Rolf Benirschke - Be There San Diego

RolfBenirschke
Progress toward Making San Diego
a Heart Attack and Stroke Free Zone
Anthony DeMaria, MD
Chair, Be There San Diego
July 27, 2016
Why are we here today?
Coronary Heart Disease Risk Markers
Modifiable
●  Elevated
●  Low
LDL-C
● 
HDL-C
●  Elevated
triglycerides
●  Elevated
pressure
●  Tobacco
blood
Thrombogenic factors
Not
●  Age
– 
PAI-1
●  Male
– 
Fibrinogen
– 
C-reactive protein
●  Family
● 
Diet
● 
Excess alcohol
consumption
● 
Physical inactivity
● 
Obesity
smoking
Pyorala K, et al. Eur Heart J. 1994;15:1300-1331.
gender
history
of CHD
●  Personal
history of
CHD
Circ,2005
Deaths
YearsofPoten.alLifeLost
Cardiovascular Disease in African Americans
HeartfailureismoreprevalentinAfrican
Americansthaninwhites,
imposeshigherratesofdeathandmorbidity,
andhasamoremalignantcourse.
BIG HAIRY AUDACIOUS GOAL (B-HAG)
ItisesCmatedthat70-75%of
cardiovasculareventscanbeeliminatedby
aggressivereducCon/controlofestablished
riskfactors.
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Medication Therapy can eliminate Major Adverse
Cardiac Events (MACE)
Archimedes:SanFrancisco,Ca
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About Be There San
Diego
Be There San Diego Mission and Vision
Mission: Eliminate Heart Attacks and
Strokes in San Diego.
Vision: Make San Diego the first heart
attack and stroke free zone in the
country.
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A Heart Attack/Stroke Free Zone
§ A clear and grand vision
§ Community ownership
§ Patient activation
§ Physician mobilization
What are we doing?
Community
Healthcare
Teams
CommunityClinical
Linkages
Healthcare
Systems
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University of Best Practices:
Participants
Be There San Diego: The Campaign
16
17
U.S.DepartmentofHealthandHumanServices
CenterforMedicare&MedicaidServices
CenterforMedicareandMedicaidInnovation
HealthcareInnova.onAwardsRoundTwo
Due:8/15/13
“proposenewpaymentandservicedelivery
modelsthatwillprovidebeGerhealth,beGer
healthcare,andlowercoststhroughimproved
qualityforMedicare,Medicaid,andSCHIP
enrollees.”
GrantSupport
HeartAGackandStrokeFreeZone
CentersforMedicareandMedicaidInnovaCon(CMMI)
HealthCareInnovaConAward
SoutheasternSanDiegoCardiacDispari.esProject
RacialandEthnicApproachestoCommunityHealth(REACH)
CentersforDiseaseControlandPrevenCon
HealthyWorksPreven.onIni.a.ve
ContractwithCounty
CentersforDiseaseControlandPrevenCon
TotalFunding$11,000,000
Heart Attack and Stroke Free Zone Project
Healthcare Teams:
Arch Health Partners (4 sites)
Neighborhood Healthcare (4 sites)
North Coast Family Medical Group (1 site)
North County Health Services (1 site)
San Ysidro Health Center (3 sites)
Scripps Clinic (2 sites)
Sharp Rees-Stealy (15 sites)
UC San Diego Family Medicine (3 sites)
UC San Diego Internal Medicine (1 site)
Vista Community Clinic (5 sites)
Thankyoutothehealthcoaches
whosupportover3,000paCentsin
starCngandadheringtotheir
cardio-protecCvemedicaCon
bundleandmakinghealthier
lifestylechoices.
