# Presentation: 377703

## American Heart Association

**Hypertension Initiative**

## AHA’s Strategic Plan Framework

| Mission: | Building healthier lives, free of cardiovascular diseases and stroke
 |
| --- | --- |
| Strategic Driving Force: | The AHA will achieve its mission by providing knowledge-based solutions for people of all ages, relative to their risk, through research, prevention and treatment; and serving global cardiovascular and stroke health needs as a partner of choice for researchers, systems, providers and consumers.
 |
| Impact Goal: | By 2010, to reduce coronary heart disease, stroke and risk by 25%
 |
| Knowledge Impact Strategy: | Improve Health Decision Making
Provide life-saving solutions based upon the best available science
Collaborate with key stakeholders to develop, integrate and leverage solutions
Expedite the application of new knowledge to achieve health outcomes
Serve diverse populations
Maintain the highest standards of accountability and transparency
 |

## The Hypertension Challenge

## Goals

**Impact Goal**
- By 2010, reduce the rate of uncontrolled hypertension by 25%
**Strategic Reach**
- To reach the highest volume of impacted individuals with uncontrolled HBP
- Diagnosed but uncontrolled
- Diagnosed but untreated
- Undiagnosed

## Target Market

- Improve awareness of implications of hypertension
- Prevention
- Diagnosis
- Engagement
- Management
- Medication
- Lifestyle

## Specifically...

- Build a critical mass of at risk consumers who understand the consequences of failing to control their blood pressure and utilize available services to improve their success.
- Build a critical mass of providers who "treat to goal" as the only acceptable practice.

## Health Care Markets

| Strategic Platforms |
| --- |
| There are three specific strategic platforms for
achieving this objective:

Building systems (providers/systems/society) to improve health and reduce disparities

2. Empowering Consumer Health Decision Making

3. Evaluating Outcomes and Improving Feedback loops |

## Health Care Markets	

**The AHA will pursue activities that...**
- Increase adherence and support process for AHA guidelines and statements
- Increase AHA presence in healthcare professional feedback and CME on professional’s performance
- Increase the use of AHA programs, products and services in the ambulatory setting
- Increase the use of clinical decision support in healthcare professional practices
- Increase medication adherence from hospital discharge through the patient’s care in the outpatient setting
- Support AHA’s belief in the importance of physician’s leveraging Electronic Medical Records (EMR) - something that is perceived as necessary for quality improvement in the ambulatory setting

## Health Care Markets

**	**_**Continuum of Care**_
- BUILD Healthier Lives by PREVENTING Disease
- PREVENT Life Threatening Events by CONTROLLING Risk
- TREAT Life Threatening Disease and Events by providing lifesaving Interventions
- ENHANCE Quality of Life Post-Event, by CONTROLLING risk and PROVIDING options

## Creating the Framework

- Target channels with the greatest reach and impact
- Drive consistent, core messages
**Action (Patient Education)**
- Take action – you are part of the solution, “learn to manage your health”
- Talk to your healthcare provider about your risk
- Take prescribed medication
-  Make appropriate lifestyle modifications
**Adherence (Professional Education)**
- Understand the guidelines and treat to guidelines
- Handling difficult cases
**Awareness (Consumer)**
- Understand the message that hypertension kills - through stroke, heart attack and renal failure (“silent killer”)
- Pre-hypertension is an early warning sign that patients and physicians should aggressively counteract – “know your numbers”
- Measure results and pursue outcomes research

## Strategic Approaches

- Push channel-specific messaging                  direct-to-patients/consumers
- Established programs (2006-2007)
- Army National Guard “Get Cuffed” Program
- Estimated 5.5 million reach
- Customized inserts and editorial within *Heart Insight*
- Estimated 3 million/issue
- Existing AHA High Blood Pressure Web Sites
- 1.3 million unique visits/year with more than 5.2 million page views
- Customized Patient Education Brochures
- TBD ordered
- King Pharmaceutical Risk Assessment
- 134,500 unique visits
- Monthly Patient Education Newsletter
- 18,750 active registrants
- Heart Profilers High Blood Pressure Module
- 7,500 unique visitors/year

