California’s environment encompasses more than beautiful beaches and mountain ranges; its great expanse is also home to significant health care disparities. The largest Hispanic population in the United States lives in California and is one of three ethnic groups most affected by cardiovascular disease, along with African Americans and Asian/Pacific Islanders. Serving the more than five million Medicare beneficiaries residing in California and dedicated to reducing the health care disparities these populations face, Health Services Advisory Group (HSAG), the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands, developed a resource to address these challenges: Promising Practices in Cardiovascular Disease: Closing the Gap in Minority Disparities.
Promising Practices offers more than 70 evidence-based, expert-recommended interventions to help physicians prevent and reduce disparities in cardiovascular-related conditions among minority populations. These interventions target the nine major factors related to quality cardiovascular care – administrative policies and procedures, communication with patients, overcoming financial barriers, patient education, dietary practices, physical activity, blood pressure control, aspirin and antiplatelet therapy, and smoking prevention and cessation. They serve as roadmaps for change that promote high-quality, efficient, and cost-effective care. For example, a Promising Practices patient education intervention recommends physicians discuss the meaning of the terms “overweight” and “obese” with their patients with cardiovascular disease. The medical definitions of these terms are different from the definitions based on cultural perspectives, and understanding what the medical community considers overweight/obese is important for patients when making choices related to health.
HSAG developed Promising Practices in response to needs identified when the organization participated in a Centers for Medicare & Medicaid Services’ (CMS) special project focused on reducing cardiovascular disparities. At the start of the project, HSAG convened a technical advisory committee of physician and non-physician healthcare disparities experts who encouraged the team to create the resource packet. “Feedback from the committee identified a specific need for the consolidation of resources about evidence-based practices related to reducing cardiovascular disparities,” said Mary Fermazin, M.D., MPA, HSAG Chief Medical Officer for HSAG in California.
Staff members conducted an exhaustive literature search to identify potential interventions and research related to improving cardiovascular care among the targeted populations – African Americans, Hispanics, and Asian/Pacific Islanders. Additionally, health care disparities experts were interviewed to gather more information about evidence-based and culturally appropriate interventions that lead to improved outcomes. HSAG staff members then synthesized their research and shared their findings with the technical advisory committee for additional feedback. When the packet was complete, according to Fermazin, “The committee suggested creating Promising Practices in an electronic format to allow busy physicians to quickly access the information they need with the click of a mouse.”
Initially, Promising Practices was offered to the medical groups and physicians participating with HSAG in the CMS special project, as well as to participants in HSAG’s peer learning group. Now, the resource is available to physician practices participating in HSAG’s cardiac health initiative and those that serve the targeted populations addressed in Promising Practices. The resource is also available on the HSAG website. To ensure Promising Practices reflects the latest recommendations, each year HSAG staff members will conduct general literature searches on the healthcare disparities, review the resource with a group of subject-matter experts, and make updates when substantive changes are identified.