Mock Community Health Promotion Program
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Heart to Heart- A Heart Disease Screening Program for Women This PP was created for a community concepts nursing graduate class. This program has not been implemented.
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Mock Community Health Promotion Program
- 1. Lafayette County Stephanie Thompson, BSN Heart to Heart A Heart Disease Screening Program for Women
- 2. • In 2013, Lafayette County had a higher mortality rate for diseases of the heart than the state of Arkansas and the nation. (Centers for Disease Control and Prevention, National Center for Health Statistics, 2015). • According to the CDC Wonder database (2015), 11 women (ages 35-85+) died in Lafayette County related to heart disease in 2013. • The CDC reports “Heart disease is the leading cause of death for women in the United States” (2015). Why Heart to Heart ?
- 3. Lafayette County Demographics Population (2013) ◦ 7,252 (6.98% decrease from 2010) • Southernmost part of Arkansas bordering Louisiana • Four towns: Bradley, Buckner, Lewisville, and Stamps Characteristics (2103) ◦ High school graduate or higher (77.5%) ◦ Caucasian (61.1%) ◦ African American (37.1%) ◦ Persons 65 year and over (21.5%) ◦ Median age 65 ◦ Women (51.7%) ◦ Median household income:$29,732 (State, $40,768) ◦ Persons below poverty level (24%)
- 4. Lafayette County Demographics • Occupations/Industry • Administrative (12.2%) • Sales (9.19 %) • Production (9.11%) • Repair (7.14%) • Management (6.22%)
- 5. Lafayette County Resources • Schools • County School District; • Elementary School in Lewisville, and High School in Stamps • Churches • First Methodist Church in Lewisville • First Presbyterian Church in Stamps • Parks/Recreational Facilities • Conway Cemetery State Park • Maya Angelou City Park • Community Resources/Centers • Cooperative Extension Service 4-H
- 6. Lafayette County Medical Resources • Health Resources • CABUN Rural Health Services (8 counties in rural southern Arkansas) • Southwest Arkansas Counseling and Mental Health Center • AR State Dept. of Health • Health Resources lacking in Lafayette County but nearby • Magnolia Regional Medical Center (Columbia County) • Dentists available in Hope (Hempstead Co), Magnolia (Columbia Co), and Texarkana (Miller Co)
- 7. Lafayette County Health Disparities • Health Disparities (2013) higher mortality rate for diseases of the heart than Arkansas and the US lower mortality rate from malignant neoplasms than Arkansas and the US lower mortality rate from ischemic heart disease than Arkansas and the US
- 8. US Arkansas Lafayette County Total population 316,128,839 2,959,373 7,252 MORTALITY RATES PER 100,000 POPULATIONS, 2013 US Arkansas Lafayette County TYPES OF DEATHS RATE (NUMBER) RATE (NUMBER) RATE (NUMBER) Diseases of the Heart 193.31 (611,105) 249.28 (7377) 330.94 (24) Malignant Neoplasms 185.01 (584,881) 225.99 (6688) 179.26 (13) Ischemic Heart Disease 117.11 (370,213) 147.19 (4356) 17.19 (15) SELECTED POPULATION DATA FOR U.S., ARKANSAS, and LAFAYETTE COUNTY, 2013
- 9. Community Assessment of Lafayette County • Community Diagnosis • Increased risk of heart disease among adult women in Lafayette County related to uncontrolled hypertension, hyperlipidemia, and current smokers as evidenced by a high mortality rate from diseases of the heart.
- 10. Healthy People 2020 Goal Heart Disease • Goal: Improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke; early identification and treatment of heart attacks and strokes; and prevention of repeat cardiovascular events (USDHHS, 2015).
- 11. Healthy People 2020 Objectives SHORT TERM Objectives – Heart Disease 1. “HDS-4 Increase the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high” (USDHHS, 2015). 2. “HDS-8 Reduce the mean total blood cholesterol levels among adults” (USDHHS, 2015). 3. “HDS-17 Increase the proportion of adults aged 20 years and older who are aware of the symptoms of and how to respond to a stroke” (USDHHS, 2015).
- 12. Targeted Health Issue Heart Disease • In 2013, Lafayette County had a higher mortality rate for diseases of the heart (330.94) than Arkansas (249.28) and the US (193.31) (Centers for Disease Control and Prevention, National Center for Health Statistics, 2015). • The U. S. Preventive Services Task Force (USPSTF) recommends that all adults aged 18 and older be screened for hypertension. (Blood Pressure in Adults, 2015).
- 13. Target Population • The target population will be women ages 35-65 living in Lafayette County who agree to participate in the program. • According to the CDC Wonder database (2015), 11 women (ages 35-85+) died in Lafayette County related to heart disease in 2013. • To prevent premature adult deaths, heart disease preventative measures need to be taught to young adults.
- 14. Behavioral Objective # 1 • “HDS-4 Increase the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high” (USDHHS, 2015). • Objective 1: Within 6 months of implementing Lafayette County’s “Heart to Heart” Heart Disease Screening Program for Women, 90% of participants will be able to state what their last blood pressure readings were and if the blood pressure was normal or high.
