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Change of Heart: Online Assessment Reaches Patients Before They Enter ER

Cynthia Johnson, September 28, 2009

Since its release in 2004, approximately 600,000 people in the United States have taken a free, online risk assessment called HeartAware through the Web sites of the 85 hospitals that offer it. The assessment, created by the HeartAware Network (a division of Byrne Healthcare) analyzes a person's risk for cardiovascular disease—the leading cause of death in the US.

Of those who have taken the survey, the company reports that about 20,000 individuals have been identified as at risk and, as a result, have received a free cardiovascular screening with a cardiac nurse at their hospital.

Advocates of the tool say it identifies those at risk for cardiovascular disease, provides them with education, and, in turn, prevents needless visits to the ER. Skeptics argue that the survey is an invitation for patients to enter the "medical mall" and purchase unnecessary services.

Program offers dose of prevention
According to Greg Gossett, president of Denver-based HeartAware Network (www.heartaware.org), a wave of non-invasive diagnostics in cardiovascular medicine was introduced around the time the tool was in development. He says the company saw this trend as an opportunity to begin identifying at risk individuals and educating them about the new resources that were becoming available.

The HeartAware assessment asks patients a set of 15 questions that revolve around known, major cardiovascular risk factors, such as blood pressure, cholesterol, weight, and family history. The company also gives hospitals the flexibility to ask additional questions if it lines up with what they want to know. For example, one hospital asks patients if they have seen a dentist recently, because physicians at the hospital were curious about the possible correlation between poor dental hygiene and heart disease.

Each hospital implements the tool a bit differently, some requiring more hand-holding than others to get up and running. HeartAware trains hospitals to use the tool and provides them with necessary resources. In return, the company receives a monthly fee to operate the program for them.

The majority of hospitals do not have outside funding, but Gossett says that he is starting to see this change. Some HeartAware providers have partnered with insurance companies to receive monthly reimbursements for offering the free screenings to their members.

Most of the facilities offering HeartAware target patients between the ages of 45 and 65 years old. Gossett says heart disease is more prevalent for patients in this age group, who have also been proven to be the most underserved.

"There's a subset of people out there who don't have symptoms and really need to get in front of a provider," he says.

Less than 10% of the respondents are over 65. Gossett theorizes that most patients in this demographic are already under the care of a physician or cardiologist.

The content of the completed assessments belong to the hospitals. HeartAware has a privacy policy and the hospitals that host the assessment each write their own disclaimer, according to their facility's policies.

"We only give out access to a few people within the hospital who need to know and access the data, such as the screener," says Gossett. "We have extensive measures to protect the data coming into this program."

Critics say program may offer pound of cure
L. Gordon Moore, MD is a family medicine physician who believes in low-overhead, high-technology medical practices that provide patient-centered care that is efficient, effective, and accessible. He says that he is skeptical of tools like HeartAware.

"If people start to go through a survey, we can find something wrong with you and we have a solution," he says. "They are going to be drawn into the medical mall and they are going to get chewed up."

Carol Luscato, who has risk factors and a family history of heart disease, recently completed the HeartAware assessment offered by Edward Heart Hospital (www.edward.org) of Naperville, IL. She was identified as at risk and qualified for free screening and testing. The hospital also advised her to complete an additional test of her heart function, which is not covered under the program.

"I don't care," she says. "A hundred dollars is nothing to me when it means my heart and my life." Moore says that behind most health assessments is a business model that has little to do with quality and more to do with driving volume. "If you drive patients into specialty practices for analysis and intervention, you drive up costs, you drive up mortality, and you drive down quality," he says. "If you drive patients into primary care practices where they have an established relationship, you drive up quality and you drive down costs."

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