An e-bulletin created for healthcare systems working with patients to control their diabetes and high blood pressure.

May, 2018

Men’s Health WeekJune 11-17, 2018www.menshealthmonth.orgCommunity Health Improvement WeekJune 3-9, 2018 www.healthycommunities.orgBlood Donor DayJune 14, 2018www. who.int Nursing Assistants WeekJune 18-22, 2018www.ashrm.org

4 Iowa schools receive USDA's healthier schools awardFour schools in an Iowa district recently received the US Department of Agriculture's Bronze Healthier US School Challenge Award. Dave Walker, the district's nutrition director, says the award was based in part on the district's focus on healthy meal options and nutrition education. The Des Moines Register (Iowa) (tiered subscription model) (4/2)

Study shows reduced CVD, other risk factors among older adultsThe average number of cardiovascular risk factors among older adults has decreased, including blood glucose, blood pressure, body mass index, cholesterol and triglycerides, according to a study in the journal Aging Clinical and ExperimentalRisk Factors, with the biggest reduction seen in people in their 60s. Using 1990 to 2010 national data on US adults age 40 and over, researchers determined that heart risks among women between ages 40 and 60 rose between 1990 and 2000, but declined by 2010. HealthDay News (4/2)

Women’s Health WeekMay 13-May 18, 2018www.womenshealth.govHigh Blood Pressure Education Monthwww.nhlbi.nih.govStroke Month (American)www.strokeassociation.orgStroke Awareness Month (National)www.stroke.orgNurse’s WeekMay 6-May 12, 2018www.nursingworld.org

“Better Choices, Better Health provided exactly what I needed and after six weeks of classes, I walked away with a much better understanding of how to better deal with stress, pain, communication, better eating, decision making, using my mind to manage symptoms, and more. I left feeling empowered, more focused, and better prepared for what’s to come. My husband and I are using so much of what we learned in the workshops. It’s amazing how much easier things have become. This program is of great value to anyone dealing with a chronic condition.” –Better Choices, Better Health Participant. Learn more at http://idph.iowa.gov/betterchoicesbetterhealth

Please consider adding your voice to ours during National Stroke Awareness Month as we raise awareness for stroke risk factors, stroke symptoms, and the need to call 9-1-1 if you suspect a stroke. The life you save just might be your own or a loved one’s. This link will provide you with many resources regarding stroke.

ABCS are continued on the next page…

Priority: Keeping People Healthy

Priority: Optimizing Care

RDN: Focus on sodium, fats, exercise to reduce heart risksHeart disease is the No. 1 killer in the US, but registered dietitian nutritionist Andrea Luttrell says people can take steps toreduce their risk by cutting back on salt, switching to unsaturated fats and getting regular exercise. Luttrell says sodium often comes from hidden sources, added to foods before they reach the table, so to reduce intake, limit oversized restaurant meals and check the Nutrition Facts label of food products for sodium content. The Republican (Springfield, Mass.) (2/13)

Report: 27.6% of Americans are physically inactiveA Sports & Fitness Industry Association report showed 27.6% of Americans ages 6 and older are physically inactive, including 17.6% of people 18 and younger and 33.3% of those older than age 55. The annual Topline Participation Report found 43% of inactive people said having someone to do an activity with would make them more likely to participate. Forbes (3/29)

AHA Aspirin Use RecommendationPeople at high risk of heart attack should take a daily low-dose of aspirin (if told to by their healthcare provider).

Racial health disparities are rampant in hypertensionHigh blood pressure is much more prevalent among black women and men than it is among other racial and ethnic groups. During a recent panel discussion at the AMA, heart care experts advised that when caring for black patients, the physician focus should be on medication adherence, patient education and lifestyle change. Read more at AMA Wire®.

8 steps to ensure your patients get their BP rightExperts at the American College of Cardiology and American Heart Association say that self-measured blood pressure (SMBP) should be used to confirm the diagnosis of hypertension and assess BP control in management. While there is no universally accepted set of protocols for SMBP, your practice’s staff can follow this training guide to help patients record and properly document their BP. Read more at AMA Wire.

Researchers use cigarette smoking behavior to identify genes that regulate blood pressureFindings could eventually lead to the development of individually targeted treatments to manage hypertension.

