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How a Healthcare Collaborative Slashed AMI Hospitalizations by 22%

Analysis  |  By Christopher Cheney  
   September 04, 2018

San Diego's healthcare collaborative cut acute myocardial infarction hospitalizations through clinical care improvement and increased engagement with patients and community organizations.

A healthcare collaborative in San Diego achieved a 22% reduction in heart attack hospitalization rates compared to an 8% reduction in the rest of California, research published this week says.

The collaborative—Be There San Diego—launched in 2011. The 22% reduction in heart attack hospitalization rates was attained from 2011 to 2014, avoiding about 3,800 hospitalizations and attaining an estimated $86 million in savings.

The collaborative was designed to decrease cardiovascular events through spreading best practices for better control of hypertension, lipid levels, and blood sugar. Be There San Diego (BTSD) also sought to increase engagement with patients and community organizations.

The researchers, who published their study in Health Affairs, say the BTSD model can be recreated across the country.

"Although this type of collaborative might be more challenging to execute in geographic areas that have larger populations or are more spread out—with a greater number of healthcare systems—than is the case in San Diego County, the basic organization and implementation of BTSD should be generally applicable elsewhere," they wrote.

Clinical care

BTSD features physician groups, health plans, federally qualified health centers, and health systems that provide care for two-thirds of San Diego County's 3.3 million residents.

The clinical care efforts of the collaborative are focused on identifying and modifying risk factors, improving quality of care, and implementing best practices:

  • Use of a simplified hypertension treatment to improve management of hypertension, lipid levels, and blood sugar
  • Adoption of a medication bundle to boost medication adherence and reduce cardiovascular events among patients at high risk of heart attack
  • Expansion of health-coach services
  • Holding monthly meetings to share best practices among clinicians and community organizations, including the review of key clinical metrics
  • Sharing information through the Data for Quality project, which gives healthcare organizations the ability to share aggregated quality metric data confidentially

Patient engagement

Health coaches are playing a key role in BTSD's patient engagement efforts, particularly in increasing the use of medications for hypertension and hypercholesteremia.

The health coaches, who are deployed by healthcare organizations and trained by BTSD, engage patients with monthly phone calls to lower barriers to medication adherence and increase goal achievement.

Community engagement

BTSD has established a faith-based partnership with African American churches in Southeastern San Diego, which is one of the county's most socioeconomically disadvantaged communities. The partnership is designed to serve as a "cardiovascular learning community," the Health Affairs researchers wrote.

"This learning community consists of faith leaders who meet to discuss efforts to improve their congregants' cardiovascular health through changes such as improved organizational nutrition policies, promoting healthy behaviors through walking clubs and other organized activities, and linking congregants who have high blood pressure to clinical care."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.

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