DM program started with focus groups
Program addresses cardio risk factors
Before Health Plan Alliance started HeartSmart Sisters, a cardiovascular disease management program, the health plan held focus groups to determine what interventions would be most effective with its targeted group, African-American women.
The program was funded by a Michigan Department of Community Health grant to address cardiovascular risk factors in an urban population, says Jessica Gubing, MS, quality management manager for the Detroit-based HMO.
Effectiveness of interventions
HeartSmart Sisters targeted African-American women who had coronary artery bypass surgery, angioplasty, or a myocardial infarction and were between 40 and 70 years old.
"We were particularly interested in looking at secondary prevention of cardiovascular disease in women who have had some kind of cardiac event," says Patricia Marine Barrett, MHSA, director of quality at Health Plan Alliance.
The members responded well to the HealthSmart Sisters program. About half of those chosen for the program actively participated in all phases.
In the group that received interventions and had at least one modifiable risk factor, 73% maintained control of one of the modifiable risk factors compared with 66% of the control group who received routine care.
Participants in the health plan's focus groups include representatives from the Detroit Urban League, the NAACP, and members from the targeted population.
"We met with them to get their input on which interventions would be most effective, how they wanted to receive communications, and what types of materials they found most useful," Gubing says.
Members of the quality department designed the program and the materials that supported it based on information they got from the focus groups.
For instance, the written materials sent to participants were based on feedback from the women in the groups.
The women told Health Plan Alliance they preferred information presented in bullet points format. They also said they preferred actual pictures to cartoon-type graphics and wanted most of the people pictured to look like them.
The women chosen to participate in the project were identified through medical review. Because the health plan's database doesn't contain information about race, the team had to review the records individually to find eligible members and to identify some of the clinical indicators for the program, such as blood pressure levels.
Once a group of members was identified, they were divided into two random groups: those who received special interventions and a control group that received routine care.
The program included calls from case management nurses who promoted smoking cessation, weight loss programs, if necessary, and worked with the members to continue taking their medication, make follow-up visits to the physician, and work to improve their own health.
The nurses called the members four times over an eight-month period and gave them a telephone number they could call if they had questions.
Using the feedback from the focus groups, the health plan created brochures on topics such as diet and exercise, smoking, diabetes, hypertension, hyperlipidemia, stroke, coronary artery disease, and diagnostic and therapeutic options.
The brochures were mailed to coincide with the telephone calls from the case managers who went over the material in the brochures.
The participants were asked to take a pre-test before they read the brochures and to take a test afterwards to test their new knowledge.
There was an overall improvement in their scores. The biggest improvement was on the material about diagnostic tests and procedures.
By filling out the tests and returning them to Health Plan Alliance (HAP), the members earned "Continuing Member Education" points, which, in turn, earned them gift certificates to a local department store.
"We feel like they learned a lot from the brochures, so we believe that the format is effective for that population, " Barrett says.
The health plan sponsored diet seminars in the community during which a nutritionist provided ethnically desirable types of recipes that were heart-smart. The participants responded well to the recipes and expressed interest in the seminars but attendance was sparse, Gubing says.
"The seminars were in the community at a central location. The women didn't indicate that the location was a problem. Attendance was not a priority with them," Barrett says.
The case managers assessed the number of risk factors each patient possessed and helped the patient decide which risk factor they were ready to address.
"The case managers reminded them about everything connected to their medical condition and focused on one issue at a time," Gubing says.
The goal most people were able to meet was lowering their blood pressure. Lowering cholesterol was next followed by stabilizing the hemoglobin A 1C levels for women with diabetes.
Members who had two modifiable risk factors, such as high blood pressure and weight, and were in the group that received interventions, had a 6% higher rate of improvement that did those in the control group.
Although the funding for the project has run out, the health plan is continuing to offer the brochures to its member. HAP publishes a newsletter for members that included a description of the program and offered support and brochures to people who wanted to participate.
The brochures are being used by case managers in the health plan's cardiovascular disease management program, who send them to members they identify as African-American.
"Because we don't have racial information in our database system, it's a fairly intensive process to obtain information. Until we have a mechanism to routinely identify African-American women at risk, we will be providing the materials upon request to people who want them," Barrett says.
Before Health Plan Alliance started HeartSmart Sisters, a cardiovascular disease management program, the health plan held focus groups to determine what interventions would be most effective with its targeted group, African-American women.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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