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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Implementing cardiac risk-factor case management: lessons learned in a county health system
Kathy Berra1, Jun Ma, Linda Klieman
1Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA 94305-5705, USA. kberra@stanford.edu
Critical Pathways in Cardiology
|December 20, 2007
Summary
Case-management (CM) effectively reduced cardiovascular risk in a low-income, multiethnic population. This study offers lessons for implementing CM programs to improve chronic disease care and patient outcomes.
Area of Science:
- Cardiovascular disease prevention
- Health services research
- Chronic disease management
Background:
- Case-management (CM) improves chronic disease care through intensive, individualized support.
- Implementing CM programs presents significant challenges, particularly in diverse, low-income settings.
- The Heart to Heart project evaluated a CM program for coronary heart disease (CHD) risk reduction.
Purpose of the Study:
- To assess the effectiveness of a CM program in reducing cardiovascular risk factors.
- To identify lessons learned for implementing CM in a county health system.
- To inform strategies for improving the efficiency and clinical impact of cardiovascular CM.
Main Methods:
- A randomized trial comparing CM plus usual primary care to primary care alone.
- CM involved intensive, longitudinal nurse and dietitian visits focusing on behavior change and guideline-based therapy.
- Participants were from a multiethnic, low-income population at elevated risk for CHD events.
Main Results:
- CM significantly reduced the mean 10-year CHD risk (1.56% absolute decrease, P = 0.007).
- Favorable changes were observed in most major CHD risk factors.
- Key lessons include the need for specific implementation strategies, methods for enhancing clinical effectiveness, and approaches to increase efficiency.
Conclusions:
- CM for cardiac risk factors faces implementation barriers, especially in county health systems.
- Recommended solutions aim to overcome these barriers and promote the adoption of evidence-based, patient-centered CM.
- Successful implementation can improve cardiovascular risk management and patient outcomes.
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