Transcript Okunji2012 USPHS Nurse Category Day

Strengthening Preventive Strategies:
Evidenced Based Recommendations
Addressing Cardiovascular Disease Leading
to a Healthy Heart
Priscilla O. Okunji, Ph.D., RN-BC
Howard University, Division of Nursing and Allied
Health Sciences, Washington DC
Purpose
Address the different preventable and leading causes of death to
include heart disease and stroke while highlighting
evidenced-based recommendations reducing cardiovascular
disease leading to a healthy heart
Objectives
At the completion of this presentation, participants will be able
to:
Categorize and apply priorities to improve the health and
wellness of our nation.
Implement effective strategies aimed at improving health.
Incorporate evidenced-based recommendations for reducing
cardiovascular disease – diabetic myocardial infarction .
Apply culturally sensitive intervention strategies to help
eliminate heart disease and stroke health disparities in
minority communities.
National Priorities
Goal #1: Strengthen Health Care Objectives (2010 – 2015)
After decades of asking, “When are we going to fix our broken health insurance system?”
we finally have an answer: “Starting now.”
—HHS Secretary Kathleen Sebelius
• Make coverage more secure for those who have insurance, and extend
affordable coverage to the uninsured.
• Improve healthcare quality and patient safety.
• Emphasize primary and preventive care linked with community prevention
services.
• Reduce the growth of healthcare costs while promoting high-value, effective
care.
• Ensure access to quality, culturally competent care for vulnerable
populations.
• Promote the adoption and meaningful use of health information technology.
Source: http://www.hhs.gov/secretary/about/goal1.html
Disease Prioritization
Prioritized List of 20 High-Impact Medicare Conditions
Major Depression
Congestive Heart Failure
Ischemic Heart Disease
Diabetes
Stroke/Transient Ischemic Attack
Alzheimer’s Disease
Breast Cancer
Chronic Obstructive Pulmonary Disease
Acute Myocardial Infarction
Colorectal Cancer
Hip/Pelvic Fracture
Chronic Renal Disease
Prostate Cancer
Rheumatoid Arthritis/Osteoarthritis
Atrial Fibrillation
Lung Cancer
Cataract
Osteoporosis
Glaucoma
Endometrial Cancer
Cardiovascular Diseases
DID YOU KNOW?
• Every 26 seconds, a person in the United States has a
major coronary event and every minute, someone dies of
one (AHA, 2008)
• Length of stay (LOS) among cardiac surgery patients with
diabetes was 0.76 days longer for every 50-mg/dL increase
in glucose (Estrada et al., 2003)
• Prior to 2010 and to the best of our knowledge, no
research reported on the outcomes of hospital inpatient
with both MI and T2D (Okunji et al., 2010)
National Costs
• MI mortality ranked first with 652,091 while diabetes ranked sixth
with mortality rate of 75,119 and total cost of $174 billion with
$116 billion in direct medical cost (NHDR, 2009)
• Diabetes mellitus may be an important factor for long-term
survival in patients with Myocardial Infarction (Chyun et al.,
2000)
• Approximately $86 billion, or 12 percent, of all U.S. health care
expenditures can be attributed to diabetes. Half of that 12
percent can be attributed to complications of diabetes alone
(Keawe'aimoku, et al. 2003)
CAD Prevalence
• Coronary heart disease is the most common type of heart
disease. In 2008, 405,309 people died from coronary heart
disease.
• Every year about 785,000 Americans have a first heart attack.
Another 470,000 who have already had one or more heart
attacks have another attack.
• In 2010, coronary heart disease alone was projected to cost the
United States $108.9 billion.
• This total includes the cost of health care services, medications,
and lost productivity.
Source: http://whereistheoutrage.net/domestic-issues/education/ler-heart-health-month/
CAD Risk Factors
Non-Modifiable:
• Increasing age
• Hereditary
• Prior stroke or heart diseases
Modifiable:
•
•
•
•
Smoking
High blood pressure
High blood cholesterol
Overweight/Obesity
Faces of Statistics
MI Pathophysiology & Treatment
Source: Aaronson, P. I., & Ward, J. P. (2007). 41.