- 15. Behavioral Objective # 2 • “HDS-12 Increase the proportion of adults with hypertension whose blood pressure is under control” (USDHHS, 2015). • Objective 2: Within 12 months of implementing Lafayette County’s “Heart to Heart” Heart Disease Screening Program for Women, 80% of participants ages 35-65 with hypertension will have normalized blood pressure readings in provider medical records.
- 16. Behavioral Objective # 3 • “HDS-8 Reduce the mean total blood cholesterol levels among adults” (USDHHS, 2015). Objective 3: After the completion of the program, Lafayette County’s “Heart to Heart” Heart Disease Screening Program for Women participants ages 35-65 will see a 25% decrease in their total cholesterol level."
- 17. Behavioral Objective # 4 • “TU-1 Reduce tobacco use by adults” (USDHHS, 2015). Objective 4: After the completion of the program, Lafayette County’s “Heart to Heart” Heart Disease Screening Program for Women, participants ages 35-65 will see a 35% reduction in tobacco use.
- 18. Program Interventions • Baseline Blood Pressure Screen - refer to PCP if indicated • Baseline Cholesterol Level - refer to PCP if indicated • Smoking Assessment – refer to Quit line if indicated • Provide Educational Materials to the target population about ways to decrease the risk of heart disease, such as exercise, dietary modifications, and smoking cessation • Sign up target population for email groups to be provide periodical heart healthy educational materials from the American Heart Association • Recheck Blood Pressure and Cholesterol at 6 and 12 months
- 19. Resources • Finances: • Community Sponsors • Business Owners to invest • Write Grants • Facilities: • The Cooperative Extension Service • CABUN Rural Health Clinic • AR Health Department in Lewisville • Team members: • APRN • RN’s and LPN’s • Administrative Personnel • Community members
- 20. Recruitment • The target population will be women ages 35-65 living in Lafayette County who agree to participate in the program to reach them advertisement is key! • Ads in local newspaper, on TV, and radio • Social media (Facebook, Twitter, Instagram) • Fliers at all medical clinics and health department • Post information on Lafayette County website • Fliers at local banks, post office and library • Word of mouth via nurses and providers
- 21. Evaluation Plan — 6 Steps • Step 1 Engage the Stakeholders: stakeholders include the target population, program facilitators/board members, and myself. • Step 2 Describe the program: to improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke; • Step 3 Evaluation design: quantitative study design to measure the number of participants who will be able to state blood pressure readings, have normalized BPs, reduced cholesterol levels and reduction in tobacco use.
- 22. Evaluation Plan cont. • Step 4 Gathering Evidence: Nurses complete screenings with strict documentation LPN’s: BPs, lab draws, smoking assessment. RN’s: education to participants APRN’s: interpret data, make recommendations, full health history. Administrative: email databases to send educational materials. • Step 5 Justifying Conclusion: analysis and interpretation of data discussed before data collection begins. • Step 6 Ensuring Use and Lessons Learned: Formal report along with meeting of stakeholders.
- 23. Summary • Lafayette County has a higher mortality rate for diseases of the heart than the state of Arkansas and the nation. • With this low-cost program, we can see a reduction in heart disease risk factors in just 12 months! • By reducing risk factors, we will see a decrease in mortality rates for those living in Lafayette County. • Teamwork is key for a successful Heart to Heart Program!
- 24. References • Blood Pressure in Adults: Screening. U.S. Preventive Services Task Force. July 2015. http://www.uspreventiveservicestaskforce.org/Page /Document/UpdateSummaryFinal/blood-pressure-in-adults-hypertension-screening • CABUN Rural Health Services - Providing Healthcare for All in Arkansas. (2015). Retrieved September 2, 2015, from http://www.cabun.org • Center for Disease Control and Prevention. (2015). Women and Heart Disease Fact Sheet. Retrieved September 16, 2015, from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_women_heart.htm • Centers for Disease Control and Prevention. (2011). Program Performance and Evaluation Office. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/eval/steps/index.htm • Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Sep 7, 2015 10:57:09 PM • Conway Cemetery State Park. (2015). Retrieved September 2, 2015, from https://en.wikipedia.org/wiki/Conway_Cemetery_State_Park • Health Unit Details. (2015). Retrieved September 2, 2015, from http://www.healthy.arkansas.gov/programsServices/localPublicHealthOffices/Pages/huDetails.aspx?show=Lafayette County Health Unit - Lewisville • James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., ... & Ortiz, E. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Jama, 311(5), 507-520. • Lafayette County, Arkansas. (2015). Retrieved August 30, 2015, from https://en.wikipedia.org/wiki/Lafayette_County,_Arkansas#Demographics
- 25. References cont. • Lafayette County, Arkansas Extension Office. (2015). Retrieved September 3, 2015, from http://www.uaex.edu/counties/lafayette/ • Lafayette County School District. (2015). Retrieved September 1, 2015, from http://www.lcscougars.org • Magnolia Regional Medical Center. (2015). Retrieved September 2, 2015, from http://magnoliarmc.org • Maya Angelou City Park. (2015). Retrieved September 3, 2015, from http://www.arkansas.com/attractions/detail/maya-angelou-city- park/96650/ • McKenzie, J., Neiger, B., & Thackeray, R. (2013). Planning, implementing, evaluating health promotion programs: A Primer (6th ed.). San Francisco, CA: Pearson Benjamin Cummings. • Occupations in Lafayette County, Arkansas. (2015). Retrieved September 17, 2015, from http://statisticalatlas.com/county/Arkansas/Lafayette-County/Occupations • Southwest Arkansas Counseling and Mental Health Center. (2015). Retrieved September 2, 2015, from http://www.swacmhc.com • U.S. Department of Health and Human Services. (2012). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics objectives/topic/heart-disease-and-stroke • U.S. Department of Health and Human Services. (2015). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics- objectives/topic/heart-disease-and-stroke • United States Census Bureau. (2015). Retrieved September 2, 2015, from http://quickfacts.census.gov/qfd/states/05/05073.html
Editor's Notes
- In 2013, Lafayette County had a higher mortality rate for diseases of the heart (330.94) than Arkansas (249.28) and the US (193.31) (Centers for Disease Control and Prevention, National Center for Health Statistics, 2015). I chose to identify a heart disease goal from Healthy People 2020 to help met this disparity in Lafayette County based on the statistics reported that there is a higher mortality rate for heart disease in this county. The Center for Disease Control and Prevention (CDC) reports “Heart disease is the leading cause of death for women in the United States (2015). In the United States, 292,188 women died from heart disease in 2009 (CDC, 2015). According to the CDC Wonder database (2015), 11 women (ages 35-85+) died in Lafayette County related to heart disease in 2013. To improve cardiovascular health of residents in Lafayette county, a heart disease risk factor screening program will be established. The target population will be women aged 35-65.
