CDC director calls for focus on public health 'ABCs'
Integrating health IT, data registries and public health interventions can lead to better care, decrease the number of deaths per year from preventable healthcare-related infections and conditions and help patients gain better control or their comorbidities such as hypertension, said Thomas R. Frieden, MD, director of the Centers for Disease Control and Prevention, during a webinar Dec. 15 sponsored by the Office of the National Coordinator (ONC) for Health IT.
Frieden said that healthcare-associated infections are linked to almost 100,000 deaths per year and cost almost $30 billion in healthcare expenditures annually, yet one-third of these are preventable.
Avoiding preventable death and illness may be feasible with a better focus on improving the health status of Americans by implementing long-lasting interventions, ongoing clinical care and education and patient counseling.
“Public health interventions can make a big difference,” Frieden offered.
But even with the integration of public health interventions, heart disease and stroke will still claim the lives of most people worldwide, said Frieden. "Nearly 800,000 people have their first heart attack each year and another half a million have a recurrent heart attack each year,” he said. In addition, coronary heart disease soaks up almost $300 billion of the total healthcare costs in the U.S.
“Coronary heart disease, stroke, hypertensive disease, heart failure and other causes are major drivers of the unaffordable healthcare inflation that we are living through,” said Frieden. “What can we do about it?”
The CDC created a model that looked at health improvements—the ABCs: aspirin, blood pressure control, cholesterol control and smoking cessation. “Those four interventions could save about 100,000 lives a year and that number is far more than any other clinical intervention,” said Frieden.
Looking at the ABCs in the U.S. and their improvements, Frieden said that the “U.S. would get an ‘F.’ Hypertension is the single leading cause of death and less than half of Americans have high-blood pressure under control. And only 29 percent of Americans have high cholesterol controlled and only 20 percent of smokers who are trying to quit get help."
Frieden said that the only way to alleviate these problems is to implement systems of change and incorporate health IT. “ABCs have the greatest potential to save lives and reduce health inequalities. They need to be promoted by systems, clinicians and the public,” he said.
EHRs can be a forerunner in facilitating clinical decision support, monitoring patients and providing feedback on specific patient populations.
Four questions that often go unanswered at practices are: How many patients are in your practice? What proportion of them has high blood pressure? Of those with high blood pressure, what proportion are under control? And of those not under control, what proportion are on a diuretic? Using the registered functions of an EHR a physician can get the answers to these questions in four clicks or less, said Frieden.
Because hospitals can now mine the patient data of specific patient populations, they have the ability to make dramatic improvements and get the majority of patients in control of their comorbidities.
Currently, our healthcare system is not structured to maximize health, and if we want patients to do something, like fill prescriptions, addressing deductibles and co-pays and creating innovative care models can make this process easier, he said.
“Ultimately we need health information systems that are oriented toward prevention. That's going to allow us to implement incentives... that reward disease prevention and effective chronic disease management,” said Frieden. “That's going to depend on care management so practice workflows support prevention and patient care. What can be measured can be managed.”
Frieden said there will be three key phases for meaningful use: immunization registries, electronic laboratory reporting and syndromic surveillance. While immunization information systems can enhance interoperability and clinical support, they are not well established, he said. In addition, while electronic lab reporting is extremely important, it is also difficult.
Use of registries, such as the tuberculosis registry, can help monitor the entire 35 million-plus population of patients with TB. However, “don't underestimate the challenge of this for your partners at state and local health departments,” said Freiden. Institutions should work with public health entities and try to “foster a relationship” to ease the troubles during meaningful use integration, he said.
“We want a world where quitting smoking is easy and starting is far from the norm, where people practice safer sex to avoid HIV and other STDs, where hospitalization is rare and safe, where our per capita healthcare costs are falling and our life expectancy is rising, where aging is a healthy and engaging process where people are disability-free for as long as possible,” Frieden concluded.
“This is all within our reach and working together we can travel that road.”
Frieden said that healthcare-associated infections are linked to almost 100,000 deaths per year and cost almost $30 billion in healthcare expenditures annually, yet one-third of these are preventable.
Avoiding preventable death and illness may be feasible with a better focus on improving the health status of Americans by implementing long-lasting interventions, ongoing clinical care and education and patient counseling.
“Public health interventions can make a big difference,” Frieden offered.
But even with the integration of public health interventions, heart disease and stroke will still claim the lives of most people worldwide, said Frieden. "Nearly 800,000 people have their first heart attack each year and another half a million have a recurrent heart attack each year,” he said. In addition, coronary heart disease soaks up almost $300 billion of the total healthcare costs in the U.S.
“Coronary heart disease, stroke, hypertensive disease, heart failure and other causes are major drivers of the unaffordable healthcare inflation that we are living through,” said Frieden. “What can we do about it?”
The CDC created a model that looked at health improvements—the ABCs: aspirin, blood pressure control, cholesterol control and smoking cessation. “Those four interventions could save about 100,000 lives a year and that number is far more than any other clinical intervention,” said Frieden.
Looking at the ABCs in the U.S. and their improvements, Frieden said that the “U.S. would get an ‘F.’ Hypertension is the single leading cause of death and less than half of Americans have high-blood pressure under control. And only 29 percent of Americans have high cholesterol controlled and only 20 percent of smokers who are trying to quit get help."
Frieden said that the only way to alleviate these problems is to implement systems of change and incorporate health IT. “ABCs have the greatest potential to save lives and reduce health inequalities. They need to be promoted by systems, clinicians and the public,” he said.
EHRs can be a forerunner in facilitating clinical decision support, monitoring patients and providing feedback on specific patient populations.
Four questions that often go unanswered at practices are: How many patients are in your practice? What proportion of them has high blood pressure? Of those with high blood pressure, what proportion are under control? And of those not under control, what proportion are on a diuretic? Using the registered functions of an EHR a physician can get the answers to these questions in four clicks or less, said Frieden.
Because hospitals can now mine the patient data of specific patient populations, they have the ability to make dramatic improvements and get the majority of patients in control of their comorbidities.
Currently, our healthcare system is not structured to maximize health, and if we want patients to do something, like fill prescriptions, addressing deductibles and co-pays and creating innovative care models can make this process easier, he said.
“Ultimately we need health information systems that are oriented toward prevention. That's going to allow us to implement incentives... that reward disease prevention and effective chronic disease management,” said Frieden. “That's going to depend on care management so practice workflows support prevention and patient care. What can be measured can be managed.”
Frieden said there will be three key phases for meaningful use: immunization registries, electronic laboratory reporting and syndromic surveillance. While immunization information systems can enhance interoperability and clinical support, they are not well established, he said. In addition, while electronic lab reporting is extremely important, it is also difficult.
Use of registries, such as the tuberculosis registry, can help monitor the entire 35 million-plus population of patients with TB. However, “don't underestimate the challenge of this for your partners at state and local health departments,” said Freiden. Institutions should work with public health entities and try to “foster a relationship” to ease the troubles during meaningful use integration, he said.
“We want a world where quitting smoking is easy and starting is far from the norm, where people practice safer sex to avoid HIV and other STDs, where hospitalization is rare and safe, where our per capita healthcare costs are falling and our life expectancy is rising, where aging is a healthy and engaging process where people are disability-free for as long as possible,” Frieden concluded.
“This is all within our reach and working together we can travel that road.”