Cardiovascular Disease Prevention in an Era of Global HIT Spread
Sonia Angell, MD, MPH Deputy Commissioner
February 25, 2016 Crystal City, Virginia Innovative Policy in Cardiovascular Non-Communicable Disease Prevention
American College of Preventive Medicine
CONFIDENTIAL AND PROPRIETARY Any use of this material without specific permission of DOHMH is strictly prohibited
Leading Causes of Death Globally, 2013
Adapted from: Naghavi M, et al. Lancet 2015, 385(9963), 117-171.
*Includes all other non-communicable disease, and injuries
Cardiovascular Disease
32%
Cancer 15%
Diabetes 2%
Chronic Respiratory
Disease 8%
Other* 22%
Communicable, Maternal,
Neonatal, and Nutritional Diseases
21%
Leading Causes of Death in New York City, 2013
*Includes all other natural and external causes (including communicable disease) Source: Summary of Vital Statistics 2013, The City of New York Appendix A, Table M1. February 2015. Can be accessed at: http://www.nyc.gov/html/doh/downloads/pdf/vs/appendixa-2013.pdf
Cardiovascular Disease
37%
Cancer 25%
DM 4%
Chronic Lower Respiratory
Disease 3%
Other* 31%
Poverty and Race/Ethnicity in NYC
6
Sources: Neighborhood poverty (based on zip code) defined as percent of residents with incomes below 100% of the Federal Poverty Level, per American Community Survey 2007-2011. Population (based on zip code) defined as percent of non-Hispanic black and Hispanic residents, per 2010 Census.
Prevention is a Space Shared by Both Clinical Medicine and Public Health
Clinical
Community
Improved Population
Health
Electronic Health Record Use: Global Growth
8
Available at: http://www.businesswire.com/news/home/20140224005325/en/Global-Market-Electronic-Health-Records-EHR-Expected
EHR Use Has More Than Tripled Since 2001 in the US
Percentage of office-based physicians with EMR/EHRs systems: United States, 2001-2013
Hsiao C-J, Hing E. Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001–2013. NCHS data brief, no 143. Hyattsville, MD: National Center for Health Statistics. 2014. Available at: http://www.cdc.gov/nchs/data/databriefs/db143.pdf
Electronic Health Records (EHRs) Make Medical Record Information Actionable
10
20
30
40
50
60
70
80
Oct
-09
Dec-
09
Feb-
10
Apr-
10
Jun-
10
Aug-
10
Oct
-10
Dec-
10
Feb-
11
Apr-
11
Jun-
11
Aug-
11
Oct
-11
Data Gives PHDs the tools we need to improve Community Health
Hub Population Health Network
Secure exchange of aggregate data through a distributed model
Send out queries Receive patient counts
overnight Currently covers:
• 700+ practices • 2.1 M patients in 2014 • 6 M patients since 2009
Scope of the Hub’s Coverage: Total Geographical Reach
4,000+ Patients Per Neighborhood 18% of all NYC in 2013
HTN Control Varies by Practice Location
13 Data were obtained from the Hub Population Health System. Buck MD, Anane S, Taverna J, Amirfar S, Stubbs-Dame R, Singer J. The Hub Population Health System: distributed ad hoc queries and alerts. J Am Med Inform Assoc. 2012 Jun;19(e1):e46-50. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392869/
Diabetes: A Social Determinants Lens
• Access to quality health care – Hemoglobin A1C – Public health detailing
• Improving the community food environment – Neighborhood Programs – Citywide Policies
• Improved everyday life – Health – Housing – Income
A1C Registry Data
• Established 2006 by Board of Health • All A1C laboratory tests from clinical
laboratories for NYC residents are electronically reportable to the Health Department
• ~132,000 individuals with diabetes had annual tests between 2006-2012
• Nearly 2/3 did not consistently maintain A1C <8
Community Health Worker Initiative – Harlem Health Advocacy Partners
Targets Residents of 5 NYCHA Developments Goals:
• Improve health of Harlem NYCHA residents
• Decrease existing disparities chronic diseases: diabetes, hypertension, asthma
• Policy agenda to advocate for CHW certification & reimbursement
Design Components
• Community Engagement
• Wellness Activities
• Health Insurance Navigation
• Health Coaching
Hotspot map display represents 900 people with uncontrolled diabetes per A1C registry (>9)
18
Potential of Aligning Mutually Reinforcing Strategies in both Environments
Clinical • Prescribing Statins • Public Health
Detailing in clinics on Tobacco
• Improved diabetes management
• A1C Registry
Community • Restricting trans fat
use in restaurants • Tobacco media
campaigns • Scale up of National
Diabetes Prevention Program
• CHW Programming
21.6 21.7 21.5
19.2 18.3
18.9
17.5 16.9
15.8 15.8
14 14.8
15.5 16.1
13.9
Smoke-free parks & beaches
1993-2001, smoking prevalence was
stable, 21.5%-21.7%
% o
f adu
lts
NYC & NYS tax increases
Smoke-free Air Act (SFAA)
Free patch programs
start
Hard-hitting media
campaigns
Adult Smoking in New York City
NYS tax increase
Federal tax
increase, NYC
banned flavored sales, & SFAA
extended to include hospital
entrances NYS tax
increase
Source: CDC Behavioral Risk Factor Surveillance Survey; NYC Community Health Survey
SFAA extended to e-cigs, Sensible Tobacco
Enforcement & Tobacco 21 laws
implemented
In Conclusion
20
• The world is more similar than different – Lessons learned everywhere have value – Don’t overlook the potential value of HIT anywhere
• Place matters – Look for precision when advancing population
health • Prevention is a shared space by clinical
medicine and public health – Innovate to integrate!
Thank you!
Sonia Angell, MD, MPH
Deputy Commissioner for Prevention and Primary Care
[email protected] Innovative Policy in Cardiovascular Non-Communicable Disease Prevention
American College of Preventive Medicine CONFIDENTIAL AND PROPRIETARY Any use of this material without specific permission of DOHMH is strictly prohibited