Preventing and Addressing Chronic Disease. Tim Nikolai, Sr. Community Health Director

Transcription

1 Preventing and Addressing Chronic Disease Tim Nikolai, Sr. Community Health Director

2 Disclosures I have no actual or potential conflict of interests involving the materials in this presentation.

3 &

4 Target: BP A national initiative to improve blood pressure control

5 What is Target: BP? A call to action motivating medical practices, practitioners and health services organizations to prioritize blood pressure control. Recognition for healthcare providers who attain high levels of blood pressure control in their patient populations, particularly those who achieve 70, 80 percent or higher control A source for tools and assets for healthcare providers to use in practice, including the AHA/ACC/CDC Hypertension Treatment Algorithm and the AMA s M.A.P. Checklist targetbp.org

6 Hypertension control rate is both a measure of and catalyst for better cardiovascular health.

7 The American Heart Association & American College of Cardiology have updated the guidelines for hypertension control. Notably, the guidelines eliminate the diagnosis of pre-hypertension and identifies anything greater than 130 or 80 as Stage 1 hypertension. Heart disease and stroke risk is doubled at 130/80 compared to blood pressure below 120/ million American adults have hypertension and approximately 46% are uncontrolled.

8 Hypertension rates by gender and ethnicity. 8

9 Top 5 Takeaways from new HTN Guidelines 1. Classification of Blood Pressure: Four new BP categories based on the average of two or more in-office blood pressure readings. 2. Prevalence of High Blood Pressure: Substantially higher prevalence of HTN under the new guideline, 46% of U.S. adults vs 32%, based on JNC Treatment of High Blood Pressure: All patients with blood pressures > normal should utilize nonpharmacological interventions. Use of BPlowering medications is recommended based on stage of HTN, individual medical history or est. CVD risk 10% using the ACC/AHA Risk Estimator. 4. Blood Pressure Goal for people with High Blood Pressure: For adults with confirmed hypertension and known CVD, or 10-year ASCVD event risk of 10% or higher, a BP goal of less than 130/80 mm Hg is recommended. 5. Use Self-measured Blood Pressure Monitoring (SMBP) to Diagnose, Reassess, and Activate Patients with High Blood Pressure. 9

10 The M.A.P. Algorithm targetbp.org

11 Impact of MAP Algorithm Greenville SC Clinic Resource limited clinic 50% African American and 50% Medicare population 6 month study of about 714 hypertensive patients with at least one visit (70+ % had 2 visits and 49% had three visits Control rate for those who visited at least once during the study increased by 28 pts from 61 to 89 pts

12 Data Submission Information

13 Target: BP and Your System/Practice Register at to gain full access to materials, webinars, etc. Data submission is required for recognition and includes: - Total adult patient population and that with HTN (total and controlled) - Adult population by age, gender and ethnicity for the Million Hearts prevalence estimator. The data submission window for 2017 data (still based on NQF #0018) is February 5 th through June 1 st. targetbp.org

14 Wisconsin s 2017 Target: BP Awardees Congratulations to All Saints Family Health Center City of Milwaukee Health Dept. Northern Health Centers, Inc. ThedaCare Milwaukee Milwaukee Lakewood Appleton Bellin Health Divine Savior Healthcare St. Ann Center for Intergenerational Care Green Bay Portage Milwaukee targetbp.org 14

15 An overview of the AHA initiative to help physicians 2018 Recognition Program and patients control cholesterol.

16 Program Overview Check. Change. Control. Cholesterol is a national initiative sponsored by Sanofi and Regeneron to bring Cholesterol management to the attention of patients and providers. High Cholesterol is a major risk factor for cardiovascular disease and stroke, the No. 1 and No. 5 killers in the U.S. This initiative aims to improve awareness, detection and management of high cholesterol by educating and empowering consumers, healthcare professionals and patients with evidence-based information and tools, while also improving quality of care for patients through AHA s quality improvement program.

17 Cholesterol Guidelines The 2013 ACC/AHA Prevention Guideline shifted from treatment to a target LDL cholesterol goal to treatment based on 10-year risk of having an atherosclerotic cardiovascular disease (ASCVD) or stroke event: 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk Goff, Circulation (2013) 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults Stone, Circulation (2013)

18 ASCVD Risk Calculator The ASCVD risk calculator is an evidence-based tool that was developed together for the 2013 Cholesterol Guidelines. The risk calculator assesses risk for having a first time cardiovascular or stroke event in the next 10 years A risk of 7.5% or greater should prompt providers and patients to discuss lifestyle changes and further treatment options (e.g., statin prescription) Online tools are available for providers and patients to estimate 10-year risk: ASCVD Risk Estimator (provider tool) Check. Change. Control. Calculator (patient tool).

19 Patient Calculator Provider Calculator

20 ASCVD Risk Calculator Why Use the ASCVD Risk Calculator? The ASCVD Risk calculator is an evidence-based tool for assessing baseline 10-year risk of having a first ASCVD event. The calculator can help inform the patient-provider discussion on lifestyle changes and incorporating medications (e.g., statins) to improve cholesterol control and reduce cardiovascular risk. The ASCVD risk calculator was included in the 2017 High Blood Pressure Clinical Practice Guideline as a component in treatment decision-making for patients with Stage 1 Hypertension. Additional tools have been developed to estimate the potential impact of Aspirin therapy in appropriate patients, Blood pressure control, Cholesterol management, and Smoking cessation (ABCS).

21 2018 Check. Change. Control. Cholesterol Recognition Program

22 Why should providers join Check. Change. Control. Cholesterol? Provider tool kit Patient tool kit Support through AHA field staff Part 4 Maintenance of Certification for providers / continuing education Patient and provider ASCVD Risk Calculators Local and national recognition

23 How does a site register? Go to heart.org/changecholesterol 1. Register (required to access materials/always open) By June 1 st 2. Achievement Award (opt.) 3. Gold Award (optional)

24 THERE ARE THREE SUBMISSION CRITERIA FOR MIPS 438 DENOMINATOR (SUBMISSION CRITERIA) 1) Patients aged 21 years at the beginning of the measurement period with clinical ASCVD diagnosis OR 2) Patients aged 21 years at the beginning of the measurement period who have ever had a fasting or direct laboratory result of LDL-C 190 mg/dl or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia OR 3) Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes and with an LDL-C result of mg/dl recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period NUMERATOR (SUBMISSION CRITERIA): 1) Patients who are actively using or who receive an order (prescription) for statin therapy at any point during the measurement period

25 How are sites recognized for their achievements? Listed on CCC Cholesterol website National recognition at AHA Scientific Sessions in 2018 Certificate can be delivered electronically and displayed within practice for both Participation and Gold levels Icon badge with AHA proclaimer statement to use internally and externally on webpages and social media Local press release template for clinics Local recognition opportunities

26 How you can help! - Share information/resources with your colleagues in ambulatory care/ clinic management - Offer assistance with data abstraction for hypertension control/statin use. - Celebrate existing success!

27 Questions? Tim Nikolai