This study aims to improve access to quality care and reduce poor health outcomes associated with cardiovascular disease generally and congestive heart failure in particular. The study will review public health data and conduct statistical analyses to understand factors related to excess hospitalization and death from heart disease in South Los Angeles. The findings will be used to inform prevention, early detection and treatment interventions.
Understanding the Burden of Congestive Heart Failure and Cardiovascular Disease in South Los Angeles: An Academic, Community, and Safety Net Provider Collaborative Effort October 18, 2012 Lark Galloway-Gilliam, MPA Annie Park, MPH Jessica Jew, MPH Community Health Councils Ami M. Shah, MPH UCLA Center for Health Policy Research Nina Vaccaro, MPH South Coalition of Community Health Centers Roberto Vargas, MD, MPH Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Medical Sciences Institute, Charles Drew University and RAND Health
Transcript
Understanding the Burden of Congestive Heart
Failure and Cardiovascular Disease in South Los
Angeles: An Academic, Community, and
Safety Net Provider Collaborative Effort
October 18, 2012
Lark Galloway-Gilliam, MPA
Annie Park, MPH
Jessica Jew, MPH
Community Health Councils
Ami M. Shah, MPH
UCLA Center for Health Policy Research
Nina Vaccaro, MPH
South Coalition of Community Health Centers
Roberto Vargas, MD, MPH
Division of General Internal Medicine and Health Services Research,
David Geffen School of Medicine at UCLA,
Medical Sciences Institute, Charles Drew University and
RAND Health
Background
South Los Angeles Healthcare Leadership Roundtable
2011 retreat Office of Statewide Health Planning and Development (OSHPD) data demonstrates high rates of Congestive Heart Failure (CHF) admissions
(706 per 100,000) in South LA compared to the rest of Los Angeles County (350 per 100,000)
2012 retreat breakout group targets reduction of disparate CHF for future partnered activity
Partnership pursued funding to collaboratively develop an approach to address the excess burden of heart disease in South LA
2
3
Los Angeles County
Service Planning
Areas SPA 6
and
Health Districts (26)
3
4
Aims
Aim 1: Engage the partner organizations to shape exploratory analyses of descriptive data on heart failure and its risk factors and related outcomes
Aim 2: Engage the partners to develop consensus on selected cardiovascular disease conditions and measures for risk factor and CHF case identification in clinic settings
Methods: Community Partnered
Participatory Research
Knowledge Exchange: Providers, academics and community on the public health problem
California Health Interview Survey (CHIS)
Small area estimates
Inpatient data (OSHPD)
Discharges
Quality indicators
Additional support for case identification and registry development
Methods: Community Partnered
Participatory Research
Knowledge Exchange: Share data with providers and community on the public health problem:
What do safety net providers need to know in
order to drive change toward improved
health?
What role can they play in reducing the
burden of disease?
How do we support this role?
Methods: Community Partnered
Participatory Research
Delphi Method Approach
Develop consensus on approach to reducing
burden of Congestive Heart Failure in the
South Los Angeles Community
Review of populations health statistics
Review clinic spectrum of disease
Review evidence on disease detection and
treatment
Outcomes
Knowledge Exchange:
South Los Angeles Healthcare Leadership
Roundtable, September 13th and October 9th
Medical Directors’ Meeting, South Side Coalition of
Community Health Centers, September 11th
Review of secondary data sources and findings
OSHPD data by Service Planning Area (SPA) and
Health Districts (HD)
CHIS data by SPA, HD and small area estimates
Iterative analyses and feedback
44 25118
45 66
380
233
699
381396
Metro West South East South Bay
ED Encounters Hospital Admissions
Heart Failure Prevention Quality Indicator #8 RatesBy SPAstandardized rates per 100,000, OSHPD 2007-2009 average
10
Heart Disease Prevalence by SPA among adults age 18 and over
6.2 7.0
5.0 6.2
6.8
Metro* West LA South LA East LA South Bay
Los Angeles County = 5.8%
11 Source: CHIS 2009, Ever diagnosed with heart disease CHIS 2009 * Estimate is unstable
* Statistical Significance (95% CI’s do not overlap)
Take away messages -SPA 6 is less confident in managing heart disease -SPA 6 more likely to be diagnosed with HBP but less likely to take meds
Risk Factors for Preventable Hospitalizations?
2009 CHIS Data
12
13
Outcomes: Iterative analyses and
feedback
Suggested Analyses
“How does insurance (uninsured/Medi-Cal) affect
access to care, can you break down the data to show
payer source? Gender? Demographics?”
“Problems of low medication adherence, are there
ways to improve compliance? Demographics of those
most at-risk and targeted outreach to these
populations?”
“Can you provide more information on the cultural
background of patients presenting with heart
disease?”
“Can this data be shown over time to see if there are
patterns/significant events that emerge?”
Outcomes: Iterative analyses and
feedback
Examples of Barriers
“There’s a disconnect at hospitalization between
community health center providers and hospital and
emergency departments care teams”
“There is no access to Echocardiograms without
cardiologist referrals and subspecialist access is
limited”
Provider workforce limitations both specialist and
primary care
Uncertainty on best evidence or “low cost” evidence
based practices for heart failure detection and care
Outcomes: Iterative analyses and
feedback
Suggested Intervention Targets
“Diabetes is often a co-occurring chronic disease
and clinics need to have a better way of targeting at
risk patients through lab/billing data. Obesity is also
another risk factor, is there a way to systematically
track these risk factors and focus on prevention?”
“How can safety net providers better track ischemic
heart disease? The quality improvement indicators
that would help to catch these patients often aren’t
used regularly in these settings. How to better
manage patients with co-occurring disorders such
as COPD, diabetes, obesity and heart disease? “
CERP Aims
Promote and sustain bidirectional knowledge
sharing between community and academia
Strengthen community infrastructure for
sustainable partnered research
Drive innovation in community engagement that
accelerates the volume and impact of partnered
research in diverse communities.
Build health services research (HSR) methods
into partnerships to accelerate design,
production, and wide adoption of evidence-
based practice and behavior
Establish a governance and operations
infrastructure that strengthens existing
partnerships and builds new bridges between
community and academia for research.
CERP Aims
Understanding the Burden of Congestive Heart Failure and Cardiovascular
Disease in South Los Angeles: An Academic, Community, and Safety Net