Million Hearts® 2022 PartnersThe only way we—as a nation—will meet the Million Hearts® goal of preventing one million heart attacks and strokes is through the collective and focused action of a diverse range of partners. Become a Million Hearts® partner by aligning your actions with the Million Hearts® priorities, spreading the word about key Million Hearts® strategies, and enlisting others in the work of the initiative. Go to the link above and find out how you can become a partner!

Diet rich in cruciferous vegetables can have cardiovascular benefitsWomen ages 70 and older who ate the most cruciferous vegetables had thinner carotid artery walls than women who ate the fewest, researchers reported in the Journal of the American Heart Association. A 0.1% decrease in carotid wall thickness was associated with a 10% to 18% lower risk of heart attack and stroke, and each additional half-ounce of vegetables consumed was associated with an almost 1% thinner artery wall. HealthDay News (4/4)

Priority: Improving Outcomes for Priority Populations:

.

Recovery After Stroke: Movement And BalanceThe most common physical effect of stroke is muscle weakness and having less control of an affected arm or leg. Survivors often work with therapists to restore strength and control through exercise programs. They also learn skills to deal with theloss of certain body movements. In order to view the fact sheet, you need to have Adobe Reader installed on your computer (download Adobe Reader).

Create Your Own Cholesterol ProtocolIn 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) released new clinical guidelines on the treatment of blood cholesterol to reduce ASCVD risk in adults. You can create your own cholesterol management protocol using the flow diagram from the guidelines. Or you can adapt one of the featured evidence-based protocols below.The guidelines from the ACC and AHA recommend statin use among four major statin benefit groups: Individuals with clinical ASCVDIndividuals with primary elevations of LDL-C ≥190 mg/dLIndividuals aged 40 to 75 who have diabetes with LDL-C of 70 to 189 mg/dL and without clinical ASCVDIndividuals without clinical ASCVD or diabetes with LDL-C of 70 to 189 mg/dL and estimated 10-year ASCVD risk ≥7.5%

Increasing Cardiac Rehabilitation Participation …The Million Hearts® Cardiac Rehab Collaborative road map outlines the key action steps and best practices to increase cardiac rehab participation rates from 20% to 70%. (Mayo Clinic Proceedings, 2016)

Depression negatively impacts heart and stroke patients

People with cardiovascular disease who haven't been diagnosed with depression but are at high-risk for it are more likely to report worse healthcare experiences and use emergency room services more often than those diagnosed with depression. Heart attack patients diagnosed with depression are more likely to be hospitalized, use emergency rooms and annually spend more on healthcare than heart attack patients without depression.

Study links beta-blockers to increased mortality risk in diabetesJapanese researchers found that patients with and without diabetes who were taking beta-blockers had all-cause death event rates of 40.6 and 13.8 per 1,000 person-years, compared with 17.1 and 5.9 among those with and without diabetes not taking such drugs, respectively. The findings in Mayo Clinic Proceedings, based on data from the US National Health and Nutrition Examination Survey 1999-2010 involving 17,524 patients with and without diabetes, showed a significantly higher all-cause mortality among those with diabetes and coronary heart disease who took beta-blockers than those who did not take the drugs. Medscape (free registration) (4/5)

Diabetes, obesity prevalence highest among US adults in Midwest regionResearchers evaluated data from the National Health and Nutrition Examination Survey involving 9,824 adults ages 20 to 65 and found that white adults in the Midwest region had a high prevalence of diabetes, metabolic syndrome and obesity, compared with those in the Northeast and West regions. The findings in Nutrition & Diabetes also revealed that black men across the Northeast, Midwest, South and West regions had a high prevalence of diabetes, while black women in the Midwest, Northeast and West regions had the highest MetS prevalence among all women. Healio (free registration) Endocrine Today (3/29)

It's everything you need to know about MedicaidAHIP's new Medicaid Primer online course gives you a solid understanding of the landmark public program that delivers health coverage to millions of Americans. You'll master Medicaid's fundamentals and ongoing innovations including funding and administration, eligibility rules, long-term services, waivers, regulation of managed care and more. Learn more about Medicaid Primer and enroll today.

Video guide to self-measured blood pressureExperts recommend physicians and their health care teams use self-measured blood pressure (SMBP) monitoring to confirm the hypertension diagnosis and to assess BP control in the management of high blood pressure. A new Target: BP™ educational video (also in Spanish) helps train care teams and patients on how to properly self-measure blood pressure. Watch.