- Lafayette County is in the southernmost part of Arkansas bordering Louisiana. There are four towns located in this county; Bradley, Buckner, Lewisville, and Stamps. The townships are Baker (most of Stamps), French, Hadley (Buckner, small part of Stamps), La Grange (small part of Lewisville), Mars Hill, Roane (Bradley), Russell, Steel (most of Lewisville), and Walker Creek (Lafayette County, Arkansas, 2015). The US Census Bureau reports an estimated 2014 population to be 7,111. This is down 134 from the year before and down over 500 since 2010 when the last census was conducted. As of the 2013 US Census Population Estimates Program (PEP), the county is 61.2% white, 37.1% Black with the remaining 2% being Hispanic. 51.5% of the population is female. 89% of people living in Lafayette County have lived in their home for at least one year or longer. The median income is $29,732 with 24% below the poverty level (United States Census Bureau, 2015). High school graduate or higher, percent of persons age 25+, 2009-2013 EDU635213 77.5% 83.7% Bachelor's degree or higher, percent of persons age 25+, 2009-2013 EDU685213 10.7% Persons 65 years and over http://statisticalatlas.com/county/Arkansas/Lafayette-County/Occupations
- http://statisticalatlas.com/county/Arkansas/Lafayette-County/Occupations Occupations in Lafayette County, Arkansas. (2015). Retrieved September 17, 2015, from http://statisticalatlas.com/county/Arkansas/Lafayette-County/Occupations
- Schools Lafayette County has a county school district with schools in both Lewisville and Stamps. The Elementary School is located in Lewisville, also the county seat of Lafayette County. The Lafayette County High School is located in Stamps (Lafayette County School District, 2015). Parks Lafayette County is home to the Conway Cemetery State Park, a historical park to honor the late James Sevier Conway’s former cotton plantation and his final resting place. Mr. Conway was the first governor of the great state of Arkansas serving from 1836-1840 (Conway Cemetery State Park, 2015). The city of Stamps is home to a city park honoring the late poet Maya Angelou. She is most known for her work titled I Know Why the Caged Bird Sings. The city of Stamps is the childhood home of Mrs. Angelou and was depicted in her autobiography (Maya Angelou City Park, 2015). Community resources There are very few community resources available for residents of Lafayette County. The most used resource is the Arkansas State Dept. of Health in Lewisville. At the health until they are able to provide communicable disease investigation, intervention and prevention, voter registration, environmental health studies, family planning, STD testing and treatment, immunizations, in home personal care services, maternity care, TB prevention, WIC and women’s health (Health Unit Details, 2015). The Cooperative Extension Service in Lafayette County is located in Lewisville. Through the extension service, they are able to help improve the well being of the residents through education regarding agriculture, 4-H, healthy living, and community development (Lafayette County, Arkansas Extension Office, 2015). Churches First Methodist Church (Lewisville, Arkansas) First Presbyterian Church (Stamps, Arkansas) Medical Facilities The Magnolia Regional Medical Center in Magnolia, Arkansas (Columbia, County) is the closest hospital to Lafayette County. The hospital that is city owned operates 49 beds. In 2010, the hospital underwent significant renovations on the 76-year-old building. The hospital services obstetric, neonatal, pediatric, adult and geriatric patients (Magnolia Regional Medical Center, 2015). CABUN Rural Health Services is a non-profit corporation that was developed to proved care to residents of 8 counties in rural south and southwestern Arkansas. The Lewisville Family Practice Center is the CABUN owned clinic that operates just down the street from the Health Unit (CABUN Rural Health Services, 2015). Southwest Arkansas Counseling and Mental Health Center provides mental health services to the residents of Lewisville and Lafayette County. The clinic is located on the same street and the Health Unit and the Family Practice Center (Southwest Arkansas Counseling and Mental Health Center, 2015). References CABUN Rural Health Services - Providing Healthcare for All in Arkansas. (2015). Retrieved September 2, 2015, from http://www.cabun.org Conway Cemetery State Park. (2015). Retrieved September 2, 2015, from https://en.wikipedia.org/wiki/Conway_Cemetery_State_Park Health Unit Details. (2015). Retrieved September 2, 2015, from http://www.healthy.arkansas.gov/programsServices/localPublicHealthOffices/Pages/huDetails.aspx?show=Lafayette County Health Unit - Lewisville Lafayette County, Arkansas. (2015). Retrieved August 30, 2015, from https://en.wikipedia.org/wiki/Lafayette_County,_Arkansas#Demographics Lafayette County, Arkansas Extension Office. (2015). Retrieved September 3, 2015, from http://www.uaex.edu/counties/lafayette/ Lafayette County School District. (2015). Retrieved September 1, 2015, from http://www.lcscougars.org Magnolia Regional Medical Center. (2015). Retrieved September 2, 2015, from http://magnoliarmc.org Maya Angelou City Park. (2015). Retrieved September 3, 2015, from http://www.arkansas.com/attractions/detail/maya-angelou-city-park/96650/ Southwest Arkansas Counseling and Mental Health Center. (2015). Retrieved September 2, 2015, from http://www.swacmhc.com United States Census Bureau. (2015). Retrieved September 2, 2015, from http://quickfacts.census.gov/qfd/states/05/05073.html
