Prevent Heart Attacks and Strokes EveryDayProgram

2005 Partnership between San MateoCounty and

Kaiser Permanente Redwood City

Executive Summary

San Mateo County Employer Group

Paul Hackleman, Benefits Manager

Pamela Gibson, Employee Health Program Coordinator

Donna Barrett, RN Diabetes Case Manager

KaiserPermanenteRedwood CityMedicalCenter

Timothy Wong, MD, Assistant Physician in Chief

Maria Wojciechowski, RN, CCM Director

Dalia Weinstein-Zatlin, Health Education Manager

Maura Georges, Senior Health Educator

Mimi Ly, CCM Program Manager

Kirstin Kim, PharmD Care Manager

Pauline Ma, PharmD Manager

Lisa Benigno, Program Assistant

Adela Lopez, Program Assistant

Susan Livingood, Marketing Account Manager

Objective: Kaiser Permanente partnered with San MateoCountyto improve the health of the San MateoCounty employees, retirees, or dependents who are identified as high risk based upon the PHASE criteria. The PHASE population is defined as a patient having one of more of the following disease states: diabetes, coronary artery disease, stroke, peripheral vascular disease, aortic abdominal aneurysm and/or chronic kidney disease. The goal of the program was to ensure that the County’s highest risk Kaiser Members (those with coronary artery disease (CAD) or certain other vascular diseases) receive recommended medications and aggressive risk factor management to help slow the atherosclerotic process and prevent future cardiac and cerebral vascular events.

Design and Methods: Kaiser Permanente RWC CCM (KP-RWC) identified Kaiser members on the PHASE Registry who were also San MateoCounty employees, retirees or dependents. Patients invited to participate in the program were those who were not in control in one or more of the following clinical parameters: Hemoglobin A1C, LDL or blood pressure. ActiveSan MateoCounty employees were given the opportunity to participate in the PHASE program as part of their regular work time.

The PHASE program consisted of an introductory class visit led by a KP-RWC CCM pharmacist care manager. Educational information on lifestyle and medication management of lipids, diabetes, and hypertension were presented. Patients with diabetes were encouraged to continue on to complete a 4 session program plan consisting of three consecutive monthly classes(led by a San Mateo County RegisteredNurse and two KP-RWC CCM pharmacist care managers) and a graduation class in six months. All patients were managed by a KP-RWC CCM pharmacist care manager on an individualized basis by telephone visits that subsequently followed the general introductory class.

Objective clinical data obtained from theKaiser electronic medical records system (CIPS Mainframe) were Hemoglobin A1C, LDL, blood pressure, medication utilization, and Urgent Care/ Emergency Room visits at the time of enrollment and at the end of the program.

A self assessment of health status survey (developed by KP-RWC Health Education Department staff and San Mateo County’s Employee Health Program Coordinator) was given to participants who completed the San Mateo/KP RWC CCM PHASE program and toSan Mateo/KP Health Plan members already in good control of their condition(s).

A PHASE program survey was sent to members enrolled in the PHASE program to collect participants’ perception of important considerations and supportive factors that led them to enroll and participate in the program.

Results: Of the239 patients who received written invitations to participate in the program, 81 patients enrolled in the PHASE program.

In participants with diabetes, 71% had good diabetes control (HgA1c < 8.0) at the start of the program compared to 80% at the end. The number of members with diabetes and LDL <100 increased at the end of the program (from 44% to 71%). The number of patients with blood pressures at goal of < 130/80increased at the end of the program (40% to. 56%). Twenty percent of the members with diabetes were started on a statin to lower LDL, 7% were started on a beta blocker and 18% were started on ACEI/ARB to assist with blood pressure control. Non-routine utilization visits were similar from 2004 to 2005 (10 to 11).

In participants without diabetes, 61% were at goal with LDL<100 at the start while 72% reached goal at the end of the program. Eighty percent of participants had blood pressures less than 140/90 at the start of the program and 94% achieved target control at the end. Seventeen percent were started on a statin, 7% were started on a beta blocker and 3% were started on ACEI/ARB. Non-routine utilization visits were similar from 2004 to 2005 (13 to 15).

Twenty four percent of “In Control” group responded to the self assessment survey while 36% of the PHASE graduates responded. Results from the Self Assessment Survey showed that members in the “in Control group” and “PHASE participants” responded to the survey in a similar way. Both groups reported having the same three challenges that kept them from attempting to improve their health or deal with their health risks: giving up things that they enjoy, lack of motivation or energy and lack of time (Question 21). Undeniably both groups identified family and health condition as the top two contributors to feeling stressed, sad or blue (Question 3&5). At least half of respondents in both groups reported that feeling sad or blue never interfered with their ability to function in personal and work life (Question 4).

Forty percent of the PHASE Program participants completed the PHASE Program Survey. The two most important considerations for participants to enroll in the PHASE Program were 1) that they wanted more support from Kaiser to improve health and 2) increased readiness to do something to improve health. The two most important considerations for participants to continue with the PHASE program were 1) seeing clear improvements in health and 2) individual attention and support from the care manager.

Conclusions:

Members who attended the KP-RWC CCM PHASE program demonstrated improvement in glycemic control, lipid control, and blood pressure control. These results would not have been possible without appropriate medication management and utilization. The findings with medication utilization illustrate that there is still potential to improve disease management among all members in the PHASE program. The utilization rate for non-routine visits to the Emergency Room and Urgent Care Clinic among the program participants shows a nominal increase from 2004 to 2005. This slight increase is not surprising especially with a group consisting mostly of retirees with chronic conditions or other co-morbidities. Previous studies have reported similar patterns and experience.

The data collected with the self assessment of health status survey is interesting and could suggest that there may be potential for the participants in the PHASE program to improve sense of self confidence, esteem and productivity with continued re-enforcement of new skills and lessons learned. The respondents to the PHASE Program Survey unquestionably cited the program as a good source of new and important facts and information pertaining to the disease process, how to improve or modify lifestyle behaviors and benefits of medication management.

Even though the evaluation methodology of the PHASE program had limitations, the value of collaboration between health plan and employer group has shown that partnership can help improve the lives of individuals at most risk. Together, both organizations addressed barriers and tailored action plans to meet participants’ needs. The intention of the partnership was to educate and help individuals’ gain greater understanding and self confidence in their ability to manage their chronic condition(s). Joint ventures, between employer groups and health plans, provide an excellent opportunity to improve the health of our communities.

2005 San MateoCounty & Kaiser Permanente RWC PHASE Program – Executive Summary

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