Improve Population Health

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Improving Cardiac Health, Preventing Stroke and Reducing Cardiac Disparities

In alignment with the U.S. Department of Health and Human Services (HHS)’ Million Hearts® goal to prevent one million heart attacks and strokes by 2017, Quality Innovation Network (QIN)-QIOs focus on improving the ABCS (Aspirin therapy when appropriate, Blood pressure control, Cholesterol management, and Smoking screening and cessation) to reduce cardiac risk. As part of this national effort, the QIO Program is targeting blood pressure measurement and control as essential to preventing heart attacks and strokes and decreasing the number of Americans who die unnecessarily as a result of untreated hypertension.

Reducing Disparities in Diabetes Care

In the United States, nearly one-third of adults 65 years and older have diabetes, according to the National Institutes of Health (NIH, 2011).

The Centers for Disease Control and Prevention (CDC) reports that African Americans are 1.4 to 2.2 times more likely to have diabetes than Caucasians. Asian/Pacific Islanders also have a higher prevalence of diabetes than non-Hispanic Caucasians, and people who identify as Hispanic/Latino have a higher prevalence of diabetes than non-Hispanic populations. The prevalence of diabetes among American Indians/Native Americans is 2.8 times the overall rate.  Through the Everyone With Diabetes Counts (EDC) program, QIN-QIOs are targeting these populations and Medicare beneficiaries of any ethnicity living in rural areas. QIN-QIOs work with familiar and trusted people and organizations such as healthcare providers, practitioners, certified diabetes educators (CDEs), and community health workers (CHW) within communities to provide diabetes self-management education, improve clinical outcomes, and increase adherence to clinical guidelines. This community-based approach encourages participation and provides a structure to support and empower people to take an active role to control their diabetes. 

Coordinating Prevention through Health Information Technology

Effective use of health information technology (health IT) decreases paperwork, improves access to medical records, and facilitates care coordination among providers. QIN-QIOs provide targeted technical assistance to physicians, acute care hospitals, and critical access hospitals that qualify for the Medicare Electronic Health Record (EHR) Incentive Program and that encounter barriers in using EHR functionality for quality improvement. QIN-QIOs continue to work with Regional Extension Centers (REC) to help more practices employ an IT-enabled care management approach for primary care prevention and early diagnosis. This approach includes using EHR functionalities – like registries – to identify patients who need a mammogram or other preventive service. By taking part in QIN-QIO health IT initiatives, physicians also will be well-positioned for future payment incentives linked to clinical data reporting.