- Medical Facilities The Magnolia Regional Medical Center in Magnolia, Arkansas (Columbia, County) is the closest hospital to Lafayette County. The hospital that is city owned operates 49 beds. In 2010, the hospital underwent significant renovations on the 76-year-old building. The hospital services obstetric, neonatal, pediatric, adult and geriatric patients (Magnolia Regional Medical Center, 2015). CABUN Rural Health Services is a non-profit corporation that was developed to proved care to residents of 8 counties in rural south and southwestern Arkansas. The Lewisville Family Practice Center is the CABUN owned clinic that operates just down the street from the Health Unit (CABUN Rural Health Services, 2015). Southwest Arkansas Counseling and Mental Health Center provides mental health services to the residents of Lewisville and Lafayette County. The clinic is located on the same street and the Health Unit and the Family Practice Center (Southwest Arkansas Counseling and Mental Health Center, 2015). The most used resource is the Arkansas State Dept. of Health in Lewisville. At the health until they are able to provide communicable disease investigation, intervention and prevention, voter registration, environmental health studies, family planning, STD testing and treatment, immunizations, in home personal care services, maternity care, TB prevention, WIC and women’s health (Health Unit Details, 2015). References CABUN Rural Health Services - Providing Healthcare for All in Arkansas. (2015). Retrieved September 2, 2015, from http://www.cabun.org Conway Cemetery State Park. (2015). Retrieved September 2, 2015, from https://en.wikipedia.org/wiki/Conway_Cemetery_State_Park Health Unit Details. (2015). Retrieved September 2, 2015, from http://www.healthy.arkansas.gov/programsServices/localPublicHealthOffices/Pages/huDetails.aspx?show=Lafayette County Health Unit - Lewisville Lafayette County, Arkansas. (2015). Retrieved August 30, 2015, from https://en.wikipedia.org/wiki/Lafayette_County,_Arkansas#Demographics Lafayette County, Arkansas Extension Office. (2015). Retrieved September 3, 2015, from http://www.uaex.edu/counties/lafayette/ Lafayette County School District. (2015). Retrieved September 1, 2015, from http://www.lcscougars.org Magnolia Regional Medical Center. (2015). Retrieved September 2, 2015, from http://magnoliarmc.org Maya Angelou City Park. (2015). Retrieved September 3, 2015, from http://www.arkansas.com/attractions/detail/maya-angelou-city-park/96650/ Southwest Arkansas Counseling and Mental Health Center. (2015). Retrieved September 2, 2015, from http://www.swacmhc.com United States Census Bureau. (2015). Retrieved September 2, 2015, from http://quickfacts.census.gov/qfd/states/05/05073.html
- SELECTED POPULATION DATA FOR U.S., ARKANSAS, and LAFAYETTE COUNTY, 2013 U.S. Arkansas Lafayette County Total Population 316,128,839 2,959,373 7,252 MORTALITY RATES PER 100,000 POPULATIONS, 2013 U.S. Arkansas Lafayette County TYPES OF DEATH RATE (NUMBER) RATE (NUMBER) RATE (NUMBER) Malignant Neoplasms 185.01 (584,881) 225.99 (6688) 179.26 (13) Diseases of the Heart 193.31 (611,105) 249.28 (7377) 330.94 (24) Ischemic Heart Disease 117.11 (370,213) 147.19 (4356) 17.19 (15) SOURCE OF RAW DATA: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Sep 7, 2015 10:57:09 PM Summary Statement: In 2013, Lafayette County had a lower mortality rate from malignant neoplasms (179.26) than Arkansas (225.99) and the US (185.01). In 2013, Lafayette County had higher mortality rate for diseases of the heart (330.94) than Arkansas (249.28) and the US (193.31). In 2013, Lafayette County had a lower mortality rate from ischemic heart disease (17.19) than Arkansas (147.19) and the US (117.11). References Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Sep 7, 2015 10:57:09 PM
- Diseases of the Heart ICD–10 codes I00–I09, I11, I13, I20–I51) Acute rheumatic fever (I00-I02) Chronic rheumatic heart diseases (I05-I09) I11 Hypertensive heart disease I13 Hypertensive heart and chronic kidney disease Ischemic heart diseases (I20-I25) Pulmonary heart disease and diseases of pulmonary circulation (I26-I28) I30 Acute pericarditis I31 Other diseases of pericardium I32 Pericarditis in diseases classified elsewhere I33 Acute and subacute endocarditis I34 Nonrheumatic mitral valve disorders I35 Nonrheumatic aortic valve disorders I36 Nonrheumatic tricuspid valve disorders I37 Nonrheumatic pulmonary valve disorders I38 Endocarditis, valve unspecified I39 Endocarditis and heart valve disorders in diseases classified elsewhere I40 Acute myocarditis I41 Myocarditis in diseases classified elsewhere I42 Cardiomyopathy I43 Cardiomyopathy in diseases classified elsewhere I44 Atrioventricular and left bundle-branch block I45 Other conduction disorders I46 Cardiac arrest I47 Paroxysmal tachycardia I48 Atrial fibrillation and flutter I49 Other cardiac arrhythmias I50 Heart failure I51 Complications and ill-defined descriptions of heart disease 120-125 Ischemic Heart Disease Acute Myocardial Infarction I21-I22 Other Acute Ischemic Heart Dis. I24 Other forms of Chronic Ischemic Heart Disease I20, I25 Atherosclerotic Cardiovascular Disease, so described I25.0 All Other Forms of Chronic Ischemic Heart Disease I20, I25.1-I25.9 References Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Sep 7, 2015 10:57:09 PM
