St. Agnes Hospital takes wellness on the road
Screenings prevent expensive episodes
Before St. Agnes Hospital took its Heart Wellness Program on the road, many people in the west Baltimore area who had little access to health care had no idea that they were at risk for heart disease. Six years and 15,000 screenings later, more than 4,000 people have discovered they are high-risk patients. At least 60% of those have gone on to seek follow-up care, says Patricia Santoni, a health educator and director of the program.
It’s difficult to track the cost savings of a program like this one, Santoni says, because many patients seek care at sites other than St. Agnes. But when you hear about the patient who "felt fine" but had a glucose level of over 500 points, you know the screenings can prevent expensive episodes.
The Heart Wellness Program offers screenings at malls, senior centers, schools, churches, neighborhood block parties, unemployment offices, city housing centers, and YMCAs in short, anywhere the underserved population is likely to spend time. What makes this program different from other screening efforts is that the service is offered free. In addition, patients receive follow-up calls and information to make sure they’re getting the care they need.
"A lot of hospitals, insurance companies, and other agencies offer screenings, but they don’t do it for free," Santoni says. "You won’t get access to these underserved people if you charge money. These people are worried about drive-by shootings in their neighborhoods, not how high their cholesterol is. A lot of them are on a fixed income, and they’re not going to spend even $5 on a screening. If it’s free, you can convince them there’s no reason not to do it."
People who want to be screened fill out a form detailing family and personal medical history. The team checks blood pressure, cholesterol, and blood sugar; a health educator distributes literature and advice. About a week later, the patient receives test results along with a letter and more information. Patients identified as high-risk based on the Dallas-based American Heart Association guidelines are referred to the hospital’s lipid management, cardiac access, diabetes education programs, or to a physician. (See Cost Management in Cardiac Care, June 1997, p. 78.) Six weeks later, and then again at six months after the screening, patients get follow-up phone calls to see how they’re doing and to offer further help finding appropriate care. One year after the screening, patients receive questionnaires.
"Patients don’t just get the screening and then never hear from us again," Santoni says. "These are people who would slip through the cracks if we operated that way."
"We convince them they don’t have anything to lose by getting screened," Santoni continues. "Many patients say they feel fine, and they do feel fine. They don’t know they have any of these things going on unless they get screened. The problem with heart disease is that it’s a silent killer."
One man who took advantage of the screening program is a mall walker. "He was screened at one of our malls," Santoni says. "[Since then], he’s dropped 100 pounds and 75 points on his cholesterol. He attributes his success to our program because, had he not stopped by that day and had his cholesterol checked, he would never have known he was at high risk. Now he’s on medication and sees his doctor regularly."
Santoni’s annual budget is $80,000. That includes her salary, a secretary’s salary, and supplies, as well as the cost of a rotating team of nurses and phlebotomists. "It’s money well-spent," she says.
If you’re interested in starting a similar program, make sure to get support from the hospital and community. Santoni says her rapport with area malls has made a big difference. She tries not to turn anyone down who wants to hold a screening and encourages word-of-mouth marketing.
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