Prediabetes screening, referral can help you succeed in MIPSMedicare offers new ways for your practice to potentially benefit financially from the work you do to help at-risk patients prevent the onset of type 2 diabetes. Two AMA-suggested population-health Improvement activities—glycemic screening services and glycemic referring services—have been added to available options for physicians participating in the Medicare Quality Payment Program’s Merit-based Incentive Payment System (MIPS). Read more at AMA Wire®. This story is featured as part of the AMA’s Navigating the Payment Process topic page. Explore other Medical Topics That Matter.

Scientists create skin patch for noninvasive glucose monitoringResearchers from the UK's University of Bath developed a graphene-based skin patch that contains miniature sensors to enable fingerstick-free monitoring of blood glucose levels through extraction of glucose from the interstitial fluid using electric current. Scientists who have successfully used the device to monitor glucose levels in healthy human volunteers and on pig skin with glucose levels similar to those of a human with diabetes are looking to determine its functionality over a one-day wear period, optimize the number of its sensors and conduct clinical trials. The findings were published in Nature Nanotechnology. New Atlas (4/9)

Improved diabetes management tied to depressive symptom changes, study findsA 1-standard deviation drop in depressive symptoms was associated with a 0.4 standard deviation increase in self-efficacy among patients with diabetes and depression, while changes in total social support were tied to self-efficacy, according to a study in Diabetes Care. Researchers studied data for 251 Hispanic patients and found that differences in diabetes management adherence across three regression models were predicted by changes in depressive symptoms. Healio (free registration)/Endocrine Today (4/1)

Survey: Only 31% of practices use EHR analytics to fullest extentThirty-one percent of medical practices surveyed use EHR analytics to the fullest extent, 22% use some of these capabilities, 31% get assistance from an external vendor to use a combination of EHR analytics, and 5% depend on an external vendor, according to an MGMA survey. The survey also found that 11% of respondents reported not analyzing EHR data at all. Healthcare IT News (4/28)

Remote Clinical Pharmacy Services: Gain real-time access to a clinical pharmacist in your practiceWant help improving patient outcomes and performance measures? Centralized Healthcare Solutions (CHS) is a team-based care approach utilizing clinical pharmacists to address chronic conditions and prevention services right here in Iowa. CHS supports primary care providers (PCPs) with comprehensive disease management and achievement of key performance measures. CHS clinical pharmacists communicate with each patient via telephone, email, text message or virtually face-to-face. Unlike other medication therapy management services, CHS clinical pharmacists have access to the patient’s EMR, allowing for individualized and immediate recommendations to the PCPs. This model has been successfully tested in two rigorous randomized controlled trials. Learn more by visiting our website at https://uiowa.edu/chs/

Report: EHR design, training can improve patient safetyCluttered, confusing user interfaces in EHRs can make it difficult for health care providers to find key information, as can needlessly sparse interfaces, according to a Pew Charitable Trusts report. Streamlining user interfaces, team-testing workflow customizations and prioritizing staff training on EHRs can reduce risks to patients, according to the report. Health IT Analytics (12/21)

The CAHPS Ambulatory Care Improvement Guide: Practical Strategies for Improving Patient ExperienceThis Guide is a comprehensive resource for health plans, medical groups, and other providers seeking to improve their performance in the domains of patient experience measured by CAHPS surveys of ambulatory care. You can use this guide to help the organizations you work with:Cultivate an environment that encourages and sustains improvements in patient-centered care.Analyze the results of CAHPS surveys and other forms of patient feedback to identify strengths and weaknesses.Develop strategies for improving performance. Sections of the Guide (PDF) include:Why Improve Patient Experience?Are You Ready to Improve?Ways to Approach the Quality Improvement ProcessDetermining Where to Focus Efforts to Improve Patient ExperienceStrategies for Improving Patient Experience

Apple unveils new health app feature to transfer medical recordsThe New York Times (1/24, Singer, Subscription Publication) reports, Apple has unveiled a new feature as part of its Health app that will allow “users to transfer clinical data,” such as physician-prescribed medications or cholesterol levels, “directlyfrom their medical providers to their iPhones.” So far, 12 US medical institutions including Johns Hopkins Medicine and Cedars-Sinai “have agreed to participate in the beta version of the new feature,” which will be opened to users . The Times says this is the latest indication of “how focused Apple is on using its iPhone, Apple Watch and apps to give people more control over their health care.” The Washington Post (1/24, Johnson) reports that “Apple has worked with three vendors of electronic medical records for the first wave of its apps: Epic, Cerner and AthenaHealth,” and that additional “hospitals and other electronic health vendors will be able to join in coming months.”TIME (1/24, Ducharme) reports that as part of the new Health Records feature, “information will be transmitted electronically from participating providers to patients’ phones.” Users will need “to opt in to the service through the Health app.”

