities to Improve Guideline Adherence in Health Care Settings:
• |
Programs in Alaska, Alabama, Colorado, Connecticut, Georgia,
Illinois, Kentucky, Montana, New York, North Carolina, and Wisconsin are addressing hospital
system quality of care through the introduction and promotion of the American Heart Association (AHA) and the
American Stroke Association's (ASA) Get With the GuidelinesSM program. For information on the
program, please see the AHA's Web site (www.americanheart.org).* |
• |
Programs in
Arkansas, Florida, Louisiana, Maine, Minnesota,
Missouri, Oklahoma, and Utah are promoting health system
supports such as reminders of care, development of
clinical performance measures, and the use of case
management services to increase health care providers'
adherence to recommended heart disease an stroke
prevention and treatment guidelines. |
• |
The
Massachusetts State Program partners with Southcoast
Hospital Group to establish leadership and education for
heart disease prevention requirements for hospitals that
are licensed to perform open-heart surgeries. |
• |
The Montana
and West Virginia programs partner with the states'
Quality Improvement Organizations, the American College
of Cardiology (ACC), physicians, nurses, and hospital
administrators to implement quality of care improvement
projects to increase adherence to the ACC/AHA practice
guidelines for Acute Myocardial Infarction (AMI)
patients. Participating hospitals receive a
Guidelines Applied into Practice (GAP) tool kit
containing background literature, sample AMI orders for
admission, sample patient information form, sample heart
attack discharge form, chart stickers, and
hospital–specific data reports, which serve as prompts
for the practice of evidence–based therapies and
treatments. Each hospital has a team lead by a
physician and a project leader who adapts, implements,
and monitors the use of the tool kit within the team.
For more information on the program, please see the
ACC's Web site (www.acc.org).* |
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Heart disease and stroke, the principal components of cardiovascular
disease (CVD), are the first and third leading causes of death in the
United States, accounting for nearly 40 percent of all deaths.1
Several organizations including the American Heart Association and the
American College of Cardiology have developed clinical practice guidelines
to assist in the diagnosis and management of patients with CVD.2, 3
Scientific studies have demonstrated that adherence to these clinical
guidelines is associated with decreases in CVD mortality and morbidity as
well as cost savings to society through reductions in productivity losses
at work and home.4,5 Yet, a significant proportion of patients
do not receive the recommended health care to prevent and control heart
disease and stroke.6-8 To address this problem, these and other
organizations have developed guideline-based tools for heart disease and
stroke care and prevention that have demonstrated health care quality
improvement.5,9,10 Additionally, federally funded community
health centers have adopted the Chronic Care Model to produce system
changes that have been effective in reducing health care costs and
improving quality care.11
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State Heart Disease and Stroke Prevention Programs Take Action
State Health Departments work with their partners, such as primary care
associations, managed care, clinics, and quality improvement organizations
to improve the quality of care provided in healthcare settings in two
ways:
- Promoting the use of guidelines for primary and secondary prevention of
heart disease and stroke.
- Increasing access to quality care in federally funded community health
centers to eliminate CVD disparities among priority populations with
higher rates of disease.
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Implications
Because of the complexity and diversity of the health care system,
there are no easy solutions to improving patient quality of care. However,
state heart disease and stroke prevention programs provide examples of how
health care setting environment and policy strategies can be implemented
to improve quality of care.
Examples of CDC–Funded State Program Activities Addressing CVD
Disparities in Health Care Settings
- To address CVD disparities and to improve the functional and
clinical outcomes of patients served in federally funded community
health centers, the Bureau of Primary Health Care of the Health
Resources and Services Administration (HRSA), the Centers for Disease
Control and Prevention (CDC) and the Institute for Health Improvement (IHI)
began the Cardiovascular Health Disparity Collaborative in 2001. State
cardiovascular programs have several key roles in the collaborative
including implementing environmental strategies and policy changes for
cardiovascular health, establishing linkages, sharing resources, and
partnering to reduce CVD risk factors.
- Programs in the District of Columbia, Connecticut, Arkansas,
Missouri, Washington, and Georgia have assisted community health centers
to establish and use patient registry systems to enhance the provision
of patient follow–up to screenings of CVD and related risk factors and
to track patient improvement.
- Several state programs including Virginia, Colorado, District of
Columbia, Georgia, Utah, and Ohio have facilitated training sessions for
federally funded health center providers on how to implement clinical
practice guidelines.
