Is it possible to capitalize on what we know about cardiovascular health and create "heart attack-free" or "stroke-free" zones?
A collaborative of stakeholders in San Diego County—the fifth most populous region of the U.S.—say they gave it their best shot and saw a reduction in heart attacks by more than 22% between 2007 and 2016, according to a study published in Health Affairs on Tuesday.
In that same time, heart attacks were reduced by only 8% across the state of California.
What made the difference? While they can't say for sure, the authors said public health officials began a collaborative called Be There San Diego in which they began began working with healthcare systems in 2010 to deploy "high-yield evidence-based practices."
That included holding monthly meetings to find ways to proactively manage hypertension, diabetes, and cardiovascular disease among their patient populations.
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Partners involved included the Department of Managed Health Care and the Right Care Initiative of the University of California Berkeley School of Public Health in collaboration with Stanford University’s Clinical Excellence Research Center and the RAND Corporation. It also included San Diego County’s health department, several local health plans, large medical groups, integrated healthcare systems and academic medical centers and federally qualified healthcare centers.
The group created four focus areas—clinical, community, community-clinical linkages, and the healthcare ecosystem—and began meeting monthly to share best practices of initiatives that fit within those focus areas.
In 2011, leaders of healthcare organizations began meeting monthly in what they called the University of Best Practices to share practical ways to implement the latest research findings and recommendations. By the following year, health organizations began meeting for an initiative called the Data for Quality project, which allowed them to confidentially share aggregate data on selected quality metrics, such as the control of blood pressure, lipid levels, and blood sugar.
"In aggregate, these activities were aimed at increasing trust and engagement among entities that frequently compete in the medical market," wrote the authors of the study, led by Allen Fremont of the RAND Corporation.
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After the federal grant that initially supported the program expired in 2013, officials formalized the activities of Be There San Diego and sought funding sources for new activities. Among those efforts, they:
—Developed and tested methods to increase the use of hypertension and hypercholesteremia medications, along with aspirin, through a study funded by the Center for Medicare and Medicaid Innovation involving 4,000 at-risk patients. They deployed health coaches to 13 participating health organizations to hold monthly telephone calls to address any barriers they faced in adhering to their medication regime.
—Organized an intensive one-day summit each year on clinical, social, and community interventions to prevent heart attack and stroke. In 2015, they launched a faith-based partnership with 19 African-American churches, meeting regularly to discuss efforts to improve their congregants’ cardiovascular health through changes such as improved organizational nutrition policies, promoting healthy behaviors through walking clubs and other organized activities, and linking congregants who have high blood pressure to clinical care.
—Became a key subcontractor in 2014 to the county’s Live Well San Diego: Healthy Works, a collection of programs and interventions carried out by the county and its contracting partners that address chronic disease, promote health equity, and advance the regional Live Well San Diego vision.
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They reported that the data shows nearly 4000 hospitalizations for heart attacks were avoided during the study, which resulted in savings of an estimated $86 million during the first six years of the collaborative. "Reductions occurred and were sustained across all adult age groups, in contrast to the rest of the state," the authors wrote.
They said the collaborative enabled a range of population health improvement activities which will serve as the "cornerstone" for the emerging San Diego Accountable Communities for Health , a planned future "wellness system" in San Diego County.