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.
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