credo and State Chapter Breakout

1. credo and State Chapter Breakout Presented at the Annual BOG Meeting January 2010

2. Presenter Disclosure Information The following relationships exist related to this presentation: • Krishnaswami Vijayaraghavan, M.B.B.S., F.A.C.C. – Consultant Fees/Honoraria from Gilead; BMS. Speaker’s Bureau for Abbott; Forrest; GSK; Novartis.

3. Objectives • What is credo? • State chapter CVD profile – Arizona • Breakout and small group discussion

4. Program Support • credo sponsors: • Independent educational grant support for credo educational initiatives provided by: • AstraZeneca, Daiichi Sankyo, Inc., Eli Lilly USA, LLC, Medtronic, and Novartis

5. What is credo? • Identify evidence-based principles of provider education that lead to equitable CVD care and outcomes • Recognize and facilitate dissemination of educational activities that meet credo principles • Develop, implement, and publish a PI-CME educational activity that targets specific CVD clinical area using ACC’s NCDR™

6. The Case for Addressing CVD Disparities • CVD disparities exist and lead to avoidable, premature morbidity and mortality • Evidence-based care can reverse CVD disparities • Tools for redressing disparities are consistent with providing patient-centered, evidenced-based care • Trends in population and cardiology compound CVD disparities

7. Increasing Diversity in the US 20082050

12. What are the keys to reducing disparities? • Performance measure-based quality improvement • Provider/patient education • Team care

13. Evidence-based Reduction in Health Disparities Data show: • Across health conditions QI and cultural competency training can increase quality, provider knowledge/attitudes, and patient satisfaction/health • In CVD, physician education necessary but not sufficient; team care and patient education can be effective • In acute hospital ACS care, QI can improve quality and reduce disparities AHRQ, Evidence Report/Technology Assessment: Strategies for Improving Minority Healthcare Quality, January 2004. Davis AM et al., “Cardiovascular Health Disparities: A Systematic Review of Health Care Interventions,” Med Care Res and Rev. 2007; 64; 29S. Expecting Success: Excellence in Cardiac Care Results from Robert Wood Johnson Foundation Quality Improvement Collaborative. 2008.

14. Keeping PACE Overview Stage A: Review performance data from associated hospital participating in ACTION-GWTG Registry • Stage B: Select Education • Online interactive case study • Local grand rounds program • Optional QI tools • Optional patient education tools/survey Stage C: Re-examine hospital performance data

15. credo Keeping PACE Program Example

16. State Chapter CVD Profile: Arizona • Population demographics • CVD in Arizona • Healthcare Quality in Arizona • State requirements for cultural competency • Health reform and disparities • ACC membership in Arizona • NCDR Representation in Arizona • Health literacy and language proficiency

17. Race in Arizona vs US

18. Ethnicity and Age in Arizona vs US

19. Poverty and Rural/Urban Residence in AZ

20. Poverty Rate by Race/Ethnicity The Kaiser Family Foundation, statehealthfacts.org. Data Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2009 and 2010 Current Population Survey

21. AZ Heart Disease Rate by Race/Ethnicity National Minority Quality Forum, the American College of Cardiology, and the Association of Black Cardiologists

22. AZ Heart Disease by Gender

23. AZ Heart Disease by Age

24. National Healthcare Quality Report Arizona Findings

25. National Healthcare Quality Report Arizona Findings

26. Ambulatory Care-Sensitive Discharges by Race

27. Patient Satisfaction Findings in CAHPS

28. Heart Failure Outcomes in Hispanic and American Indian Populations CMS Quality Improvement Organization Program, 2007.

29. US Cultural Competency Legislation

30. Text from Legislation • House bill 2544 (47th Legislature, 2006) • Will create a Task Force on Cultural Competence that will, “study and make annual recommendations on specific course curricula for each health-related education field offered by a university…and by a community college.” • Components of cultural competence health courses shall include: “1)cross-cultural communication; 2)culturally and linguistically appropriate health policy considerations; 3) exploration of health beliefs and explanatory models; 4)culturally competent health care delivery; 5)health disparities, privilege and equity factors in the health system; 6)culturally and linguistically competent care supported by policy, administration and practice.”

31. Arizona Department of Health ServicesCultural Competency Advisory Committee • Work Plan for 2009-2011 requires compliance with CMS and AZ Heath Care Cost Containment System requirements • Initiatives include: • Education and Training – annual CC training • Mandatory oral interpreters and bilingual staff • Annual Diversity Report • Collaboration with Community Based Organizations • Provider and Organizational Self-Assessments of Cultural Competence

32. Health Reform and Disparities – Provisions Specific to Race/Ethnicity Patient Protection and Affordable Care Act contains provisions to: • Mandate collection of patient race/ethnicity, language, gender data (section 4302) • Funding for cultural competence training (5301 and 5307) • Health disparities research (6301) • Indian Health Care Improvement Act – permanent reauthorization to improve access and modernize facilities (10221)

33. Health Reform and Disparities – General Provisions Impacting Diverse Populations • Coverage expansions – Medicaid, employer mandate, health exchange (2001,1513,1311) • Community health center expansion (10503) • Quality improvement incentives (3011 and 3501) • Public health initiatives and prevention – National Prevention & Public Health Council and Prevention & Public Health Fund (4001 and 4002) Kaiser Family Foundation. Health Reform and Communities of Color: Implications for Racial and Ethnic Health Disparities. September 2010. Joint Center for Political an Economic Studies. Patient Protection and Affordable Care Act of 2010: Advancing Health Equity for Racial and Ethnically Diverse Populations. July 2010.

34. Arizona ACC Membership - Physicians

35. Arizona ACC Membership - Physicians

36. Arizona ACC Membership - CCAs

37. NCDR in Arizona • 47 NCDR sites (hospitals and practices) enrolled in ACTION, CARE, CathPCI, ICD and PINNACLE • Six sites enrolled in at least 3 registries • Arizona Regional Medical Center • Casa Grande Regional Medical Center • Flagstaff Medical Center • Maricopa Integrated Health System • Scottsdale Healthcare Osborn • Verde Valley Medical Center

38. Health Literacy • Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions • 12% of adults have proficient health literacy U.S. Department of Health and Human Services. (2000). Healthy People 2010 (2nd ed.)

39. Language Proficiency in Arizona

40. Suggested Resources • Unified Health Communication (UHC): Addressing Health Literacy, Cultural Competency, and Limited English Proficiency: Free Online CME Course - http://www.hrsa.gov/publichealth/healthliteracy/ • Rapid Estimate of Adult Literacy in Medicine—Short Form (REALM-SF): 7-item word recognition test for quick assessment of patient health literacy - http://www.ahrq.gov/populations/sahlsatool.htm • HRET Disparities Toolkit: A Toolkit for Collecting Race, Ethnicity, and Primary Language Information from Patients - http://www.hretdisparities.org/ • NCQA’s Multicultural Health Care (MHC) product offers distinction to organizations that engage in efforts to improve culturally and linguistically appropriate services and reduce health care disparities. - http://www.ncqa.org/tabid/1195/Default.aspx For more information about credo and a full listing of resources, visit www.cardiosource.org/credo

41. Patient Education – Cardiac Rehab • Placehold for clip from cardiac rehab video

42. credo CME Online Webinar www.cardiosource.org/credowebcast

43. Cultural Competency Mini-Training www.cardiosource.org/culturalcompetence

44. Breakout – Questions for Discussion • What challenges do you face treating diverse patient populations? How do you address these challenges? • Do issues of disparities/cultural competence/health literacy impact members in your chapter? • What tools, resources or trainings would be beneficial for your chapter?