Hospitals look to AHA programs to improve population health
By Gray Ellrodt, M.D.  

As healthcare systems, hospitals and communities throughout the U.S. continue to address the often uphill challenge of improving population health, more and more are looking to the turnkey packages of prevention and treatment programs developed by the American Heart Association (AHA) across the life span of the average American.

‘While U.S. life expectancy (currently at 78.6 years) is down slightly for the first time in nearly 100 years, perhaps driven by the recent epidemic in opioid overdose deaths, the fact is that Americans are living longer than ever. The big question, of course, is around the quality of those longer lives. In some ways, we’re living longer, but somewhat sicker lives, kept alive by the medical and pharmaceutical advances of the 20^th and 21st centuries.

 If you were to plot a simple axis graph tracking quality of life over time in years, from pre-birth to end of life, you would see a steep downward slope in quality of life far earlier in the life span than ideally should be the case, particularly for patients who are socio-economically challenged.  Our goal as the stewards of population health is to push out that timeline and make the downward slope much more gradual, so that quality of life actually improves before slowly declining toward the end of life.

Many healthcare systems have tried to develop their own strategies and tactics to move that needle, but increasingly they are finding greater success in adopting ready-made, scientifically-tested programs developed by organizations like American Heart.  Having experienced the effectiveness of AHA’s Get with the Guidelines program, setting new in-hospital protocols for treating heart attacks, strokes, atrial fibrillation, heart failure and other conditions, hospitals are looking to other AHA programs covering a life-long spectrum of conditions.

Using predictive analytics that identify likely health conditions over time, those programs are bundled into four categories along the continuum:

PRIMORDIAL CARE.  This is the period of life from before birth (when mother is bearing the child) through infancy, childhood, adolescence and young adulthood. By identifying high-risk groups early, the goal is to prevent early onset of chronic conditions. The AHA offers several programs and family services which many hospitals are incorporating

PRIMARY PREVENTION. The focus here is on patients at higher risk of diabetes, hypertension, heart disease and other condition based on such factors as family history and actual behaviors like diet and smoking.  The AHA has created multiple consumer-facing programs such as Target BP which health systems are tailoring to their populations.

ACUTE CARE & DISEASE MANAGEMENT. Here’s where an acute event likely has occurred and the patient has an established high-risk condition such as coronary artery disease, cardiovascular disease and heart failure. Again, the goal is to treat the condition in a way that extends and improves quality of life. The AHA’s flagship Mission Lifeline and Get with the Guidelines programs are part of this mix.

END OF LIFE. Once a patient has reached this stage, hopefully having enjoyed a long, good-quality life, the emphasis moves to palliative care and emotional support for patient and family. Here again, the AHA has guidelines and recommendations to utilize.

Actionable guidelines like those developed by AHA, if fully integrated into treatment protocols of hospitals and health care systems, can dramatically improve quality and continuity of care and truly improve the health of our communities.  That level of focus is particularly critical in areas with large segments of socio-economically stressed patients, whose lives are significantly shorter and sicker than the population at large.  We can close that gap and remove those inequities through a system of accountable care that reaches everyone.

A healthier community is why so many of the nation’s 5,000-plus hospitals are embracing these proven models of treatment delivery.

Gray Ellrodt, M.D., is chief quality officer, chairman, Department of Medicine, Berkshire Medical Center.