# Presentation: 493768

## Community Based Cardiovascular Improvements:Translating Knowledge into OutcomesCARMEN– October, 2004

- Richard J. Schuster, M.D., M.M.M.
- Boonshoft Chair and Director
- NHLBI EDUC Center of Excellence

## Enhanced Dissemination Utilization Center(EDUC)

- This project has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health under contract number N01-HO-29235

## Slide 3

**CARMEN to Wright State**

## Why Focus on “Translation”

**We have failed!**
**Practitioner **_**knowledge**_** is good**
**Practitioner **_**practice**_** is poor**
**How Poor? ***
**How many of your hypertensives do you **_**believe**_** are under control:  **_**50 - 60%**_
**How many of your hypertensives are **_**actually**_** under control:  **_**25%**_
- *Oliveria, et. al.,  Arch Intern Med. 2002 Feb 25;162(4):413-20.

## Why Focus on “Translation”

**We have failed!**
**We know what to do**
**The public receives mediocre care in the US**
**How Poor?  **
**Only **_**31%**_** hypertensives  in the US are under control ****1**
**Only **_**35%**_** of people with high cholesterol know their condition ****2**
- 1 NHANES 1999-2000, Hajjar, JAMA, 2003, 290(22):199.
- 2 NHANES 1999-2000, Ford, Circulation, 2003, 107(17):2185.

## Physician Behavior Change“Eisenberg’s Rules” ***

- Education [Grand Rounds]
- Administrative Changes [“Hassles”]
- Participation
- Financial Incentives
- Rewards
- Penalties
- Feedback

- *** Nash, David, “Three Faces of Quality,” ACPE

## Getting the Numbers Better

**The Hawthorne Effect?**

## Getting the Numbers Better:Beyond The Hawthorne Effect 

**Show doctors their numbers**
**Review Guidelines**
**Give them expectations**
**Show them the numbers again**

## Cholesterol Management in Patients with Coronary Artery Disease Program 

**Cholesterol Management in Patients with Coronary Artery Disease Program**

_**Target Population**_**:  ****Coronary Artery Disease Patients  **
_**Program**_**: Physicians receive clinical outcomes**
_**Program**_**: Patients receive**
**Personally signed letter from their physician giving them a target LDL cholesterol**
**NHLBI produced reading material**
**Wallet card to record their “metabolic syndrome” number **
**Follow-up phone call**

- 30%

- 51%

- 20%

- 23%

- 11%

- 6%

- 3%

- 1%

- 0.4%

- 0.5%

- 31%

- 12%

- 0%

- 20%

- 40%

- 60%

- Optimal

- (<100)

- Near

- Optimal (100-

- 129)

- Borderline

- High (130-

- 139)

- High (160-

- 189)

- Very High

- (>=190)

- Missing

**LDL Levels (ATP III Guidelines)**

- Baseline Intervention

- Follow up Intervention

- 105 Physician Primary Care Group

- Outcomes

- P<0.05

##         Hypertension - Obesity Management Program

**        ****Hypertension - Obesity Management Program**

_**Target Population**_**:  African American & Appalachian Populations**
_**Program**_**:  **
**Physicians receive feedback on their clinical performance**
**Physicians measure waist size as a “vital sign” during visits of hypertensive patients**

## 145

**145**

**136**

- 78

- 78

- 0

- 50

- 100

- 150

**Systolic**

- Diastolic

**Mean Blood Pressure  **

**Levels at Baseline and at 1 Year Follow-up**

**p=0.001**

- Urban Health Centers

## LDL Levels 

- 21%

- 29%

- 29%

- 27%

- 12%

- 17%

- 10%

- 5%

- 3%

- 3%

- 25%

- 19%

- 0%

- 5%

- 10%

- 15%

- 20%

- 25%

- 30%

**Optimal**

- (<100)

- Near Optimal

- (100-129)

- Borderline

- High
- (130-159)

- High
- (160-189)

- Very High

- (>/=190)

**Missing**

**LDL Levels **

**Based on ATP III Guidelines**

**p=0.21**

**p=0.15**

## Mass Media:  Social Marketing 

**Mass Media:  Social Marketing**** **
**Educate the Public**** **
**(Just Like the Drug Companies)**

## Know Your Numbers

_**Project type**_**:  Mass Media Social Marketing Campaign**
_**Entering 4**__**th**__** Year**_
_**$600,000 Campaign**_
_**Outcomes**_**:  **
**African American Middle-aged women  - Early effect**
**Middle-aged women - Effect**
**General population – Late effect**

## 35%

- 34%

- 40%

- 30%

- 32%

- 34%

- 36%

- 38%

- 40%

- Baseline

- 6 month

- 12 month

**Do You Know Your Cholesterol Numbers?**

- 14% increase in the number of women who know their cholesterol numbers.

- p=.191 between baseline and 12 month.

- 14% increase

## Did Seeing the KYN Commercial Prompt You 

**13%**

**23%**

- 0%

- 10%

- 20%

- 1 year-

- W

- 2

- years-

- W

**Did Seeing the KYN Commercial Prompt You **

**to Have Your Blood Pressure or Cholesterol **

**Checked?**

- 85% increase
- p=0.019

_**12,711 middle-aged women**_** **_**had either their cholesterol or BP checked in 2 years from the KYN campaign**_

## Physician Obesity Awareness Program

_**Program**_**  **
**Physicians identify obesity as a CV risk factor **
**Routinely record the recommendation to lose weight in the medical record using a **_**sticker**_** in the body of the medical record**

## How Comfortable are Physicians in Discussing Obesity with their Patients ?

## Have Physicians Responded?

- Early Report

## Community Based Cardiovascular Improvements:Translating Knowledge into OutcomesCARMEN– October, 2004

- Richard J. Schuster, M.D., M.M.M.
- Boonshoft Chair and Director
- NHLBI EDUC Center of Excellence