Hospitals in Action >> Case Examples

ST. ELIZABETH MEDICAL CENTER - Edgewood, Kentucky
Northern Kentucky Women’s Cardiovascular Assessment, Risk reduction and Education (CARE) Collaborative

Overview
St. Elizabeth Medical Center is a 364-bed hospital serving residents in Northern Kentucky.  Kentucky has a high prevalence of cardiovascular disease, with 38 percent of all deaths in Kentucky caused by heart disease or stroke.  As of 2006, Kentucky ranked 47th worst in state mortality for heart disease among Caucasian women.  In addition, Kentucky currently has the highest smoking death rate in the nation.  With federal funding in 2007, St. Elizabeth Medical Center created the Northern Kentucky Women’s Cardiovascular Assessment, Risk reduction and Education (CARE) Collaborative.  Through the partnership of multiple health care providers, churches, hospital departments, and community partners, this three-year initiative aims to raise awareness about hypertension and encourage women to “take action” by adopting healthy lifestyle habits to reduce their risk of cardiovascular disease, heart attack, and stroke.

The Northern Kentucky CARE Collaborative coordinates the efforts of more than 40 partner organizations to meet the following Healthy People 2010 goals and objectives:

• In 8 Northern Kentucky counties, increase the number of hypertensive adult women ages 20 to 80 who are taking action to help control their blood pressure from 84% to 98% by enrolling 500 hypertensive women in CARE Collaborative interventions;
  
• Increase the proportion of persons appropriately counseled about health behaviors including physical activity and exercise, diet and nutrition, smoking cessation, and reduced alcohol consumption;
  
• In 8 Northern Kentucky counties, increase the number of adult women ages 20 to 80 who have had their blood pressure measured within the preceding 2 years and can state whether it is normal or high from 90% to 95%;
  
• Increase the proportion of hospitals and managed care organizations that provide community disease prevention and health promotion activities that address the priority health needs identified by their community.

Impact
The program is anticipated to reach more than 75,000 women by August 2010 with blood pressure screenings, cardiovascular health education, and intensive lifestyle interventions for women with established cardiovascular disease risk factors.  At the completion of Year 1, more than 20,000 patient encounters were documented.  In patients returning to the screening program (n>2,000), 58% of patients reported that they began “taking action” by modifying their lifestyle risk factors, and 51% of patients had a documented decrease in blood pressure.  Of those, 17% demonstrated decreased blood pressure into the “green” normal range (less than 120/80).  Additionally, 450 women have been enrolled in an IRB-approved long-term study examining the impact of lifestyle changes on blood pressure, body mass index, and other health parameters.

Challenges/success factors
The SEMC CARE Program has realized that occasional circumstances may force the rearrangement of the grant program timeline to accomplish all goals in a logical and reasonable manner.  Feedback regarding the materials developed, including the Blood Pressure (BP) screening card, has been positive.  The early months of use taught program leaders that utilization will be rapid and therefore, order quantities were increased.  In addition, the BP zones screening card has undergone four revisions based on user commentary and suggestion.  Program leaders anticipate that the BP card will continue to be revised over the years of the grant to optimally meet the needs of the partners and patient populations.  Finally, they are learning that there are certain providers who will need to be more strongly incentivized than others.  For the time being, program leaders have addressed this by revising the BP Daily Tally sheets used for tracking patients in each office and by directly visiting the offices that were lacking in data points and not submitting data.  In addition, they are hoping to see larger patient numbers from some of the physician partners.

Future direction/sustainability
Collaborative leaders are partnering with the CDC Kentucky Heart Disease and Stroke Prevention Task Force on the state level, which focuses on systems-level change.  The blood pressure zones card educational encounter has stimulated interest in several regions throughout the state.  The CARE Collaborative will facilitate an in-service in the blood pressure card educational encounter broadcast through regional state health departments to expand collaborative partnerships throughout the state.  The primary sustainability effort during the first year of the grant cycle has been to adapt the BP cards and BP Daily Tally sheets to meet the needs and suggestions of the partner organizations.  Through frequent contact with the partner sites, Collaborative leaders intend to enhance participation and long-term acceptance of the protocol and enhanced educational encounter practices.  The intention of the CARE Collaborative is to make the BP card an important part of the medical record for the women and men of Northern Kentucky.  Collaborative leaders believe that within the three years of the grant, the distribution of this card as part of the portable health record could be so widespread that emergency medical personnel will know to look for this card when a person presents to the emergency room or presents seeking other healthcare.  Once the card becomes more prevalent in the community, there will be greater interest in continuing to provide this piece of medical literature/record.

St. Elizabeth Medical Center remains committed to facilitating the printing of these cards on an ongoing basis beyond August 2010.  In addition, the CARE staff have begun to brainstorm regarding the addition of corporate partners (pharmacies, etc.) who will also participate in the BP screening and utilize the tool as a marketing piece and, therefore, absorb some of the long-term production costs.  In terms of oversight, the St. Elizabeth Medical Center Project Director and Coordinator have requested that representatives from each of the collaborating partners remain on the Steering committee past August of 2010.  The CARE Collaborative staff intends the Steering committee to be a dominant voice in the community planning with respect to meeting the needs of reducing the incidence of hypertension in Northern Kentucky.

Advice to others
The CARE Collaborative has found the individuals educated through the screening program to be very receptive to the information.  We recommend meeting with key stakeholders in your area and collaborating to provide a cohesive message on cardiovascular disease to the community.  Any hospitals interested in starting this particular model screening program are encouraged to contact the CARE Collaborative to discuss partnership.  Blood pressure screening cards are provided free of charge to active partners throughout the grant cycle, ending in August 2010.

Contact: Kristin Theobald, MS, CGC
CARE Project Coordinator
Telephone: (859) 301-6333
E-mail: ktheobal@stelizabeth.com