The Cardiovascular System at a Glance (At a
Glance) (3 ed., pp. 86). Malden, MA: WileyBlackwell
Evidenced Based
Few studies on the hospital characteristics and their treatment
outcomes have been focused on:
• Chronic heart failure and pneumonia (Ayanian, et al. 1998)
• Preventable adverse effects (Thomas, et al. 2000)
• Surgical outcomes (Sloan, et al. 2000)
• Cardiovascular diseases (Polanczyk, et al. 2002)
• Patient safety indicators (Romano, et al. 2003)
• Effects of hospital characteristics and economy on T2D
(Dowell, et al. 2004)
• Acute myocardial infarction alone (Allison, et al. 2007)
• No study has focused on patients with both MI and T2D treatments
and outcomes prior to 2010 (Okunji, et al. 2010)
Our Study -- Background
Diabetic Myocardial Infarction Inpatient: Prevalence,
Disparities and Outcomes
• Reducing disparities in health care requires measurement
and reporting (NHDR, 2009).
• The ability to monitor and track changes in disparities is
critical.
• Growing interest in public reporting for quality improvement
activities continues to be an impetus to improve not only
the quality of data but also the quality of care provided.
• The Department of Health and Human Services strongly
advocates for patient-centered outcomes research (PCOR).
Method
• Data from the National Inpatient Stay (NIS) Healthcare
Cost and Utilization Project under the Agency for
Healthcare Research and Quality (HCUP_AHRQ) was
retrospectively analyzed and compared for 2006
hospital discharges .
• Statistical analyses using descriptive, bivariate,
regression and dummy coded methods to answer the
study hypotheses .
Result & Conclusions
• Troubling disparity between gender and patient insurance, X2 (1, N = 1480)
= 1.598, p < .001.
• More males 1,862 (67%) than females 912 (33%) admitted.
• Male had more major procedures than their female counterparts, X2 (1, N =
2127) = 1.343E2, p < .001).
• More females died than expected, X2 (1, N = 2771) = 23.12, p < .001.
• Older patients with the age groups (59 – 71) and (72 – 84) had longer LOS,
more transferred and died more after adjustment.
• Transfer to Short Term Hospital (B = -.091, p < .001) and Another Nursing
facility (B = -.095, p < .001) were major predictors of patient mortality when
compared to Routine discharge.
• Patient mortality not affected based on if the hospital was a teaching or non
teaching hospital X2 (1, N = 1034) = .023, p = 1.00.
Our Recommendations
• Ensure healthcare to all patients regardless of age, race,
ethnicity, or insurance possession.
• MI inpatient with T2D mortality rates to be reduced with
timely diabetes screening.
•
Emergent treatment procedure in a timely fashion (Time
is muscle).
• Healthcare providers to adopt effective communication,
listen to their patients, show respect, and answer their
questions.
Preventive Strategies
HHS
Pillar
Priority
Goal
Sample
Measures
and
Practices
Healthy People/ Healthy Communities
Population Health
Clinical
Preventive
Services**
Healthy Lifestyle
Behaviors**
Community
Health Index
Breast, Cervical,
Colorectal
Screenings*
Child & Adult
Pneumonia
Influenza
Immunizations*
Health Partners
Composite
Smoking Cessation
Counseling*
BMI*
Young Adult Health
Care Survey
(YAHCS)*
Promoting Healthy
Development Survey
(PHDS)*
Health Partners
Composite
MATCH
(Univ. of
Wisconsin)
** Need to
address aspirin,
blood pressure,
cholesterol,
smoking
counseling
Prevention
Quality
Indicators
(PQI)*
** Need to address
smoking, nutrition,
physical activity,
risky alcohol use
Source: http://www.nationalprioritiespartnership.org/uploadedFiles/NPP/NonPartners/Newsletters/NPP%20Input%20to%20HHS%20on%20Priorities%20for%202011%20National%20Quality%
20Strategy_Final%20Report(2).pdf
Preventive Measures
• Monitor your blood pressure regularly
• Maintain a healthy weight
• Heart healthy nutrition
• Get 30 to 60 minutes of moderate physical activity most days
of the week
• Eat less saturated fat and sodium
• Eat more fruits and vegetables
• Limit beverages and foods with sugar
• Have regular checkups with your health care provider
• Take medications as prescribed by your health care provider
• No smoking
• Find healthy ways to manage stress
• Get a good night sleep
Preventive Measures
• Lipid disorders screen and treat men ≥35 years and women ≥45
years of age for lipid disorders.
• Screen and treat men 20-35 years and women 20-45 years with
increased risk for coronary heart disease
• Hypertension, screen men and women ≥18 years
***Screen
all overweight children and teenagers for T2D
Source: U.S. Preventive Services Task Force. Recommendations.
Available at:
http://www.ahrq.gov/clinic/uspstfix.htm#Recommendations.
Accessed 6/12, 2007.
Solve The Portion Puzzle
© 2010 California Walnut
Board. www.walnuts.org
Ask Questions!!!
Questions to ask your Healthcare Provider
• What is my risk for heart disease?