- Programs in Arkansas, Wisconsin, and North Carolina have assisted
community health centers to adopt the Chronic Care Model, which provides
an organizational approach to care for people with CVD and other chronic
disease in a primary care setting. For more information see http://www.improvingchroniccare.org/change/index.html.*
- The North Carolina state program has developed partnerships with its
State Primary Health Care Association and the federally funded health
centers that are participating in the collaborative. The program has
developed a mapping process linking patients treated in hospital
emergency rooms with federally funded health centers to improve the
continuum of care, standardized procedures, and facilitate correct blood
pressure measurement techniques.1
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References
-
Preventing Heart Disease and Stroke: Addressing the Nation’s Leading
Killers—2003. Centers for Disease Control and Prevention.
-
Smith SC, Blair SN, Bonow RO, Brass LM, Cerqueira MD, Dracup K, Fuster
V, Gotto A, Grundy SM, Miller NH, Jacobs A, Jones D, Krauss RM, Mosca L,
Ockene I, Pasternak RC, Pearson T, Pfeffer MA, Starke RD, Taubert KA.
AHA/ACC Scientific Statement: AHA/ACC guidelines for preventing heart
attack and death in patients with atherosclerotic cardiovascular
disease: 2001 Update: A statement for healthcare professionals from the
American Heart Association and the American College of Cardiology. Circulation 2001;104:1577–1579.
-
Pearson TA, Blair SN, Daniels SR, Eckel RH, Fair JM, Fortmann SP,
Franklin BA, Goldstein LB, Greenland P, Grundy SM, Hong Y, Miller NH,
Lauer RM, Ockene IS, Sacco RL, Sallis JF, Smith SC, Stone NJ, Taubert
KA. AHA Scientific Statement: AHA guidelines for primary prevention
of cardiovascular disease and stroke: 2002 Update: Consensus panel guide
to comprehensive risk reduction for adult patients without coronary or
other atherosclerotic vascular diseases. Circulation
2002;106:388–391.
-
Grover SA, Ho V, Lavoie F, Coupal L, Zowall H, Pilote L. The importance
of indirect costs in primary cardiovascular disease prevention.
Archives of Internal Medicine 2003;163:333–339.
-
Fonarow GC, Gawlinski A, Moughrabi S, Tillisch JH. Improved treatment
of coronary heart disease by implementation of a cardiac hospitalization
atherosclerosis management program (CHAMP). The American Journal of
Cardiology 2001;87:819–822.
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McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr
EA. The quality of health care delivered to adults in the United
States. The New England Journal of Medicine 2003;348:2635–2645.
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Burwen DR, Galusha DH, Lewis JM, Bedinger, MR, Radford, MJ, Krumholz,
HM, Foody JM. National and state trends in quality of care for acute
myocardial infarction between 1994–1995 and 1998–1999: The Medicare
health care quality improvement program. Archives of Internal
Medicine 2003;163:1430–1439.
-
Asch SM, Kerr EA, Lapuerta P, Law A, McGlynn EA. A new approach for
measuring quality of care for women with hypertension. Archives of
Internal Medicine 2001;161:1329–35.
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Mehta RH, Montoye CK, Gallogly M, Baker P, Blount A, Faul J,
Roychoudhury C, Borzak S, Fox S, Franklin M, Freundl M, Kline-Rogers E,
LaLonde T, Orza M, Parrish R, Satwicz M, Smith MJ, Sobotka P, Winston S,
Riba AA, Eagle KA. Improving quality of care for acute myocardial
infarction: The Guidelines Applied in Practice (GAP) Initiative.
Journal of the American Medical Association 2002;287:1269–1276.
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Marciniak TA, Ellerbeck EF, Radford MJ, Kresowik TF, gold JA, Krumholz
HM, Kiefe CI, Allman RM, Vogel RA, Jencks SF. Improving the quality
of care for Medicare patients with acute myocardial infarction: Results
from the Cooperative Cardiovascular Project. Journal of the American
Medical Association 1998;279:1351–1357.
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Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for
patients with chronic illness: The chronic care model, part 2. Journal of the American Medical Association 2002;288:1775–1779.
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*Links to non–Federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the Federal Government, and none should be inferred. The CDC is not responsible for the content of the individual organization Web pages found at this link.
Date last reviewed:
05/12/2006
Content source: Division for Heart Disease and Stroke
Prevention,
National Center for Chronic Disease Prevention and
Health Promotion |
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