- http://www.healthdata.org/sites/default/files/files/county_profiles/US/County_Report_Lafayette_County_Arkansas.pdf http://www.healthy.arkansas.gov/stats/county_health_data/lafayette.pdf The Institute for Health Metrics and Evaluation (IHME) at the University of Washington analyzed the performance of all 3,143 US counties or county-equivalents in terms of alcohol use, life expectancy at birth, smoking prevalence, obesity, physical activity, and poverty using novel small area estimation techniques and the most up-to-date county-level information. http://www.healthy.arkansas.gov/programsServices/healthStatistics/Brfss/Documents/CountyHealthSurveys/Adult/LafayetteCounty2003BRFSSReport.pdf 23.7% female smokers 2012 In 2013, female life expectancy was in the worst 25% of all counties at 77.7 years, while male life expectancy was in the worst 10% of all counties at 69.6 years. This compares to the national average of 81.2 years for females and 76.5 years for males. ● Changes over the period from 1985 to 2013 were in the middle-performing 50% of all counties for females and in the worst-performing 10% of all counties for males, with females having an increase of 1.1 years and males having an increase of 1.8 years. The national average was an increase of 3.1 years for females and an increase of 5.5 years for males.
- In 2013, Lafayette County had a higher mortality rate for diseases of the heart (330.94) than Arkansas (249.28) and the US (193.31) (Centers for Disease Control and Prevention, National Center for Health Statistics, 2015). I chose to identify a heart disease goal from Healthy People 2020 to help met this disparity in Lafayette County based on the statistics reported that there is a higher mortality rate for heart disease in this county. The Center for Disease Control and Prevention (CDC) reports “Heart disease is the leading cause of death for women in the United States (2015). In the United States, 292,188 women died from heart disease in 2009 (CDC, 2015). According to the CDC Wonder database (2015), 11 women (ages 35-85+) died in Lafayette County related to heart disease in 2013. To improve cardiovascular health of residents in Lafayette county, a heart disease risk factor screening program will be established. The target population will be women aged 35-65. Healthy People Health Disparity #1: Heart Disease Heart Disease Goal: Improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke; early identification and treatment of heart attacks and strokes; and prevention of repeat cardiovascular events (USDHHS, 2015). Short Term Objectives 1. “HDS-4 Increase the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high” (USDHHS, 2015). 2. “HDS-8 Reduce the mean total blood cholesterol levels among adults” (USDHHS, 2015). 3. “HDS-17 Increase the proportion of adults aged 20 years and older who are aware of the symptoms of and how to respond to a stroke” (USDHHS, 2015). U.S. Department of Health and Human Services. (2015). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke Heart Disease Goal: Improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke; early identification and treatment of heart attacks and strokes; and prevention of repeat cardiovascular events (USDHHS, 2015). Long Term Objectives 1. “HDS-1 (Developmental) Increase overall cardiovascular health in the U.S. population” (USDHHS, 2015). 2. “HDS-2 Reduce coronary heart disease deaths” (USDHHS, 2015). 3. “HDS-3 Reduce stroke deaths”. (USDHHS, 2015). U.S. Department of Health and Human Services. (2012). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke References U.S. Department of Health and Human Services. (2012). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke Center for Disease Control and Prevention. (2015). Women and Heart Disease Fact Sheet. Retrieved September 16, 2015, from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_women_heart.htm Centers for Disease Control and Prevention, National Center for Health Statistics (2015). Underlying Cause of Death 2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Sep 7, 2015 10:57:09 PM Centers for Disease Control and Prevention, National Center for Health Statistics (2015). Underlying Cause of Death 2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Sep 15, 2015 11:32:09 PM U.S. Department of Health and Human Services. (2012). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke
- U.S. Department of Health and Human Services. (2015). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke
- Using the CDC Wonder database (2015), I was able to determine the leading cause of death of Lafayette County Older Adult (65 and older) residents. Diseases of the heart are the leading cause of death for this target population. This ICD 10 group includes acute and chronic rheumatic fever, hypertensive heart disease, hypertensive heart disease and chronic kidney disease, and ischemic heart diseases (I20-I25). Ischemic heart disease diagnoses include pulmonary heart disease, pericarditis, endocarditis, valve disorders, valvular endocarditis, myocarditis, cardiomyopathy, AV and left bundle branch block, cardiac arrest, atrial fibrillation, other arrhythmias, heart failure and complications of heart disease. To prevent these older adult deaths, you need to begin preventative measures earlier. Therefore, to