COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Employee and Public Services Department

 

DATE:

August 31, 2001

BOARD MEETING DATE:

September 18, 2001

 

TO:

Honorable Board of Supervisors

FROM:

Mary Welch, EPS Director
Paul Hackleman, Benefits Manager

SUBJECT:

Continuation of the Heart Program developed by Stanford's Center for Research in Disease Prevention and participation in the Stanford Heart Network.

 

Recommendations
Approve a resolution authorizing:

    1. A $50,000 increase in the Health and Fitness Trust Fund appropriation to pay costs to continue the County's Hear2t Program and

    2. The EPS Director to sign an agreement with Stanford to join its Stanford Heart Network to offer County employees a web-based Cardiovascular Risk Assessment.

 

Background
In 1997, the County implemented a cardiovascular risk reduction program developed by Stanford's Center for Research in Disease Prevention called Hear2t (Health Education and Risk Reduction Program). The program was implemented to address the County's nearly $1 million annual expenditures on cardiovascular-related disease. The County's three health plans contributed $180,000 with the County contributing $20,000.

In the initial program, 8,014 Cardiovascular Risk Assessments (CRAs) were sent to County employees, retirees and their dependents. The CRA was developed by Stanford as a highly predictive assessment tool for identifying individuals who are at risk for a cardiac event (heart attach, stroke, angioplasty) in the next five years.

Nearly 2,700 individuals completed the CRA and a total of 715 were identified in the "high" or "very high" risk category. These individuals were invited to complete clinical screenings. Based on these results, 319 individuals completed screenings and 266 individuals entered the program. In the program, participating individuals worked with a nurse who developed individualized action plans, monitored ongoing changes and coordinated medical care with the participant's physicians.

In 1999, a Phase II program was implemented. The County's three health plans contributed $90,000 and the County contributed $30,000. A total of 166 individuals were enrolled in Phase II, using the same eligibility criteria as Phase I. In 2000, the Aetna Foundation contributed an additional $20,000 to the program. Again, per Attachment 1, program results have continued to be evaluated by Stanford and demonstrate the same success in reducing risk factors in high risk individuals.

After each Phase, Stanford conducted clinical reviews. Attachment 1 is a summary by Stanford in five dimensions that indicates the impact of the program in reducing overall cardiovascular risk:

· Graph 1 summarizes the reductions participants made in nine cardiovascular risk factors at baseline (1997) and follow-up (through Phase II);

· Graph 2 identifies the percent of participants in the "high" or "very high" at baseline and follow-up, reflecting significant reductions in some categories and moderate reductions in other categories;

· Graph 3 summarizes the knowledge participants gain in developing strategies to reduce their risk;

· Graph 4 identifies the behavioral changes made by participants during both Phases;

· Graph 5 reflects the percentage of participants who followed the nurse's advice to involve their physician in initiating or modifying prescription therapy for reducing risk.

 

Discussion
In the next phase (Phase III) Stanford recommends that the program be transferred from Stanford to the County Health and Fitness / Risk Reduction program. A contract nurse would continue the individual counseling / case management services previously provided by the Stanford nurse. Individuals would continue to be identified as high risk through other County risk reduction programs (e.g. Health Risk Appraisals or County "Check" programs), or through CRAs.

In addition to transferring the program to the County, Stanford has asked the County to become a member of SHN. The County's participation would:

· Allow participants access to an on-site, self-administered (CRA) questionnaire that can be immediately reviewed / printed,

· Provide computer-generated, customized reports that identify risk factors and offer an participant-specific initial plan of action.

· Establish the County's Heart Program homepage on the SHN site,

· Incorporate important information links for the County and program participants,

· Allow Stanford to provide ongoing data to participants on ways to reduce identified risks,

· Be used to summarize aggregate data (without compromising the confidentiality of individual site / CRA participants) for use in evaluating the effectiveness of risk reduction interventions.

Participation in SHN requires the County to sign a StanfordHeart.Net Research Agreement. The resolution authorizes the Employee and Public Services director to sign the agreement upon approval by County Counsel and Stanford University.

 

Fiscal Impact
The cost of transferring the program is estimated at $50,000 including:

· Contracting with a nurse case-manager - $35,000 - $40,000

· Joining the Stanford Heart Network - $5,000 - $10,000

· Administrative expenses (e.g. County office space, phones, printing) - $5,000

The cost of the program will be paid by monies from the Health and Fitness Trust Fund that was established by the Board in 1995 as part of the implementation of the Blue Shield Point-of-Service Plan.