**Notes:**
All reach is 2006-2007 figures provided by patient education as of July 2007
Heart Insight – including pass along 3 million
Monthly Patient Ed HBP Newsletter - Average open rate is 20.5% and average click-through rate is 5.9%

## Professional Education

## CME Accreditation Outcomes     Levels and Timing

_**Level 1**_
- Outcomes or “smile sheet” rates the CME activities quality, usefulness, objectives, presentation, faculty
_**Level 2**_
- Measures a change in participants’ knowledge, skills, or attitude – an intention to change (correlates highly with actual change)
_**Level 3**_
- A self-reported change in clinician behavior or practice
_**Level 4**_
- An objectively measured change in clinician behavior      or practice
_**Level 5**_
- An objectively measured change in patient health status

- Immediate

- 1-3 mo.
-  Post
- Activity

- 6-12 mo.
- Post
- Activity

**Notes:**
Mission:
To provide best practice and emerging scientific knowledge to healthcare and science professionals, and resources to translate that knowledge for the prevention, diagnosis and treatment of cardiovascular disease and stroke.

Continuing Medical Education (CME) Requirements

ACCME Accreditation Element Criteria 3:
The provider generates activities/educational interventions that are designed to change
Competence,
Performance, or
Patient outcomes

## Developing Targeted Channels

**Developing Targeted Channels**

- Statements &
- Guidelines

- Cardiologists

- PCPs

- PA’s/APNs

- Pharmacists

- Conferences
- Workshops
- Seminars

- Journals

- Cable TV

- Self-Directed Learning
- Webinars
- Interactive Webcasts

- Mobile CE
- Podcast

- Satellite Broadcasts
- - Hospital based

- Needs Assessment

- Grand Rounds
- Hospital based
- Office based

**Live – Face to Face**

**Synchronous and Asynchronous**

**Asynchronous**

**Notes:**
Professional Education
Needs Assess
Develop courses
Teach methodology
Evaluate the practitioner
Treat to goal/evaluate outcomes

## Improving Outcomes - Patient Engagement and Empowerment- Testing Interventions

## Testing the Structural            Integrity – Outcomes Evaluation

- Disease Management Application
- Heart Profilers
- Risk Calculator – Aggregated Data (new opportunity to track reach and potential health impact)
- Patient Education System (PES) –
- New program designed to reach/teach at point of discharge
- Longitudinal Study Opportunities
- AVAIL
- YWAMI
- HMO Network
- Methodology to evaluate providers outcomes (Professional Education)

- Test intervention... use results to drive new programs and develop new methods of engagement

**Notes:**
Continuing education Programs are all designed to measure outcomes in practitioner competence, behavior or patient outcomes. AHA currently measuring as high as a level 4 on a 5 point scale on selected activities.

## HMO Network – Outcomes Evaluation

**Kaiser Permanente Colorado Clinical Trial Using Home-based, Multi-**
**modal Interventions to Manage Patients with Hypertension Project **
_**Project Description**_
- The purpose of this project is to develop, implement and evaluate a home-based, multi-modal intervention to manage patients with hypertension.  The interventions to be tested  will include:
- 	1)  “Heart Profilers,” an interactive decision support tool designed to help patients make informed treatment decisions and either
- 	(2a)  Home blood pressure device that keeps track of patients home blood pressure readings and automatically uploads the readings into a personal computer and transmission to an internet server accessible to the patients healthcare providers for tracking and analysis ***or***
- 	(2b)  Basic home blood pressure device that patients can use to measure their blood pressure at home, record the readings in a log, and transmission of  the blood pressure readings to their healthcare providers using IVR technology
- We envision a randomized controlled clinical trial (RCT) with three arms: 1) a usual care arm; 2) Heart Profiler/automated home blood pressure machine/home computer/internet arm; and 3) Heart Profiler/a basic blood pressure machine/IVR arm

**Notes:**
Notes:
Purpose here is to formally test multiple interventions and use the results to drive new programs and develop new methods of engagement