The Alliance for Strong Families and Communities has published the report A National Imperative: Joining Forces to Strengthen Human Services in AmericaAccording to the study's findings, "too many community-based organizations (CBOs) operate under persistent deficits, have few or no financial reserves, and lack access to capital to invest in technology and modern data sharing tools.

The Iowa Department of Public Health -- Health Promotion and Chronic Disease Control Partnership

Terry Y. MeekHealth Systems Coordinator

terry.meek@idph.iowa.gov

Laurene HendricksLinkage Coordinator

laurene.hendricks@idph.iowa.gov

Editors:

This e-Bulletin is supported by Cooperative Agreement Number 5U58DP004807-05 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Iowa Department of Public Health.

Study shows efficacy of consultation model in diabetes careDutch researchers found that a consultation model -- comprised of setting personal goals, determining required care, inventory of disease and patient-related factors, and choosing treatment -- was applicable in 72.4% of cases, according to physicians, who often spent less than 25 minutes in consultation. The findings in Diabetes Care, based on a survey of 74 physicians and 31 nurses reporting on 1,366 consultations with type 2 diabetes patients, revealed that the model resulted in more patient involvement, including shared decision-making, and 52.5% of patients saw an improvement in their consultation. Physician's Briefing/HealthDay News (1/29)

Study: Longer duration of diabetes, prediabetes tied to higher CAC presenceEach five-years-longer duration of diabetes and prediabetes in adulthood was associated with a 1.15 and 1.07 higher hazard ratio, respectively, for the presence of coronary artery calcified plaque in middle age, according to a study in Diabetes Care. Researchers used a cohort of 3,628 white and black adults, ages 18 to 30, and found that diabetes and prediabetes duration correlated with early diastolic relaxation and worse subclinical function, while diabetes duration was associated with a higher diastolic filling pressure. Physician's Briefing/HealthDay News (1/12)

Study: Diabetes patients less likely to survive in-hospital cardiac arrestA study in The American Journal of Cardiology showed that diabetes patients were modestly less likely to survive in-hospital cardiac arrest than those without diabetes. Researchers used a cohort of more than 1 million patients and found a lower survival risk among those with a primary diagnosis of cardiovascular disease, patients with ventricular fibrillation or ventricular tachycardia as the cardiac arrest rhythm and those who were younger, as well as those with chronic kidney disease. Healio (free registration)/Cardiology Today (4/12)

Expert offers suggestions to help reduce physicians' frustration with EHRsImproving the password process and providing physicians with individualized optimization training to personalize EHR settings would help reduce physician frustration with EHRs, Dr. Martin Pricco from the Gould Medical Group writes in Medical Economics. Pricco also suggested customizing EHRs according to specialty and workflow, creating a review process and installing printers in exam rooms. Physician's Briefing/HealthDay News (4/10)

How to make the most of patient-measured BP dataAfter implementing a self-measured blood pressure monitoring program in your practice, what do you do with the BP information your patients report? Here is how to use the data from your patient’s self-measured BPs to make better decisions about diagnosing and treating hypertension. Read more at AMA Wire. These stories are featured as part of the AMA’s Navigating the Payment Process and Targeting Hypertension topic pages. Explore other Medical Topics That Matter.

Study compares EHR clinical documentation notes between physicians, nursesA study in the International Journal of Medical Informatics showed that only 26% of patients' EHRs had exact matches in clinical documentation notes between physicians and nurses. Researchers used Unified Medical Language System Concept Unique Identifiers to evaluate 58 distinct physician discharge summaries and corresponding plans from nurses and found that in general, around 27 terms were included in physician discharge summaries, compared with an average of 18 terms in nurse discharge summaries. EHR Intelligence (3/22)

Women are Most at Risk for StrokeStroke affects 55,000 more women than men each year in the U.S., is a leading cause of disability and the third leading cause of death in women, researchers note.