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The DATA
Patients with Hypertension, by Year and Health
Care Organization
200000
Patients with Hypertension
180000
160000
Group 1
Group 2
Group 3
Group 4
Group 5
Group 6
Group 7
Group 8
140000
120000
100000
80000
60000
40000
20000
0
2010
2011
2012
2013
2014
Datasources:DataforQualityGroupreporCng
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Patients with Diabetes, by Year and Health Care
Organization
120000
Patients with Hypertension
100000
Group 1
Group 2
Group 3
Group 4
Group 5
Group 6
Group 7
Group 8
80000
60000
40000
20000
0
2010
2011
2012
2013
2014
Datasources:DataforQualityGroupreporCng
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San Diego Trends in AMI and HTN Control
San Diego Trends in AMI and HTN control
180
UniversityofBestPracCcesformedin2010
DataGroupformedin2012
140
120
76%
74%
75
72%
71%
132
117
100
112
71%
109
70
106
65
80
60
60
40
55
% Patients with controlled BP
County AM I hospitalization rate (per 100K)
160
80
79%
20
0
0
50
2010
2011
2012
SD County AMI hospitalization rate
2013
2014
2015
% Patients with HTN and controlled BP
%Patients with DM and controlled BP
Datasources:DataforQualityGroupreporCngandAMIdatafromHospitalDischargeData,(CAOSHPD),
CountyofSanDiego,Health&HumanServicesAgency,Epidemiology&ImmunizaConServicesBranch
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Gender Disparity in LDL Control
Men
Women
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
-1.0%
-2.0%
-3.0%
-4.0%
-5.0%
DM:BP<140/90
DM:LDL<100
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Great work on hypertension control!
Thank you to the organizations participating in
the Data for Quality Group:
•  Arch Health Partners
•  Health Center Partners
•  Kaiser Permanente
•  Multicultural Medical Group
•  Scripps Clinic
•  Scripps Coastal
•  Sharp Rees Stealy
•  UCSD Medical Group
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HospitalizationratesforAMIsinSanDiegoCounty
decreasedvstherestofthestateafterCARightCare
InitiatedSanDiegoUniversityofBestPractices
300
150
200
250
California RCI's UBP Starts
100
Hospitalizations per 100,000 Adult Population
PRELIMINARYDRAFTRESULTS
2007
2008
2009
2010
-0.5%
-3.4%
-11.2%
-17.0%
2011
2012
2013
2014
Calendar Year
CA (ex SD County) - Strokes
SD County - Strokes
CA (ex SD County) - AMI
SD County - AMI
Notes:CaliforniaRightCareInitiative’s(RCI)UniversityofBestPractices(UBP)startedinSanDiegoCountyinFebruary2011,justafterthe2010datapointsinthefigure.UBPplanningandpreparationbeganin
November2009,withmeetingswithSanDiegohealthsystemsbeginningin2010.SDCounty:SanDiegoCounty;CA(exSDCounty):CaliforniaexcludingSanDiegoCounty;AMI(acutemyocardialinfarction
[ICD-9-CM410]);Strokes(ICD-9-CM430-438);Adultpopulationisages18+yearsold.Percentchangesarefrom2010.
Source:Authors’analysisof2007-2014CaliforniaOfficeofStatewideHealthPlanningandDevelopment’sPatientDischargeData
PreliminaryDraftResults:Donotquote,cite,ordistribute.
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AssociationofSanDiegoUBPw.reducedAMI
hospitalizationfrom2011–2014:equivalentstoa13.5%
reductionofAMIsand$41Mreducedexpenditures
170
150
160
California RCI's UBP Starts
13
13
130
140
13
Reductions
120
Hospitalizations per 100,000 Adult Population
PRELIMARYDRAFTRESULTS
2007
2008
2009
2010
2011
2012
2013
2014
Calendar Year
CA (ex SD County) - AMI
SD County - AMI
SD County - AMI Hypothetical without UBP Association
Notes:seepreviousslidesSource:Authors’analysisof2007-2014CaliforniaOfficeofStatewideHealthPlanningandDevelopment’s
PatientDischargeData
PreliminaryDraftResults:Donotquote,cite,ordistribute.
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What is next?
Report and Monographs
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What will you do!?!
BecomeaHeartCareChampion
•  LinkpaCentstoDiabetesPrevenConPrograms
•  AdopttheBTSDSimplifiedTreatmentApproachtoHypertension
•  ImplementtheBTSDApproachtoDiagnosingUnidenCfiedHypertension
•  AssesspaCentriskusingtheASCVDRiskCalculator
#betheresd
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