State-Level Systems Changes to Improve Cardiovascular Health Outcomes Talyah Sands, MPH Director, Health Improvement Association of State and Territorial Health Officials September 12, 2018
Vision State and territorial health agencies advancing health equity and optimal health for all. Mission To support, equip, and advocate for state and territorial health officials in their work of advancing the public s health and well-being.
We Will Cover: 1 2 3 4 5 ASTHO s heart disease and stroke prevention work Systems change and quality improvement approaches Learning collaborative goals and processes Success stories from participating jurisdictions Takeaways and resources
Chapter 1: ASTHO s Heart Disease and Stroke Prevention Work A Brief History
Heart Disease and Stroke a State Public Health Issue Leading cause of death, disability, healthcare cost in U.S. Hypertension control is necessary prevention measure an opportunity for public health State public health agencies serve a vital role as conveners to effect systems changes to improve cardiovascular health outcomes
Supporting Jurisdictions through a Learning Collaborative Funded by the Centers for Disease Control and Prevention s Division for Heart Disease and Stroke Prevention Launched in 2013 to assist state and territory health agencies to prevent heart attack and stroke Focused on integrating efforts with healthcare and community partners to control blood pressure
Logic Model
Outputs
Outcomes
Learning Collaborative History 2013-2016 Million Hearts State Learning Collaborative Year 1: AL, DC, IL, MD, MN, NH, NY, OH, OK, VT Year 2: AL, AR, DC, GA, IL, KS, MD, MI, MN, NH, NY, ND, OH, OK, Palau, VT, VA Year 3: AR, CO, CT, GA, IN, KS, MI, MS, ND, Palau, TX, USVI, VA, WI 2016-2018 ASTHO/CDC Heart Disease and Stroke Prevention Learning Collaborative Year 4: AL, AK, AR, CO, CNMI, CT, Guam, ND, OK, Palau, SC, TX, USVI, UT, VA, WI Year 5: AL, AK, AR, CNMI, FL, Guam, NV, OK, Palau, SC, USVI, UT, VA, WI
Learning Collaborative History USAPI 2013-2016 2016-2018 Million Hearts State Learning Collaborative Payers ASTHO/CDC Heart Disease and Stroke Prevention Learning Collaborative Year 1: AL, DC, IL, MD, MN, NH, NY, OH, OK, VT Familial Support Tribal-State Partnerships Year 2: AL, AR, DC, GA, IL, KS, MD, MI, MN, NH, NY, ND, OH, OK, Palau, VT, VA Year 3: AR, CO, CT, GA, IN, KS, MI, MS, ND, Palau, TX, USVI, VA, WI Year 4: AL, AK, AR, CO, CNMI, CT, Guam, ND, OK, Palau, SC, TX, USVI, UT, VA, WI Year 5: AL, AK, AR, CNMI, FL, Guam, NV, OK, Palau, SC, USVI, UT, VA, WI
Learning Collaborative Goals Improve hypertension control and prevention Increase the percentage of patients 18 85 years of age who had a hypertension diagnosis Identify and build networks Test models for collaboration Deploy a quality improvement process
Chapter 2: Improving Quality, Changing Systems
Quality Improvement PLAN: aim statement and action plan DO: implement action plan and test strategies STUDY: evaluate test ACT: revise action plan and test again
https://www.youtube.com/watch?v=qxoffax5qhi
Communication Leadership and Vision
Examples of Systems Changes Creating and standardizing protocols for hypertension identification, management, control, and referral Leveraging data systems to identify individuals with hypertension in clinical and community settings to engage them in care Using team-based care models that involve community health workers, pharmacists, public health nurses, and others in supporting patients in managing their hypertension
Chapter 3: Learning Collaborative in Action
Refresher: Learning Collaborative Goals Improve hypertension control and prevention Increase the percentage of patients 18 85 years of age who had a hypertension diagnosis Identify and build networks Test models for collaboration Deploy a quality improvement process
Components of the Learning Collaborative Kick-off In-person stakeholder meeting Virtual learning sessions Site visit Data reporting Progress reporting
State Systems Change Leverage state resources to improve state systems, which lead to healthier community systems. Partnerships between health agencies, payers, knowledge partners, and data partners are key to the success of PDSA cycles.
Chapter 4: Jurisdictions Take Initiatives off the Ground
Illustrations by See In Colors
Illustrations by See In Colors
Illustrations by See In Colors
Illustrations by See In Colors
Illustrations by See In Colors
Example Protocol from Palau
Example Workflow from Palau
Example from Georgia Collaboration between a local health department and a FQHC to launch a hypertension screening & management program; included screening for tobacco use Created a cessation referral program for patients with hypertension Led to conversations between the health department and GA Hospital Association to create tobacco-free hospitals
Chapter 5: Takeaways and Resources
Keys to Lasting Success 1. Build partnerships across public health, healthcare, and communities. 2. Use data to identify patients and drive quality improvement. 3. Standardize practices and protocols for treatment, workflows and referrals. 4. Gain support from leadership, payers, and policymakers. 5. Incorporate successful strategies in state strategic plans. 6. Leverage other statewide initiatives and chronic disease prevention efforts.
Tools for Change http://www.astho.org/prevention/heart-disease-and-stroke/tools-for-change
Talyah Sands, MPH Director, Health Improvement Association of State and Territorial Health Officials tsands@astho.org