Cardiovascular Disease Has a Significant and Widespread Impact on Patients

1outof3
US deaths is attributed to CVD and is the leading cause of death in the United States1
~ 92.1million
Americans are living with at least 1 form of CVD2
73.5million
adults in the United States have high LDL-C, a major risk factor for CVD and stroke1
  • People with high cholesterol have twice the risk for heart disease3
  • Fewer than half of adults with high LDL-C are getting treatment1

There Are Costly Financial
Implications as Well

Total direct* and indirect costs for CVD and stroke1
The projected increase in total medical costs from $21 billion in 2012 to more than $53 billion by 20302
Patients with heart failure who account for total Medicare Fee-for-Service readmissions3
The percentage of total Medicare spend attributed to heart failure for all inpatient admissions; ~ 6% of total Medicare spend for all-cause readmissions is attributed to heart failure beneficiaries3
$316.6Billion1
2.5 Fold Increase2
55%3
~17%3

Care Gaps: Contributing Factors to CVD Have Room for Improvement

According to CMS Hospital Compare

  • National HF and AMI patient readmission rates are 21.6% and 16.3%, respectively1
  • National HF and AMI patient mortality rates are 11.9% and 13.6%, respectively2

In the us adult population

  • HYPERCHOLESTEROLEMIA
  • OBESITY
  • HYPERTENSION
  • DIABETES
  • HEALTHY DIET
  • PHYSICAL ACTIVITY
39.7%have hypercholesterolemia(LDL-C ≥ 200 mg/dL)3
37.7%are obese3
34%have high blood pressure, with 45.6%not meeting recommended targets3
9.1%are diagnosed with diabetes;another 33.9% have prediabetes3
ONLY1.5%follow an ideal, healthy diet3
1/3of US adults do not participatein leisure time physical activity3

Who Are the Quality Care Stakeholders in CV Health?

CMS 5-STAR (2018)1
Controlling Blood Pressure Improving or Maintaining Physical Health
Medication Adherence for Hypertension (RAS antagonists) Monitoring Physical Activity
Medication Adherence for Cholesterol (Statins) Adult BMI Assessment
Medication Reconciliation Post-discharge
NCQA HEDIS® (2018)2
Controlling High Blood Pressure Statin Therapy for Patients with Diabetes
Statin Therapy for Patients with Cardiovascular Disease Physical Activity in Older Adults
Persistence of Beta-Blocker Treatment After a Heart Attack Medical Assistance with Smoking and Tobacco Use Cessation
Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia Adult BMI Assessment
Follow-up After Emergency Department Visit for People with High-risk Multiple Chronic Conditions Plan All-Cause Readmissions
Transitions of Care Hospitalization for Potentially Preventable Complications
Metabolic Monitoring for Children and Adolescents on Antipsychotics
MSSP-ACO (2017)3
Statin Therapy for the Prevention and Treatment of Cardiovascular Disease Preventive Care and Screening: Body Mass Index Screening and Follow-Up
Controlling High Blood Pressure Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
All-cause Unplanned Admissions for Patients with HF Risk Standardized, All Condition Readmission
IVD: Use of Aspirin or Another Antithrombotic Skilled Nursing Facility 30-Day All-cause Readmission Measures
All-cause Unplanned Admissions for Patients with Multiple Chronic Conditions
HOSPITAL COMPARE4
Rate of Readmission for CABG Surgery Patients Death Rate for CABG Surgery Patients
Rate of Readmission for Heart Attack Patients Death Rate for Heart Attack Patients
Rate of Readmission for HF Patients Death Rate for HF Patients
Rate of Readmission for Stroke Patients Death Rate for Stroke Patients
Excess Readmission Ratio for Heart Attack Patients
Excess Readmission Ratio for HF Patients
Excess Readmission Ratio for CABG Patients
MACRA QUALITY PAYMENT PROGRAM5
Hypertension: Improvement in Blood Pressure Documentation of Current Medications in the Medical Record
Statin Therapy for the Prevention and Treatment of Cardiovascular Disease Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
IVD: Use of Aspirin or Another Antiplatelet Preventive Care and Screening: BMI Screening and Follow-up Plan
Controlling High Blood Pressure Care Plan
Preventive Care and Screening: Screening for High Blood Pressure and Follow-up Documented Use of High-risk Medications in the Elderly
CAD: Antiplatelet Therapy Cardiac Rehabilitation Patient Referral from an Outpatient Setting
CAD: Beta-blocker Therapy—Prior MI or LVEF < 40% Persistent Beta-blocker Treatment After a Heart Attack
HF: ACE Inhibitor or ARB Therapy for LVSD Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling
HF: Beta-blocker Therapy for LVSD
IVD All or None Outcome Measure (Optimal Control)

A Case of Improved CV Health—St Luke’s Hospital, Cedar Rapids, IA

Situation
Task
Actions
Results
The Situation1
A private midwest hospital, member of Iowa Health System, largest IHS in the Iowa/Western Illinois region
With 534 licensed beds and 2,642 employees*
Sees 18,513 admissions, 52,598 ER visits*
Problem

In 2006, St. Luke’s Hospital demonstrated a 25% readmission rate for patients with HF. Hospital leadership believed that reducing the HF readmission rate was a significant opportunity for improvement, as it aligned with the hospital’s strategic plan to deliver demonstrably better care to patients.

The Task1

After assembling a Heart Failure Team, St. Luke’s also joined the Institute for Healthcare Improvement’s (IHI) Transforming Care at the Bedside collaboration in an effort to

Reduce

Reduce preventable hospitalizations for patients with HF, aligning with the hospital’s strategic plan to produce care of demonstrably better quality

Develop

Develop data analytics, performance improvement, clinical integration, and other competencies critical to value-based reform

The Actions1
Cross-continuum participation and alignment
  • Engaging, involving, and empowering a wide range of stakeholders to be honest and active participants in the care redesign process
  • Pursuing a patient- and family-centered approach with guidance from its in-house Patient/Family Advisory Council
  • Fostering meaningful partnership and engagement with physicians
Standardized tools and compatible information infrastructure
  • Ensure that patients receive coordinated care as well as unified, consistent, and reinforcing messages from all sources
  • The Heart Failure Team reviewed and revised the hospital’s patient education materials, and developed an enhanced teaching and learning strategy for coordination across all care settings
  • Implementing “Teach-back,” in which patients are asked to recall and restate in their own words what they were just taught by the provider, then tracking the rates of accuracy
Horizontal leaders and executive sponsorship
  • Identified horizontal leaders: individuals who could identify system-wide trends and work effectively across disciplines and care setting to address patients needs as a central element of the desired leadership capability
  • Established a formal executive sponsorship system to establish personal accountability for program performance on the executive level, as leadership support and guidance were important to the initiative’s growth, scale, and diffusion
Rapid learning from external and internal sources
  • Identify, adopt, and refine concepts from other departments, organizations, and practice areas and use them to reduce readmissions
  • Outside learning: capitalized on learning opportunities available through IHI and other health care institutions, accounting for both evidence-based successes and lessons from others’ difficulties
  • Internal sharing: looked internally for concepts, care models, and strategies that could help to reduce readmissions, such as complementary in-home visits
The Results1

HF READMISSIONS (FOR ANY CAUSE) WITHIN 30 DAYS

30-day readmission rate for patients with HF (any cause) was reduced from 25% in 2006 to 15% in 2011