improve cardiovascular health of residents in Lafayette County, the target population will be women aged 35-65. According to the CDC Wonder database (2015), 11 women (ages 35-85+) died in Lafayette County related to heart disease in 2013. An important screening intervention that can be performed at every patient contact is high blood pressure screening. The U. S. Preventive Services Task Force (USPSTF) recommends that all adults aged 18 and older be screened for hypertension (HTN). This screening applies only to those without a hypertension diagnosis previously. This screening recommendation is graded A which means that there is substantial benefit if the service is provided (Blood Pressure in Adults, 2015). The USPSTF recommendations state “HTN should be diagnosed only after 2 or more elevated readings on at least 2 visits over a period of 1 to several weeks (2015).” There is not a recommended screening interval, but it easily completed with every patient contact. According to the panel members appointed to the Eighth Joint National Committee (JNC 8), hypertension is one of the most preventable and important contributors to disease and death. There have been blood pressure goals established for general population (no chronic kidney disease (CKD) or diabetes) and those patients with CKD and diabetes. General population patients 60 and older should have a BP goal of <150/<90 and those younger than 60 should have a BP goal of <140/<90. Any age patient with CKD or diabetes should have a goal of <140/<90 (James et. al, 2014). References Blood Pressure in Adults: Screening. U.S. Preventive Services Task Force. July 2015. http://www.uspreventiveservicestaskforce.org/Page /Document/UpdateSummaryFinal/blood-pressure-in-adults-hypertension-screening Center for Disease Control and Prevention. (2015). Women and Heart Disease Fact Sheet. Retrieved September 16, 2015, from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_women_heart.htm Centers for Disease Control and Prevention, National Center for Health Statistics (2015). Underlying Cause of Death 2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Sep 7, 2015 10:57:09 PM James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., ... & Ortiz, E. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Jama, 311(5), 507-520.
- Using the CDC Wonder database (2015), I was able to determine the leading cause of death of Lafayette County Older Adult (65 and older) residents. Diseases of the heart are the leading cause of death for this target population. This ICD 10 group includes acute and chronic rheumatic fever, hypertensive heart disease, hypertensive heart disease and chronic kidney disease, and ischemic heart diseases (I20-I25). Ischemic heart disease diagnoses include pulmonary heart disease, pericarditis, endocarditis, valve disorders, valvular endocarditis, myocarditis, cardiomyopathy, AV and left bundle branch block, cardiac arrest, atrial fibrillation, other arrhythmias, heart failure and complications of heart disease. To prevent these older adult deaths, you need to begin preventative measures earlier. Therefore, to improve cardiovascular health of residents in Lafayette County, the target population will be women aged 35-65. According to the CDC Wonder database (2015), 11 women (ages 35-85+) died in Lafayette County related to heart disease in 2013. An important screening intervention that can be performed at every patient contact is high blood pressure screening. The U. S. Preventive Services Task Force (USPSTF) recommends that all adults aged 18 and older be screened for hypertension (HTN). This screening applies only to those without a hypertension diagnosis previously. This screening recommendation is graded A which means that there is substantial benefit if the service is provided (Blood Pressure in Adults, 2015). The USPSTF recommendations state “HTN should be diagnosed only after 2 or more elevated readings on at least 2 visits over a period of 1 to several weeks (2015).” There is not a recommended screening interval, but it easily completed with every patient contact. According to the panel members appointed to the Eighth Joint National Committee (JNC 8), hypertension is one of the most preventable and important contributors to disease and death. There have been blood pressure goals established for general population (no chronic kidney disease (CKD) or diabetes) and those patients with CKD and diabetes. General population patients 60 and older should have a BP goal of <150/<90 and those younger than 60 should have a BP goal of <140/<90. Any age patient with CKD or diabetes should have a goal of <140/<90 (James et. al, 2014). References Blood Pressure in Adults: Screening. U.S. Preventive Services Task Force. July 2015. http://www.uspreventiveservicestaskforce.org/Page /Document/UpdateSummaryFinal/blood-pressure-in-adults-hypertension-screening Center for Disease Control and Prevention. (2015). Women and Heart Disease Fact Sheet. Retrieved September 16, 2015, from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_women_heart.htm Centers for Disease Control and Prevention, National Center for Health Statistics (2015). Underlying Cause of Death 2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Sep 7, 2015 10:57:09 PM James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., ... & Ortiz, E. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Jama, 311(5), 507-520.
