According to a 2015 Centers for Disease Control and Prevention (CDC) report, the cardiovascular disease (CVD) mortality rate in Washington, D.C. was 187.6 per100,000 residents. The national mortality rate was 168.5 per 100,000. Additionally, a comparison of CVD mortality rates by race shows that African Americans in Washington, D.C. are twice as likely to die from CVD than their white counterparts. Heart disease continues to rank as the number one cause of death for residents of the District of Columbia.
To help address this public health crisis, the Atlantic Quality Innovation Network—the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for New York, South Carolina and Washington, D.C.—teamed with the District of Columbia Department of Health to initiate a cardiovascular disease (CVD) reduction program specifically tailored to the nation’s capital.
Inspired by the national Million Hearts initiative pioneered by the U.S. Department of Health & Human Services, the DC Million Hearts Learning Collaborative brings together public and private organizations on a monthly basis for networking and sharing of best practices as they relate to health care quality improvement, and to discuss interventions and provide resources to patients with chronic diseases. The collaborative includes both national and regional organizations, local health care systems, academic organizations and community organizations working toward the common goal of reducing mortality caused by heart disease among residents of Washington, D.C.
One participant in the collaborative is the Medical Home Development Group (MHDG), a medical clinic that practices in an underserved area of Washington, D.C. Based on recommendations from the collaborative, MHDG implemented a comprehensive and scalable program to enhance CVD screening for its high-risk, largely African-American patients, many of whom have co-occurring mental health and substance abuse disorders. To treat these complex combinations of diseases, MHDG is integrating substance use disorder treatment with chronic care management.
“We have a motto of the whole person approach to care,” said Dr. Melissa Clarke, vice president of population health and provider contracting at MHDG. “Although we do have initiatives specific to certain areas, we view everything within the context of a person’s overall well-being.”
Clarke said her practice has found it critical to identify the social determinants of health, including housing instability, food insecurity, mental health, smoking and transportation to care facilities, in order to deliver effective care for its patient population. Many patients face barriers in more than one of these areas and cannot easily resolve them.
“We have a motto of the whole person approach to care. Although we do have initiatives specific to certain areas, we view everything within the context of a person’s overall well-being.”
Bearing this in mind, MHDG fully integrated patient-centered technology applications in its practice to expand access to on-demand specialty care and chronic care management, and to address social barriers outside of the care facility. These applications include an extensive health assessment tool that was embedded into MHDG’s health records system, allowing clinicians to identify the need for interventions within their patient population. Based on this knowledge, MHDG decided to use alternative measures to determine the success of population health interventions.
“We consider hypertension to be a manifestation of some of the socioeconomic factors that determine health,” said Clarke. By addressing cardiovascular disease in the clinical setting, patients are made aware of the factors that drive poor health, enabling them to come to a consensus with their doctor on the best care path forward.
The DC Million Hearts Collaborative has recruited five home health agencies, 21 practices, and 137 clinicians in 37 locations to begin similar cardiac prevention programs.