National Forum

Mid-year Membership

Meeting

Celebrating World

Hypertension Day

May 17, 20181

NationalForum.org

Welcome & Panelist Introduction

John M. Clymer

Executive Director

National Forum for Heart Disease

& Stroke Prevention

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Before We Begin

•Download today’s handouts by going to the File menu in the

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Document.”

•We encourage you to submit written questions at any time

during the presentation, using the Q&A Panel located at the

bottom right of your screen.

• Today’s session is being recorded.

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Agenda

•World Hypertension LeagueDaniel Lackland, DrPH, President

•New Report on Gaps in Heart Disease and Stroke Mortality over the Past 15 Years Stephen Sidney, MD, MPH, Director of Research Clinics Kaiser Permanente Northern California, Division of Research

•Creating a Culture of Health in the City of West ChicagoMayor Ruben Pineda

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Agenda

ABCS and Using Data to Improve Cardiovascular Health

Outcomes

Mary Arenberg, MD, Family Physician

Plymouth Family Physicians, Plymouth, Wisconsin

Million Hearts® Hypertension Champion

Team Based Care Approach to Hypertension

Jennifer Casey, MD, Chief Medical Officer, Lorain County

Health and Dentistry, Lorain, OhioMillion Hearts® Hypertension Champion

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Agenda

National Forum Member Organizations

American Heart Association

Heather Alger, Ph.D., Director of Risk Factors Programs

Health Initiatives

Centers for Disease Control and Prevention

Betsy L. Thompson, M.D., M.S.P.H., Dr.P.H.

CAPT, U.S. Public Health Service

Director, Division for Heart Disease and Stroke Prevention

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World Hypertension League

Daniel Lackland, DrPH

Professor of Epidemiology

Medical University of South

Carolina;

President, World Hypertension

League

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New Report on Gaps in Heart Disease and Stroke Mortality over the Past 15 Years

Stephen Sidney, MD, MPH, Director of Research Clinics,

Kaiser Permanente Northern

California, Division of Research

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Background

▪ United States

– Mortality rate from heart disease and stroke has declined for several decades

– From 2000 to 2011, average annual rate decline for heart disease and stroke was about 4% until 2011, slowing to less than 1% since then

▪ Kaiser Permanente Northern California (KPNC)– Integrated health care system – more than 4 million

members

– Significant decline in the occurrence of heart attacks since 2000

– Mortality trends from cardiovascular disease have not been examined

Mortality Trends in Heart Disease 2000-2015, US & KPNC

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Mortality Trends in Stroke 2000-2015, US & KPNC

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Heart Disease

Decline in Age-Adjusted Mortality Rates (% change) from 2000-2015, US and KPNC

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Stroke

Decline in Age-Adjusted Mortality Rates (% change) from 2000-2015, US and KPNC

Why the greater declines among younger adults in KPNC than the US?

▪ Likely reasons include:

– Successful population management programs for prevention of cardiovascular disease events.

▪ Hypertension control program

▪ Preventing Heart Attacks and Strokes Everyday (PHASE) program

– Integrated health care for optimum coordination of care and therapeutic interventions.

Summary and Conclusions

▪ 15-year rate of decline in heart disease and stroke mortality was substantially greater in KPNC than in the U.S. for the younger (<45 years and 45-64 years) age groups.

▪ More than 40,000 deaths from heart disease in the 45-64 years age group would have been prevented in the US in 2015 alone if the rate of heart disease and stroke mortality decline in the US had equaled the rate of decline in KPNC.

▪ Findings support:

– Prioritization by Million Hearts® of the 35-64 years age group as a target population for preventative interventions

– Integrated health care enabling access to coordinated care that combines prevention and appropriate therapeutic interventions

Creating a Culture of Health in the City of West Chicago

The Honorable Ruben Pineda

Mayor

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Healthy West Chicago is dedicated to increasing healthy eating and physical activity in the City of

West Chicago to make West Chicago one of the healthiest communities in the region. Through

engaging events and policy efforts,

we aim to make

the healthy choice, the easy choice.