- U.S. Department of Health and Human Services. (2015). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke
- U.S. Department of Health and Human Services. (2015). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke
- U.S. Department of Health and Human Services. (2015). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke
- U.S. Department of Health and Human Services. (2015). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke
- APRNs – To develop the pamphlets and email topics to provide to the participants To also provide treatment, as needed Nurses – to assist with vital sign checks and blood draws at the health fair and home health agencies One home health nurse to be the evaluator of the program Administrative Personnel— to handle email and general paperwork duties throughout the program Supplies needed will be: Blood pressure monitors from local doctor’s offices/health department (No cost) Test tubes and laboratory fees (Paid for by grants and sponsorship) Paper and ink for pamphlets (Paid for by grants and sponsorship) Email (free)
- Centers for Disease Control and Prevention. (2011). Program Performance and Evaluation Office. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/eval/steps/index.htm McKenzie, J., Neiger, B., & Thackeray, R. (2013). Planning, implementing, evaluating health promotion programs: A Primer (6th ed.). San Francisco, CA: Pearson Benjamin Cummings. This framework uses 6 steps: engaging stakeholders, describing the program, focusing the evaluation design, gathering credible evidence, justifying conclusions, and ensuring use and shared lessons learned (Centers for Disease Control and Prevention, 2011). Step 1 is to engage the stakeholders, which is “those involved in the program, those served or affected by the program, and the primary users of the evaluations results” (McKenzie, 2013). For the Heart to Heart program the stakeholders are the target population, program facilitators/board members, and myself. The next step, step 2, is to describe the program. McKenzie (2013) states that this sets the frame of reference for the rest of the evaluation. Included in this step are the mission, goals, and objectives of the program (Centers for Disease Control and Prevention, 2011). For the Heart to Heart program, the goal is to Improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke; early identification and treatment of heart attacks and strokes; and prevention of repeat cardiovascular events through increasing the number of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high and to increase the proportion of adults with hypertension whose blood pressure is under control. These objectives are key for the Heart to Heart program to be beneficial to the target population of women ages 35-65 living in Lafayette County who agree to participate in the program. Step 3 is focusing on the evaluation design which involves making sure that those in the program development have used the resources appropriately and efficiently. For this step it is best to formulate a research question and determine the type of design that is going to be used (Centers for Disease Control and Prevention, 2011). For the Heart to Heart program, a Quantitative study design is the best fit, since we will be measuring the number of participants will be able to state what their last blood pressure readings were and if the blood pressure was normal or high and the number of participants ages 35-65 with hypertension will have normalized blood pressure readings in provider medical records.
- Centers for Disease Control and Prevention. (2011). Program Performance and Evaluation Office. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/eval/steps/index.htm McKenzie, J., Neiger, B., & Thackeray, R. (2013). Planning, implementing, evaluating health promotion programs: A Primer (6th ed.). San Francisco, CA: Pearson Benjamin Cummings. Step 4 is gathering credible evidence, which involves deciding measurement indicators, quality, quantity, and the logistics for collecting the evidence. This step requires a lot of organization to keep the data needed for measuring the evidence (Centers for Disease Control and Prevention, 2011). For the Heart to Heart program, this will require all parties to be involved, especially the nurses who are completing the screenings. Documentation will play a critical role in this step. The duties of the personnel involved in the Heart to Heart program will be listed in detail prior to implementation. LPN’s will be asked to complete blood pressure monitoring via sphygmomanometer, lab draws for cholesterol screenings, and smoking screenings. RN’s will be asked to complete the educational portion of the program, including follow up education for those with further questions. RN’s will also be asked to assist the LPN’s if the screening process becomes extremely busy as to avoid having any patient wait longer than set by the stakeholders. APRN’s will interpret the data collected by the LPN’s and RN’s and make recommendations based on this data. The APRN’s will also be completing a full health history with a focus on cardiovascular health history. Administrative staff will create email databases based on the recommendations of APRN’s in order to send the appropriate educational materials. Step 5 entails justifying conclusion, which compares the evidence against five elements: “standards, analysis/synthesis, interpretation, judgment and recommendations.” (Centers for Disease Control and Prevention, 2011). For the program in Lafayette County, the techniques used for analysis of the data and interpretation of findings should be discussed and determined before data collection begins. This will require that the stakeholders in the Heart to Heart program know that the conclusions for the data must be directly linked to the evidence (Centers for Disease Control and Prevention, 2011). The final step, step 6, is ensuring use and sharing lessons learned. The step focuses on what the group does with the results. For the Lafayette County program, this will involve stakeholders stating their needs to each other so that trust can be built and maintained. In sharing of lessons learned, this can take place in a formal report or a less formal verbal meeting that should be predetermined by the stakeholders (Centers for Disease Control and Prevention, 2011). Stakeholders, when developing the program evaluation framework, should discuss strengths and weaknesses. For the Heart to Heart program in Lafayette County, strengths include reducing heart disease for the target population, educating the population about heart disease and the associated risk factors. Other strengths of the program include reducing the number of people with high blood pressure, high cholesterol and smoking history. One weakness that I have been able to determine is participants not following through with recommendations or appointments. Another weakness is patients who lack the self-efficacy to change their behavior.