• What is my blood pressure? What does it mean for me and what do I
need to do about it?
• What are my cholesterol numbers? (these include total cholesterol, LDL,
HDL and triglycerides. What do they mean for me and what do I need
to do about them?
• What are my body mass index (BMI) and waist measurement? Do they
mean that I need to lose weight for my health?
• What is my blood sugar levels, and does it mean that I’m at risk for
diabetes? If so, what do I need to do about it?
• What other screening tests do I need to help protect my heart?
• What can you do to help me quit smoking?
• How much physical activity do I need to help protect my heart?
• What’s a heart healthy eating plan for me?
• How can I tell if I’m having a heart attack? If I think I’m having one, what
should I do? (http://www.cdc.gov/women/heart/)
Cultural Focus
• Identification of community/opinion leaders as potential
stakeholders to reach out to minority population.
• Initiate and/or expand English, other language tutorial
programs for minority population on nutrition, exercise, etc.
• A dialogue to be focused on minority population.
• Trust building between minority, providers, and community
activists on health issues.
• Regional and national networking, communications, and
dialogue among minority based community and
organizations.
Cultural
CulturalFocus
Focus
• Design culturally appropriate prevention (Screening) and care
interventions for the community.
• Involve youths in all of the above aspects.
• Eliminate stigma in the community towards certain diseases.
• Clinicians awareness of the current conditions and offer
themselves to meet the health needs of this group by
practicing in inner communities.
• Encourage comprehensive health checks for new arrivals,
particularly from high-risk areas.
• Nurse Practitioners to be more involved in preventive
measures of chronic diseases prior to complications.
Meaningful Use (Safety)
• All hospitals to adopt electronic documentation by 2014
• Introduce nursing informatics and EHR in our traditional
classrooms and online programs for the future paperless work
environment
• Community multipurpose/mobile telehealth screening tool to
target areas of high density of minority population
• Distance/on-line learning and “3D” second life real time virtual
healthcare classroom for the cyber (younger) generation
• Increase grants and training funding for healthcare tech leaders
in nursing profession for a cost effective health care
References
• Aaronson, P. I., & Ward, J. P. (2007). The Cardiovascular System at a Glance (At a
Glance) (3 ed., pp. 86). Malden, MA: Wiley-Blackwell.
• American Heart Association (AHA). (2008). Heart disease and stroke statistics 2008 update. Dallas, TX:
American Heart Association, In Ignatavicious, D. D. and Workman, M. L. (2009). Medical-Surgical
nursing. Patient-centered collaborative care (6th ed). St Loius: Sounders.
• Chyun D, Obata J, Kling J, Tocchi C (2000). In-hospital mortality after acute myocardial infarction in
patients with diabetes mellitus. Am J Crit Care. May;9(3):168 79.
• Estrada CA, Young JA, Nifong LW, Chitwood WR Jr. (2003). Outcomes and perioperative
hyperglycemia in patients with or without diabetes mellitus undergoing coronary artery bypass grafting.
Ann Thorac Surg.;75:1392-1399.
• HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 2008.
Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/nisoverview.jsp
HCUP Clinical Classifications Software (CCS) for ICD-9-CM. Healthcare Cost and Utilization Project
(HCUP). 2006.
• Agency for Healthcare Research and Quality, Rockville, MD. www.hcupus.ahrq.gov/toolssoftware/ccs/ccs.jsp. Accessed July 10, 2008
• Keawe'aimoku, K.J., Haynes, S.N., Grandinette, A., Chang, H.K. (2003). Biological, psychosocial, and
sociodemographic vairables associated with depressive symptoms in persons with type 2 diabetes.
Journal of Behavioral Medicine, Vol. 26, Issue 5, pp. 434-458.
• National Healthcare Disparities Report: Summary (2009). Agency for Healthcare
Research and Quality, http://www.ahrq.gov/qual/nhdr03/nhdrsum03.htm
• Americanheart.org
• http://www.cdc.gov/heartdisease/facts.htm
• National Heart, Lung and Blood Institute, National Institute of Health.
Acknowledgement
•Dr. Mary Hill, Professor and Dean, College of Nursing and
Allied Health Sciences, Howard University, Washington,
DC
• Dr. Afrooz Afghani, Professor, Trident University College of
Health Sciences, Cypress, CA
• Dr. Angela Hegamin, Associate Professor, Trident University
College of Health Sciences, Cypress, CA
• Dr. Frank Gomez, Professor and Director of PhD program,
Trident University College of Health Sciences, Cypress,
CA
• Dr. Tenasescu, Professor and Dean, Trident University College
of Health Sciences, Cypress, CA
Thank You !!!
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