Outlook: Newsletter of the Society of Behavorial Medicine

Summer 2018

An Introduction to the Health Collaborative Model with CARDI-OH

Elizabeth A. Beverly, PhD, Diabetes SIG Chair

After reading the title, you may be asking yourself, “What is a collaborative and how is this relevant to me?” A Health Collaborative is a model that brings together a large number of teams from hospitals and organizations to share experiences in order to accelerate learning and the implementation of best practices.1 For members of SBM, a Health Collaborative is an opportunity to highlight developments in behavioral medicine by connecting researchers, clinicians, managed care, and community stakeholders to improve the delivery of healthcare to manage specific conditions and/or implement behavioral change. Case Western Reserve University School of Medicine recently established a statewide collaborative, the Ohio Cardiovascular Health Collaborative, with four partner institutions – Ohio University, Ohio State University, University of Cincinnati, and Wright State University – funded by the Ohio Department of Medicaid. This Collaborative aims to improve cardiovascular care as well as diabetes care. Other institutions can learn from this model and establish collaboratives to promote effective interventions and services.

The Ohio Cardiovascular Health Collaborative is a complementary approach to improve cardiovascular health outcomes in people with diabetes. Despite reductions in mortality, cardiovascular disease (CVD) remains the leading cause of death in the United States.2,3 Clinical risk factors, such as hypertension, dyslipidemia, and diabetes, are associated with long-term risk of CVD.4-6 People with diabetes will develop CVD at a younger age compared to people without it.7 In addition, the longer a person has diabetes, the more likely they will develop CVD.6 People with type 2 diabetes are two to four times more likely to die from a CVD-related event,8,9 with the risk of fatal outcome increasing 17% for every 1% increase in A1C.10 Also, CVD is the leading cause of death among people with type 1 diabetes, accounting for 22% of deaths in the Allegheny County childhood-onset type 1 diabetes registry (n=1075).11 Thus, approaches that complement standard diabetes care are critically important to prevent cardiovascular disease, increase lifespan, and improve the quality of life of people with diabetes. The purpose of the Ohio Cardiovascular Health Collaborative is to expand the primary care team capacity to prevent, diagnose, and manage cardiovascular disease in Ohio’s Medicaid population. Specifically, the Collaborative aims to identify and address disparities in cardiovascular health care and outcomes affecting the Ohio Medicaid population. The culmination of work from year 1 of the Ohio Cardiovascular Health Collaborative was an inaugural in-person statewide conference: “Taking the Pulse: Connecting to Improve the Health of the Medicaid Population” to highlight the best practices among Ohio’s institutions. This conference was held in Columbus, Ohio on June 8th, 2018 and included over one hundred clinicians, researchers, managed care providers, and community stakeholders.

 

References

  1. The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. . Boston: Institute for Healthcare Improvement; 2003.
  2. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. Mar 7 2017;135(10):e146-e603.
  3. Writing Group M, Mozaffarian D, Benjamin EJ, et al. Executive Summary: Heart Disease and Stroke Statistics--2016 Update: A Report From the American Heart Association. Circulation. Jan 26 2016;133(4):447-454.
  4. Miura K, Daviglus ML, Dyer AR, et al. Relationship of blood pressure to 25-year mortality due to coronary heart disease, cardiovascular diseases, and all causes in young adult men: the Chicago Heart Association Detection Project in Industry. Archives of internal medicine. Jun 25 2001;161(12):1501-1508.
  5. Stamler J, Daviglus ML, Garside DB, Dyer AR, Greenland P, Neaton JD. Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity. JAMA : the journal of the American Medical Association. Jul 19 2000;284(3):311-318.
  6. Huo X, Gao L, Guo L, et al. Risk of non-fatal cardiovascular diseases in early-onset versus late-onset type 2 diabetes in China: a cross-sectional study. The lancet. Diabetes & endocrinology. Feb 2016;4(2):115-124.
  7. Statistics About Diabetes. 2017; http://www.diabetes.org/diabetes-basics/statistics/. Accessed September 27, 2017.
  8. Coutinho M, Gerstein HC, Wang Y, Yusuf S. The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes care. Feb 1999;22(2):233-240.
  9. Emerging Risk Factors C, Sarwar N, Gao P, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. Jun 26 2010;375(9733):2215-2222.
  10. Zhang Y, Hu G, Yuan Z, Chen L. Glycosylated hemoglobin in relationship to cardiovascular outcomes and death in patients with type 2 diabetes: a systematic review and meta-analysis. PloS one. 2012;7(8):e42551.
  11. Secrest AM, Becker DJ, Kelsey SF, Laporte RE, Orchard TJ. Cause-specific mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes. Diabetes. Dec 2010;59(12):3216-3222.