Healthy West Chicago

Campaigns- Move with the MayorWest Chicago's Mayor Ruben Pineda promotes wellness

throughout our community, and invites everyone to participate

to improve their physical fitness, and overall health. Together

we can develop a Healthy West Chicago!

Come join Mayor Pineda as he walks a 5

kilometer route each Saturday and Sunday.

Meeting each weekend from April through

mid-November, weather permitting. These

are FREE and everyone is welcome. The

walks typically last one hour and always

start promptly at 9:00 A.M.

Campaigns- Rethink Your Drink

Automatic Water Fountains in every elementary school building and the Middle School

Home 4x8 Garden Build Weekends

Community Teaching Garden

Garden Resource Center

West Chicago Garden Network

School Gardens

Gardenworks Project Partnership

Campaigns- Community Gardens

Partners

Mayor Ruben Pineda

RPineda@westchicago.org

www.healthywestchicago.org

Thank You

ABCS and Using Data to Improve Cardiovascular Health Outcomes

Mary Arenberg, MD

Plymouth Family Physicians

Plymouth, Wisconsin

Million Hearts® Hypertension Champion

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ABCS and Using Data to

Improve Cardiovascular

Health Outcomes

Million Hearts® Hypertension Challenge Champion

Mary Arenberg, MD

Plymouth Family Physicians, Plymouth, Wisconsin

2 MD practice since 1985, PBRN since

2000

Our 18+ year method:

Entire staff, weekly 90 minute

meetings

Office problem solving and staff

education.

Entire staff, quarterly 3 hour

meetings, centered around data

from our PBRN.

Our advantage:

Data in two forms covering now

60+ clinical markers.

2 year running graphs of

performance

Patient level, granular reports on

these markers enabling outreach,

evaluation of processes, activation

of patients and staff.

ABCS – ASPIRIN DATA EXAMPLE

Antiplatelet Medication for High Risk Patients

Eligible Patients: Adults ages 50-69 years old

with a ≥ 10% 10-year CVD risk

Criteria: Active Rx for an antiplatelet medication

Patients not meeting criteria:

Patient

ID

Last

Name

First

Name

PPRNet

ID DOB Sex

Provide

r

10-year ASCVD

Risk (%)

Antiplatel

et Rx date

ABCS - BLOOD PRESSURE DATA EXAMPLE

Controlling High Blood Pressure (BP)Eligible Patients: Patients 18-85 years of age with an active Dx of

Hypertension [Excluding Patients with ESRD, dialysis, renal

transplant, pregnancy during the year, or who received Hospice

services]

Criteria: BP measured in past year and most recent BP <140/90

Patients not meeting criteria:

Patient

ID

Last

Name

First

Name

PPRNet

ID DOB Sex

Provide

r

Last BP

date

Systolic

Value

Diastoli

c Value

ABCS – CHOLESTEROL DATA EXAMPLE

Cholesterol abnormalities screening and HDL-C screening

Eligible Patients: Patients 40-75

Criteria: A Total cholesterol lab result and an HDL-cholesterol lab result recorded

in previous 5 years

Patients not meeting criteria:

Patient

ID

Last

Name

First

Name

PPRNet

ID DOB Sex Provider

Cholesterol

date

Cholesterol

Value HDL date

HDL

Value LDL date

LDL

Value

ABCS – SMOKING DATA EXAMPLE

Tobacco Use: Screening and cessation intervention

Patients not meeting criteria:

Patient ID

Last Name

First Name

PPRNet ID DOB Sex

Provider

Insurance

Current

Smoking Status

Tobacco Abuse

Tobacco

Screening date

Tobacco

Counseling date

Tobacc

o Rx date

This can’t be done without data.

