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National Learning Consirtium: Advancing America's Healthcare

ELECTRONIC HEALTH
RECORDS IN ACTION
Stories of Meaningful Use

January 2014

Million Hearts: How regional Extension Centers and Providers Are Working Together to Prevent Heart Attacks

A discussion of public and private partnerships that leverage existing initiatives to improve cardiovascular care, including specific best practices used by both RECs and practices to improve Million Hearts measures.

Introduction

In 2011, the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS) launched the Million Hearts initiative to prevent 1 million heart attacks by 2017 by improving performance on the "ABCS" (see table). In August 2013, the Office of the National Coordinator for Health Information Technology convened federal agencies, representatives from the regional extension centers (RECs), physicians, quality improvement organizations (QIOs), and other stakeholders to share best practices, tools, and resources related to the initiative. During the 2-day conference, participants discussed the challenges they face and successes they experience in recruiting practices to participate in Million Hearts and in improving the Million Hearts Measures.

Partnerships

Participants from other federal partners highlighted ways in which their work could support that of the RECs and physicians, as well as the ways the RECs may be able to contribute to the work that they are doing:

  • CDC's Community Transformation Grants1 are building capacity to implement evidence- and practice-based changes to prevent chronic disease and supporting implementation of interventions in tobacco free living, active living, healthy eating, and other areas.
  • The Comprehensive Primary Care Initiative2 from the Center for Medicare and Medicaid Innovation, a model to strengthen primary care through collaboration between public and private health care payers, requires reporting on several measures in the Million Hearts ABCS.
  • Health Center-Controlled Networks 3 from the Health Resources and Services Administration are groups of safety net providers collaborating to advance adoption and implementation of electronic health records (EHRs), promote Meaningful Use of EHRs, and advance quality through the use of health IT, including achieving Healthy People 2010 goals on Uniform Data System clinical measures (aspirin therapy, cholesterol, hypertension, tobacco use/cessation), which are analogous to the ABCS.
Indicator Baseline 2017 Goal
Aspirin use for people at high risk 47% 65%
Blood pressure control 46% 65%
Effective treatment of high Cholesterol (LDL-C) 33% 65%
Smoking prevalence 19% 17%
Source: http://millionhearts.hhs.gov/Docs/MH_Fact_Sheet.pdf

RECs also highlighted their partnerships with other stakeholders, noting that these collaborations through a common interest in the Million Hearts campaign are a great way to extend the RECs' reach. For instance, the Oklahoma REC targeted its Million Hearts outreach to ZIP codes identified by the Oklahoma Health Department as having a high density of low-income individuals who might be harder to reach. Furthermore, 11 facilities with tribal affiliations standardized their policies on aspirin use.

Tools, Resources, and Technical Assistance

Several RECs shared Million Hearts tools and resources that they had developed for their practices. They also shared some of their best practices in promoting improvement in the Million Hearts measures.

  • The Utah REC noted that it had created several EHR-specific guides to measuring and improving on the Million Hearts measures. Other RECs might consider following suit and providing guides specific to some of the more popular EHR products in their areas.
  • Missouri chose a Million Hearts goal that would be demonstrable to the public: to save enough lives to fill the Scottrade Center in St. Louis. To reach this goal by 2017, Missouri has recruited physician champions in the state's seven regions and charged them with initiating Million Hearts campaigns in their regions and serving as expert resources to local practices.
  • The Oklahoma REC's interventions follow the "EAST" framework: Easy, Attractive, Social, and Timely. The REC has provided technical assistance to 59 practices across the state to help them generate, interpret, and act on quarterly data reports, making it easier for practices to use the data they have to improve their practices in real time. The Oklahoma Office of Rural Health held half-day workshops at four locations across the state on various health IT topics (including Million Hearts), which helped the REC attract and reach a lot of stakeholders. Staff also mentioned lowtech interventions, such as one practice that puts a red magnet on the exam room door of patients with hypertension to remind each staff member visiting the patient to address cardiovascular health.
  • Participants noted the importance of data entry; only accurate data can yield accurate quality measurement. Although some practices have separate quality assurance protocols to allow some flexibility in data entry, an REC and a QIO noted that they have de-emphasized flexibility to help practices achieve their Million Hearts aims. They ask their practices to collect data in the exact same way so that they are able to abstract data easily and reliably and help the practice act on that data.
  • Several participants noted that financial incentives are not enough to encourage providers to change practice, but peer recognition can be a powerful tool to accomplish this. Recognizing achievements such as greatest improvement in quality over time can be meaningful. Creating a physical representation of such recognition, such as a certificate that can be displayed, can compound the motivating effects.

Conclusions

Participants emphasized that the Million Hearts initiative is an opportunity to enhance provider care, not hinder it. Modifying current clinical practice and existing workflows can achieve impressive results. One participant noted that moving the conversation on tobacco cessation from the provider to the triage process improved their counseling rate by 70%. Although this kind of transition requires a lot of technical assistance and "handholding", shifting from individual health to population health can save lives. For the Million Hearts campaign, saving a million lives is just the beginning.

For more information about Million Hearts, please visit http://millionhearts.hhs.gov/index.html.


1http://www.cdc.gov/communitytransformation/
2http://innovation.cms.gov/initiatives/comprehensiveprimary-care-initiative/
3http://www.hrsa.gov/healthit/toolbox/HealthITAdoptiontoolbox/OpportunitiesCollaboration/abouthccns.html

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