Collaborative cardiovascular program

Collaborative for Cardiovascular Health Equity. Cardiovascular Disease Disparities in North Philadelphia. Learn More. WomenHeart Philadelphia Resources and community events to promote education on heart disease prevention strategies and the availability of treatments to residents located in North Philadelphia.

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But opting out of some of these cookies may affect your browsing experience. Necessary Necessary. Necessary cookies are absolutely essential for the website to function properly. The cardiology faculty draw from the broad and deep tradition of excellent cardiovascular care provided by the Iowa Heart Center.

The group was first formed by a single cardiologist in During the three year training period, cardiovascular disease fellows at the MercyOne Iowa Heart Center program will be exposed to a wide range of cardiovascular disease and a high volume of diagnostic and therapeutic procedures. Throughout their training, fellows will gain training in all areas of cardiovascular care including echocardiography transthoracic and transesophageal , stress testing, diagnostic angiography, cardiac MR, nuclear imaging, cardiac CT, temporary and permanent pacing, ECG interpretation, care of the advanced heart failure patient, cardiovascular disease prevention, adult congenital heart disease, clinical cardiac electrophysiology and critical care cardiology.

Figure 4. Percentage of hypertension patients aged 18 to 59 years with controlled blood pressure, the Hearts of Sonoma County Initiative, Sonoma County, California. Between and , the community engagement effort has conducted 99 outreach events, reaching 1, individuals, and conducted 1, blood pressure screenings. A total of of the people screened were found to have high or very high blood pressure readings and were contacted for follow-up by bilingual Center for Well-Being staff to evaluate the effectiveness of the screening and to motivate them to connect with their doctor or a referred provider.

Partners such as St. Future outreach opportunities being explored include senior centers, school parent groups, and grocery stores located in low-income neighborhoods.

The HSC collaborative provides the overall structure and support for the clinical and community activities, including forming relationships for interventions linking clinics and communities.

The collaborative has achieved sustainability, a result that eludes many collaboratives. Understanding why it has been successful may provide lessons for other similar collaboratives.

Figure 3 summarizes the 6 elements in the coalition model that were used to enumerate and understand the success of the collaborative. Quotes were drawn from interviews with key HSC stakeholders, which included someone from each of the major participating organizations. HSC successfully fulfilled all 6 of the essential elements in the model. The shared purpose of reducing CVD risk through clinical and community approaches used was agreed to by all, and the language was revisited and updated as the initiative continued.

A component of success was a strategic approach in aligning the existing goals, interests, and requirements of individual primary care organizations with the shared communitywide goal of improving CVD health. Measurements were developed that would most closely match the specifications of required performance metrics to take advantage of data the organizations were already collecting. This approach and alignment meant that improvements resulting from the collaborative work of the HSC initiative translated to improved outcomes on performance measures that are important to the individual entities participating in the initiative, which in turn supported ongoing investment in the process.

Effective leadership of HSC has generally been present in the form of a rotating group of clinical leaders from the different health systems. They have competing priorities but have always been engaged in this effort. Active collaboration is a critical but hard-to-define property of effective collaboratives: people and organizations set aside their more narrow organizational interests in support of the whole group.

All of the informants understood the concept and agreed that over time people had seen the value of collaboration. How can we improve care for all, recognizing differences and helping each other. People take things back. In addition to validating the elements of the CCHE model, we asked respondents in a more open-ended way about the key accomplishments of HSC and why they thought the effort had lasted.

They did not often mention specific activities or clinical improvements, but rather that they appreciated the collaboration itself and being able to step outside the competitive realm of their different health systems to focus on what could be done to improve patient and community health. The dialog and shared learnings at the monthly meetings built trust and promoted the active collaboration.

Respondents attributed the sustainability of the HSC effort to the building of that level of trust. Although the positive results — early but encouraging countywide trends in blood pressure control and significant community engagement activities with more in the works — are important, another goal of the HSC evaluation was to understand the factors behind the staying power and impact of the collaborative.

We looked in particular for structural or process factors that might be generalizable to other, similar collaboratives. Three such factors that emerged were starting small and focused, while working within the framework of a larger effort, and providing backbone support that was open-ended and not limited by funding time constraints.

Start small and focused to build trust and demonstrate value. A small number of clinical champions from the key health organizations came together to see whether sharing lessons from others could benefit their own organizations.

They were able to agree on a purpose and mission and move to action fairly quickly even though resources to implement whatever changes they identified were limited and had to come from within their own organizations. These early successes helped build trust and demonstrate the value of the collaborative.

Operate within a larger structure. Although the health care work involved a small number of people with a narrow focus, it was embedded in the larger Health Action collaborative. This had 3 long-term advantages.

Second, connections were created with a larger group of member organizations who were potential collaborators as the work grew in scope. Third, it was easier to secure long-term backbone support from Sonoma County, because the effort had a broad focus and therefore a wider political constituency.

The lessons about starting small but operating within a larger structure suggest a path for others seeking to ultimately create a large-scale collaborative to achieve health system transformation. Create a large, ambitious collaborative structure and membership, but be willing to focus initial activities narrowly where progress can most readily be made. This requires accepting modest results in terms of health impact, which can also help build the trust required for sustainability.

Other lessons were learned through this process. Grant-funded collaboratives are often time-limited, and it can be challenging to find funding streams to sustain the effort. This was enough to provide support to the early focused efforts of HSC. Also, administrative and especially clinical leadership in each organization is essential to teach colleagues, guide the direction of change, and encourage the use of protocols. These can all be difficult for clinicians to accept and implement, so leadership is essential.

Finally it is important to have small successes and celebrate them along the way. This keeps people interested and knowing progress is being made.

Having the shared purpose, however, is key. These lessons are consistent with what others have found 8 and not revolutionary, but they are often ignored in the sense of urgency created by the need to transform the health care system and the availability of large-scale, but time-limited, funding available through State Innovation Model grants 3 , Medicaid DSRIP Delivery System Reform Incentive Payment Waivers 13 , and other sources.

Some limitations should be noted. The evaluation of the community engagement activities has been a more qualitative, process evaluation; longer-term outcome measures are still being developed. The data on CVD outcomes eg, blood pressure are limited to the 4 participating providers, which represent just over half of the county patient population. Finally, HSC is focused on CVD only, which, although a leading cause of illness and death, is not indicative of overall health system transformation.