Supportive data, based on established guidelines, best practice.

Actionable data, granular enough for outreach and process evaluation and

improvement.

Data from extended group, dedicated to this process, able to demonstrate

benchmarks of care.

PPRNet is open to any practice with an EMR!

www.pprnet.org

Team Based Care Approach to Hypertension

Jennifer L. Casey, M.D., Chief Medical Officer

Lorain County Health &

Dentistry, a Federally

Qualified Health Center

Lorain, Ohio

Million Hearts® Hypertension Champion

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TEAM BASED APPROACH to

HYPERTENSION

“It takes each of us, working together, to make a difference in our community’s health”

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LCH&D

- FQHC and safety net provider in our area- Target those patients at or below 200% of the poverty

level

- Adult and Family Medicine, Pediatrics, and OB/GYN- Dentistry, Podiatry and Optometry

- Integrated Behavioral Health, Nutrition Services- Wellness Coordinator and Care Managers

- 6 sites throughout Lorain County, Ohio- Patient Centered Medical Home (level 3)

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Socioeconomic Diversity

• Almost 2/3 are a racial or ethnic minority▫ Hispanic/Latino ▫ African-American▫ 12% best served by a language other than English

Almost all are at or below 200% the federal poverty level

Barriers to care include transportation, language, homelessness, changing phone numbers

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Hypertension and LCH&D in 2017

• Total visits at LCH&D - 44,500

• 14, 200 unduplicated patients

• Over 25% of our patients have a diagnosis of hypertension

• In the last 5 years, LCH&D has had 82% of our hypertensive patients controlled with a blood pressure less than 140/90

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HYPERTENSION:

Our Team Based Approach

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• Utilizing ALL members of the organization• Best Practice • “Check it, Change it, Control it”

• Care begins from the first phone call to make an appointment

• Access to care is a priority• Patients get the first available appointment• Same day appointments, open access, walk-ins

Hypertension:

Our Team Based Approach

• Daily Huddles • Clinical Protocol • Functional Lifestyle Goal at each appointment

▫ Clinical Assistants (LPNs)▫ Wellness Coordinator (LPN)▫ Providers (Physicians and Nurse Practitioners)▫ Dietician

Use USPTF and JNC guidelines for managing hypertension

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Hypertension:

Our Team Based Approach• Community Support Worker

▫ Connecting patients with local resources

• Integrated Behavioral Health Team

▫ Help screen for barriers to care, such as transportation and literacy

• Customer Service Representatives

▫ Schedule follow-up appts for all patients

• Medical Trackers

▫ Follow-up on tests, diagnostics and referrals

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Hypertension:

Our Team Based Approach • Quality Department

▫ Monthly monitoring and reporting

▫ Transparency reporting

▫ Identifying patients due for an appointment

▫ Reporting to Board of Directors

• Dental, Vision, OB/GYN & Podiatry

▫ Blood pressure checked in all clinics

▫ PCP referrals made for follow-up care

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Hypertension:

Our Team Based Approach• Organization wide

commitment to caring for the community

• Each member of the team takes ownership in helping the patients

• Share information, success stories and quality indicators monthly with staff

• Constant attention to continued quality improvement

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American Heart Association

Heather M. Alger, PhD

Director of Risk Factor Programs

American Heart Association

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AMERICAN HEART ASSOCIATIONBLOOD PRESSURE PROGRAMS

Heather M. Alger, PhDDirector of Risk Factor ProgramsAmerican Heart Associationheather.alger@heart.org

AHA’s Goal for Better BP Control

REDUCE WEIGHT 5 mm Hg

AEROBIC PHYSICAL ACTIVITY 5-8 mm Hg

ADOPT D.A.S.H.EATING PLAN 11 mm Hg

MODERATION OF ALCOHOL CONSUMPTION 4 mm Hg

LOWER SODIUM INTAKE 5-6 mm Hg

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Nearly half

(46%)of adult Americans

have HBP

KEY LIFESTYLE OPPORTUNITIES TO LOWER BLOOD PRESSURE:

