According to a report published last month in Circulation, South Asians (from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan and Sri Lanka) are at higher risk of death from atherosclerotic cardiovascular disease (ASCVD) compared to other Asian groups and non-Hispanic whites. This is due to a unique profile of elevated risk factors such as cultural, linguistic and social barriers to accessing health care, which may impede clinical- and self-management of hypertension. Physicians also often lack evidence-based tools to identify and manage South Asian hypertensive patients or refer them to culturally-appropriate resources for cardiovascular care.
Recognizing the severity of the issue at hand, Atlantic Quality Innovation Network (AQIN), the Quality Improvement Network-Quality Improvement Organization (QIN-QIO) serving New York, South Carolina and Washington, D.C., partnered with New York University – City University of New York Prevention Research Center (NYU-CUNY PRC) and Healthfirst, a managed care organization, on a five-year project aimed at providing tools and resources to assist providers in better managing at-risk South Asian patients.
Beginning in October 2014, the QIN-QIO joined Project IMPACT (Implementing Million Hearts® for Provider and Community Transformation), a core research project of NYU-CUNY PRC, to spread Million Hearts interventions across small primary care settings serving the South Asian communityin New York City.
Phase one of the campaign focused on providing training to support the optimization of electronic health record (EHR) functions including registries, alerts and order sets to better manage hypertensive patients. During this phase, AQIN also assisted participating practices in using their EHRs to identify patients with uncontrolled hypertension. Phase two focused on integrating community health workers (CHWs) as part of the primary care team in participating practices, providing health coaching on hypertension control and management, and engaging patients in self management.
As a result of the program, all 14 participating practices implemented the EHR intervention strategies taught and completed EHR training on developing templates and alerts, creating order sets, printing patient-specific education materials and running registry reports. Four practices requested and received additional training on blood pressure measurement and management.
Nine of the participating practices were able to successfully attest to Medicaid Meaningful Use for 2016. Prior to Project IMPACT, only two practices were successful in attestation. Five participating practices also received National Committee for Quality Assurance Patient-Centered Medical Home recognition, and seven practices are currently working with CHWs on patient engagement in blood pressure control.
As cardiovascular disease continues to impact the South Asian community, AQIN is hoping Project IMPACT will be a starting point for practices to reverse the trend and make a positive change in the community.
Details of the clinical results of this NYU-CUNY PRC research study are expected to be published in Medical Care in winter 2019.