More than 859,000 Americans die of heart disease, stroke, or other cardiovascular diseases every year. With a FY 2019 budget of $165 million, CDC https://www.cdc.gov/dhdsp/index.htm is looking for ways to reduce these risk factors especially for groups affected by health disparities which can differ across different geographic, racial, ethnic, and socioeconomic groups. To help find solutions, CDC funds and guides states, cities, tribes, and territories to use interventions to prevent and manage heart disease and stroke.
The funding is used to:
- Increase the use of EHRs and other technology to identify people who have heart disease and stroke risk factors
- Expand the use of team-based care so that doctors can work with pharmacists, community health workers, and others outside of medical settings to manage patients risk factors
- Increase the number of people with high blood pressure who can check their own blood pressure regularly and then share the measurements with their healthcare professionals
- Refer people to effective lifestyle programs to help them learn to be physically active and eat nutritious food
One of the states funded is North Dakota which is predominantly rural with many counties designated as medical shortage areas. These regions tend to have older, lower income, and less insured populations than urban areas resulting in disparities not always having access to hypertension care.
To study the issue, the ASTHO/CDC Heart Disease and Stroke Prevention Learning Collaborative funded by CDC’s Division for Heart Disease and Stroke Prevention, and the North Dakota Department of Health (NDDoH) https://www.nd.gov, are partnering with stakeholders from local health units, emergency medical professionals, payers, and health systems.
CDC and North Dakota have tested health IT approaches to improve blood pressure measurement and referral systems in eight local health units and in one tribal jurisdiction. This project focused on improving hypertension identification and control among residents of two local health units.
The NDDoH and partners employed several strategies to test innovative health IT approaches. However, NDDoH’s efforts to use health IT platforms has been a challenge. These challenges include registering individuals for computer program compatibilities which is time and resource intensive along with concerns related to confidentiality and liability issues.
As a result of these challenges, the partners decided to collaborate with the Altru Health System https://www.altru.org to develop an electronic portal to enable patients to self-report blood pressure data through Altru’s EHRs.
It was found that the Altru Health System, a participant in the North Dakota Health Information Network (NDHIN) https://www.nd.gov/itd/statewide-alliance.nd.ndhin has proven to be an effective and efficient tool in the state plus the database provides good support and monitoring.
The next steps for NDDoH is to:
- Collaborate with partners to collect and analyze data for hypertension and other chronic diseases based on public employees’ health insurance claims data
- Develop a toolkit to promote the Cardiac Ready Community (CRC) program model and expand training for EMS personnel
- Partner with Blue Cross Blue Shield North Dakota to offer blood pressure protocol trainings
NDDoH recommends developing data collection tools, protocol and communication templates, and factsheets in collaboration with stakeholders. Also, NDDoH recommends that State and Territorial Health Agencies build and sustain relationships across sectors such as third-party payers, industry, and healthcare to encourage stakeholders to be active participants in the program.