Million Hearts Workshop: Health Systems Change for Blood Pressure Control
Submission Date: September 2015
Entry Type: Case Study
State/Territory Submitted on the Behalf of: California
States/Territories Involved: California
Funding Source: CDC
CDC Funding:Yes
CDC Funding (Specified):(1305) State Public Health
Domain Addressed:Health Systems Strategies
Public Health Issue:- Heart disease and stroke are the first and third leading causes of death in California.In 2010, more than 78,000 Californians died of heart disease.
- A person with high blood pressure is four times more likely to die from a stroke and three times more likely to die from heart disease. People with diabetes who also have high blood pressure are at even higher risk of developing serious complications of diabetes such as a heart attack.
- Controlling high blood pressure is a major goal of the national Million Hearts® initiative whose mission is to prevent a million heart attacks and strokes by 2017.
- California joined the Million Hearts® initiative and is working with stakeholders to promote team-based care – a proven strategy for controlling blood pressure.
The goal of the Million Hearts® one-day workshop was to teach participants how to leverage electronic health records (EHRs)to improve the electronic exchange of health information within provider communities to support implementation of team-based care (patient-centered medical home) for the treatment and management of high blood pressure.
Specific workshop objectives were to: (1) increase understanding of Million Hearts® and how it aligns with the work being conducted in Prevention First; (2) support the implementation of team-based care/patient-centered medical homes by leveraging the potential of EHRs and health information exchanges to facilitate communication between health care providers, including community-based providers; and (3) identify promising team-based care models that will enhance the treatment and management of high blood pressure through the secure exchange of health information across a comprehensive health care team.
Program Action:- The California Department of Public Health (CDPH), Chronic Disease Control Branch’s, Heart Disease and Diabetes Prevention Unit conducted a Million Hearts® stakeholders’ workshop in June 2014 with technical assistance support from the National Association of Chronic Disease Directors.
- The workshop brought partners together to learn more about preventing cardiovascular disease and health system strategies for controlling blood pressure.
- The workshop was attended by representatives of 19 public and private sector organizations including the California Department of Health Care Services, California Primary Care Association, American Heart Association, Health Information Exchange Partnerships, California’s Quality Improvement Organization (Health Services Advisory Group), Federally Qualified Health Centers (FQHCs), and other key partnerships.
- Funding for the workshop was from the Centers for Disease Control and Prevention’s State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health grant, known in California as Prevention First.
Results of the post-workshop evaluation survey are as follows:
- Most participants indicated that the information shared during the workshop will be useful in their current work.
- The workshop met two of its stated objectives very well, and the third moderately well.All responding participants are committed to sustain the workshop objectives.
- As a result of the workshop, participants are “likely” to “definitely” better able to align their organization’s activities with the goals of the Million Hearts® initiative.
Comments from participants included the following:
“I would like to say definitely can move forward and support – but we need to get the key players together and plan. Education and marketing is key. It would be great to have an opportunity for a community meeting focused on the Million Hearts® initiative and come up with a plan to meet goals.”
“Expected more of “how to” approach that included all key stakeholders in the process, not just CHW and HIE. Important components, but so are other aspects.” “I would have liked to have learned more about team-based care utilizing healthcare extenders.”
Impact/Accomplishments:- The workshop led to development of a working relationship between CDPH and two phenomenal health information technology (HIT) consultants that CDPH is utilizing to advance their work to promote blood pressure control.These consultants provided training and technical assistance to ten local health department grantees at a Prevention First and Lifetime of Wellness Grantee Kick-off training in June 2015 on how using EHRs improves health outcomes and which EHR software is most useful.
- CDPH adopted the workshop outcomes and included them in the Prevention First cardiovascular disease prevention related activities. Prevention First cardiovascular disease prevention strategies include: (1) increasing electronic health record adoption and the use of health information technology to improve performance; (2) increasing the institutionalization and monitoring of aggregated/standardized quality measures at the provider and systems level; and (3) increasing engagement of non-physician team members in hypertension and diabetes management in health care systems.
Challenges to project implementation included delays in working with two critical partners that attended the Million Hearts workshop:
- Partner engagement opportunities were delayed with the California Primary Care Association (CPCA) due to their internal reorganization.As a result, discussions on partnership opportunities to promote the adoption of Electronic Health Records and Team Based Care within FQHCs were postponed until after CPCA’s reorganization.Subsequently, CDPH has engaged in conversations with CPCA and learned of their success in implementing Meaningful Use through certified EHRs within 90% of all FQHCs in the CPCA network.
- CDPH maintains a regular and meaningful partnership with the California Department of Health Care Services (DHCS) on multiple chronic disease prevention efforts including promoting implementation of quality improvement processes in health systems. However, CDPH experienced delays in directly working with DHCS Health Information Technology (HIT) Providers.In June 2015, DHCS awarded four new contracts to HIT Training and Technical Assistance Providers (HIT TA) for services previously provided by the Regional Extension Centers.The new HIT TA contractors will promote the adoption and meaningful use of health information technology. The Prevention First Health System Interventions Lead Staff is closely working with DHCS and the HIT TA Providers to promote efforts to increase the proportion of Health Care Systems reporting on Prevention First quality measures.
- CDPH will follow up with California’s Health Information Exchange Partnerships to further promote Prevention First activities focused on clinical innovations to increase the proportion of health care systems reporting on blood pressure control and diabetes management. CDPH will also continue to work with the HIT consultants to provide training and technical assistance to the LHD staff through webinar trainings and one-on-one technical assistance services. Prevention First cardiovascular disease prevention related future activities include:
- Developing a plan of action for working in designated health system(s) within geographic focus areas and outreach to designated health systems to identify their specific status regarding implementation of EHR and Meaningful Use.
- Meetings with DHCS to determine how and where CDPH will work with the Medi-Cal EHR Incentive Program’s regional technical assistance providers to identify and implement strategies that support health system/providers in implementing EHRs to better manage high blood pressure and diabetes.Strategies include educating DHCS affiliated Medicaid/Medicare providers on the importance of supporting and guiding the implementation (within EHRs) of reminder systems, patient lists, clinical decision supports, and blood pressure algorithms based on the Joint National Committee guidance for blood pressure management to identify patients that have high blood pressure but do not yet have a diagnosis of hypertension.
- Convening key partners/stakeholder regionally to determine the needs for training and technical assistance to providers/health systems to optimize EHR and Meaningful Use implementation.
- Providing training and technical assistance to local health systems, including FQHCs to evaluate existing processes and increase engagement of non-physician team members to improve performance in hypertension and diabetes management.
Heart Disease and Stroke
State Contact Information:
CA
Shirley Shelton
California Department of Health
916-552-9942
Shirley.shelton@cdph.ca.gov