- References Blood Pressure in Adults: Screening. U.S. Preventive Services Task Force. July 2015. http://www.uspreventiveservicestaskforce.org/Page /Document/UpdateSummaryFinal/blood-pressure-in-adults-hypertension-screening CABUN Rural Health Services - Providing Healthcare for All in Arkansas. (2015). Retrieved September 2, 2015, from http://www.cabun.org Center for Disease Control and Prevention. (2015). Women and Heart Disease Fact Sheet. Retrieved September 16, 2015, from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_women_heart.htm Centers for Disease Control and Prevention. (2011). Program Performance and Evaluation Office. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/eval/steps/index.htm Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Sep 7, 2015 10:57:09 PM Conway Cemetery State Park. (2015). Retrieved September 2, 2015, from https://en.wikipedia.org/wiki/Conway_Cemetery_State_Park Health Unit Details. (2015). Retrieved September 2, 2015, from http://www.healthy.arkansas.gov/programsServices/localPublicHealthOffices/Pages/huDetails.aspx?show=Lafayette County Health Unit - Lewisville James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., ... & Ortiz, E. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Jama, 311(5), 507-520. Lafayette County, Arkansas. (2015). Retrieved August 30, 2015, from https://en.wikipedia.org/wiki/Lafayette_County,_Arkansas#Demographics Lafayette County, Arkansas Extension Office. (2015). Retrieved September 3, 2015, from http://www.uaex.edu/counties/lafayette/ Lafayette County School District. (2015). Retrieved September 1, 2015, from http://www.lcscougars.org Magnolia Regional Medical Center. (2015). Retrieved September 2, 2015, from http://magnoliarmc.org Maya Angelou City Park. (2015). Retrieved September 3, 2015, from http://www.arkansas.com/attractions/detail/maya-angelou-city-park/96650/ McKenzie, J., Neiger, B., & Thackeray, R. (2013). Planning, implementing, evaluating health promotion programs: A Primer (6th ed.). San Francisco, CA: Pearson Benjamin Cummings. Occupations in Lafayette County, Arkansas. (2015). Retrieved September 17, 2015, from http://statisticalatlas.com/county/Arkansas/Lafayette-County/Occupations Southwest Arkansas Counseling and Mental Health Center. (2015). Retrieved September 2, 2015, from http://www.swacmhc.com U.S. Department of Health and Human Services. (2012). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke U.S. Department of Health and Human Services. (2015). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke United States Census Bureau. (2015). Retrieved September 2, 2015, from http://quickfacts.census.gov/qfd/states/05/05073.html
- References Blood Pressure in Adults: Screening. U.S. Preventive Services Task Force. July 2015. http://www.uspreventiveservicestaskforce.org/Page /Document/UpdateSummaryFinal/blood-pressure-in-adults-hypertension-screening CABUN Rural Health Services - Providing Healthcare for All in Arkansas. (2015). Retrieved September 2, 2015, from http://www.cabun.org Center for Disease Control and Prevention. (2015). Women and Heart Disease Fact Sheet. Retrieved September 16, 2015, from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_women_heart.htm Centers for Disease Control and Prevention. (2011). Program Performance and Evaluation Office. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/eval/steps/index.htm Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Sep 7, 2015 10:57:09 PM Conway Cemetery State Park. (2015). Retrieved September 2, 2015, from https://en.wikipedia.org/wiki/Conway_Cemetery_State_Park Health Unit Details. (2015). Retrieved September 2, 2015, from http://www.healthy.arkansas.gov/programsServices/localPublicHealthOffices/Pages/huDetails.aspx?show=Lafayette County Health Unit - Lewisville James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., ... & Ortiz, E. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Jama, 311(5), 507-520. Lafayette County, Arkansas. (2015). Retrieved August 30, 2015, from https://en.wikipedia.org/wiki/Lafayette_County,_Arkansas#Demographics Lafayette County, Arkansas Extension Office. (2015). Retrieved September 3, 2015, from http://www.uaex.edu/counties/lafayette/ Lafayette County School District. (2015). Retrieved September 1, 2015, from http://www.lcscougars.org Magnolia Regional Medical Center. (2015). Retrieved September 2, 2015, from http://magnoliarmc.org Maya Angelou City Park. (2015). Retrieved September 3, 2015, from http://www.arkansas.com/attractions/detail/maya-angelou-city-park/96650/ McKenzie, J., Neiger, B., & Thackeray, R. (2013). Planning, implementing, evaluating health promotion programs: A Primer (6th ed.). San Francisco, CA: Pearson Benjamin Cummings. Occupations in Lafayette County, Arkansas. (2015). Retrieved September 17, 2015, from http://statisticalatlas.com/county/Arkansas/Lafayette-County/Occupations Southwest Arkansas Counseling and Mental Health Center. (2015). Retrieved September 2, 2015, from http://www.swacmhc.com U.S. Department of Health and Human Services. (2012). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke U.S. Department of Health and Human Services. (2015). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke United States Census Bureau. (2015). Retrieved September 2, 2015, from http://quickfacts.census.gov/qfd/states/05/05073.html