New BP Classifications

2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive SummaryA Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

2017 High Blood Pressure Guidelines

2017 High Blood Pressure Guidelines

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Bringing the Guidelines to life to change lives• 4.5 BILLION total media reach within the first

month of the GL launch• AHA Newsroom Release, Social Media• Radio Media Tour• 2.4K Placements including NY Times, USA Today,

Bloomberg, and more

• TEDMED Live Event Via Facebook

Collaboration with the Ad Council on a consumer campaign

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• www.loweryourhbp.org• English and Spanish

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Target: BP Program Overview

• The American Heart Association and the American Medical Association partnered to launch Target: BP in 2015 to improve blood pressure control and build a healthier nation.

• This national initiative aims to reduce the number of Americans who have heart attacks and strokes by urging medical practices, health service organizations, and patients to prioritize blood pressure control.

• Target: BP supports healthcare providers by offering access to the latest research, tools, and resources to reach and sustain blood pressure control within the patients populations they serve.

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Bringing the Guidelines to life to change lives – for healthcare providers

Target: BP 2017 Program Reach and Recognition

• 1206 clinical sites participated in 2017 Target: BP• 87M adults covered by these clinical sites• 310 sites were recognized for submitting patient data

through the online portal• 14.3M adults covered by clinics recognized by the Target: BP

program• 3.4M adults in this patient population had hypertension• 2.1M patients reached BP control by the end of the program

• Gold Recognition: 185 sites reached 70% or great blood pressure control in their patient population

• Participant Recognition: 125 sites will be recognized at the Participant Level

• 2018 Recognition Program – open through June 1, 2018

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Check. Change. Control

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Bringing the Guidelines to life to change lives – for patients

Developed to support hypertension management among the adult population, Check. Change. Control.® engages participants, emphasizing 3 important aspects of managing hypertension:

1. Checking for high blood pressure and symptoms;2. Changing lifestyle and seeking treatment; 3. Controlling hypertension by taking preventative measures.

From July 2017 to April 2018, more than 1.05M participants had enrolled in the Check. Change. Control. ® blood pressure self-monitoring program.

HBP Education Month

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AHA Goals for May:

• 3 Million BP Checks (AHA+ national & affiliate partners)

• Increase affiliate/alliance participation

• Increase reach of activities and traffic to heart.org/hbp

HBP Education Month

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Activations:

April 26 - Bilingual Twitter Chat• High blood pressure management means making dietary changes• How can you make these changes and honor Hispanic culture?• Invite local experts, chefs and foodies to join the conversation• Featured guest – Chef Ronaldo Linares

May 10 - Satellite Media Tour (SMT)Is your blood pressure being taken all wrong?7 common mistakes in measurement

• Dr. Michael Hochman (WSA), Officer Marcus Whitehead (patient)• Bookings updated weekly on Sharepoint.• Use radio interview as an opportunity to connect with stations

to promote local BP check events• MEDIA ALERT available

Bringing the Guidelines to life to change lives – for communities

Centers Disease Control and Prevention

Betsy L. Thompson, MD, MSPH, DrPH

CAPT, U.S. Public Health Service

Centers Disease Control and

Prevention

Director, Division for Heart Disease

and Stroke Prevention

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Q & A

•We encourage you to submit written questions using the

Q&A Panel located at the bottom right of your screen.

•After typing your questions in the space at the bottom, hit

the Send button.

•YOUR questions will not be seen by other members of the

audience, and will be addressed, time permitting.

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8:00 a.m. – 3:30 p.m. ET

Barbara Jordan Conference Center Washington, DC

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Closing & Contact Information

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The National Forum for Heart Disease & Stroke

Prevention

1150 Connecticut AVE NW

Washington, DC 20036

www.nationalforum.org