Understanding the Burden of Heart Disease in South Los Angeles


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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.

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Understanding the Burden of Heart Disease in South Los Angeles

  1. 1. Understanding the Burden of Congestive HeartFailure and Cardiovascular Disease in South LosAngeles: An Academic, Community, andSafety Net Provider Collaborative EffortOctober 18, 2012Lark Galloway-Gilliam, MPAAnnie Park, MPHJessica Jew, MPHCommunity Health CouncilsAmi M. Shah, MPHUCLA Center for Health Policy ResearchNina Vaccaro, MPHSouth Coalition of Community Health CentersRoberto Vargas, MD, MPHDivision of General Internal Medicine and Health Services Research,David Geffen School of Medicine at UCLA,Medical Sciences Institute, Charles Drew University andRAND Health
  2. 2. 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. 3. Los Angeles CountyService PlanningAreas SPA 6andHealth Districts (26) 3 3
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  5. 5. 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
  6. 6. Methods: Community PartneredParticipatory ResearchKnowledge 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
  7. 7. Methods: Community PartneredParticipatory ResearchKnowledge 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?
  8. 8. Methods: Community PartneredParticipatory ResearchDelphi 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
  9. 9. 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
  10. 10. Heart Failure Prevention QualityIndicator #8 RatesBy SPAstandardized rates per 100,000, OSHPD 2007-2009 average ED Encounters Hospital Admissions 699 396 380 381 233 118 44 25 45 66 10 Metro West South East South Bay
  11. 11. Heart Disease Prevalence by SPAamong adults age 18 and over Los Angeles County = 5.8% 7.0 6.8 6.2 6.2 5.0 Metro* West LA South LA East LA South Bay Source: CHIS 2009, Ever diagnosed with heart disease CHIS 2009 11 * Estimate is unstable
  12. 12. Risk Factors for Preventable Hospitalizations?2009 CHIS Data * 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 12
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  14. 14. 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?”
  15. 15. Outcomes: Iterative analyses andfeedback  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
  16. 16. Outcomes: Iterative analyses andfeedback  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? “
  17. 17. 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.
  18. 18. CERP Aims 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.
  19. 19. Understanding the Burden of Congestive Heart Failure and Cardiovascular Disease in South Los Angeles: An Academic, Community, and Safety Net Provider Collaborative EffortMilestones Timeline in Months 3 6 9 12Aim 1 Knowledge exchange anddescriptive database creationAim 2 Clinical condition andindicator selection for registry andprotocol developmentCommunity partner engagementmeetings, dialogue, and feedbackComplete analyses of secondarydata, generate final report andmanuscript
  20. 20. Added Value from CTSI Improved access to databases and supported relevant secondary data analyses Increased engagement of research community with safety-net providers and community based organizations Supported continued dialogue Partnered hypothesis generation Intervention design suggestions
  21. 21. Next steps Complete knowledge exchange: Guidelines, evidence reviews, and current research findings Additional grant support: National Institute for Minority Health and Health Disparities and Centers for Disease Control  Patient engagement  Extend work into other communities  Implement registry  Design and implement interventions  Prevention, disease detection, treatment and care coordination