- Email: [email protected]
Role of hospital discharge statistics in evaluating the impact of statewide coordination of high blood pressure control programs
450
ABSTRACTS: HIGH BLOOD PRESSURE CONTROL
180 age > 36) are contacted by mail and telephone to request attendance at a follow-up blood pressure clinic. To date, 25,085 ER records have been reviewed and 2,662 individuals had elevated blood pressures and have been contacted for secondary screening. To date, 770 have returned for rescreening. There were 237 individuals referred to their family physician due to elevated blood pressures; 100 reported no prior history of hypertension. Follow-up with clients and their physicians allows us to monitor progress toward achieving and maintaining blood pressure control. Of the 237 clients referred to a physician only 5 are out of follow-up. Of the remaining 232 clients, 164 have been successfully referred to their family physician. Complete physician reports on 93 clients indicate that 85% are under treatment for high blood pressure and 63% have achieved blood pressure control. Initial screening, in the form of ER chart review, costs $.28 per person. It costs $29.86 to follow-up each referral to physician and $168.52 per new hypertensive identified and placed under a physician’s care. Our experience indicates that the total annual costs of this program are approximately $6,300. This model hospital based program could easily be used for cost-effective blood pressure control in most communities. A-75 as an Indicator of High Blood Pressure Control Progrum Success. BELAVADI S. Maryland State Department of Health and Mental Hygiene, 201 W. Preston Street, Baltimore, Maryland 21201; JOHN W. SOUTHARD.
Stroke Mortulity SHANKAR,
Age-adjusted stroke mortality rates (for persons age 35 and older) between 1969 and 1977 show interesting trends among different race and sex groups and among HSA Regions in Maryland. While rates generally declined over the period in all groups, the trends and the magnitude of decrease are, by no means, uniform. Blacks in the state experienced a stroke mortality rate reduction of almost onethird, while whites enjoyed only a 15% drop. In Baltimore City, decline was about 32% for both races and both sexes. The two suburban counties surrounding Washington, D.C. show striking differences. Although Prince George’s County shows a higher decline overall as compared to Montgomery County, blacks in the Prince George’s County experienced an increase in their rates. These differences and similarities are examined in the light of geographic and population characteristics, availability and utilization of health services, etc. Regression analysis techniques are used in an attempt to identify the variables (from among more than twenty-five independent variables) that could influence stroke mortality rates. The results of these analyses will be used in developing the Statewide High Blood Pressure Coordination Plan as well as in the assessment of the impact of statewide activities to control high blood pressure. This mortality study is part of continuing research at the Maryland State Department of Health and Mental Hygiene. A-76 Role of Hospital Discharge Statistics in E\uluuting the Impact oj’statewide Coordination of High Blood Pressure Control Programs. BELAVADI S. SHANKAR, Maryland State Department of Health and
Mental Hygiene, 201 W. Preston Street, Baltimore, Maryland 21201; R. W. SCHURMAN;JOHN W. SOUTHARD.
PATTERSON RUSSELL;
EARL
A systematic random sample of 5% from all patients 18 years and older discharged during 1978 from 50 hospitals in the state has been selected. Minimum data, such as age, race, sex, blood pressure, diagnostic and treatment procedure, advice, and follow-up regarding high blood pressure, were abstracted. Twenty-two thousand abstracts from about 500,000 discharges are included in the analysis. Preliminary analysis shows that about 8% of patients had diastolic blood pressure measurements of 100 or more at admission, and about 18% had at least one diastolic blood pressure measurement of 100 or more while in the hospital. Only 23% of those with diastolic of 100 or more were diagnosed as hypertensive and only 60% of those diagnosed were given medication and 30% were instructed regarding hypertension. Practices of diagnosis, treatment, and advice for these patients are described. Evidence from recent studies shows that almost everyone has had his blood pressure taken within 3 years and that people are increasingly becoming aware of the problem. Yet high blood pressure control rates are still not satisfactory, and the prevalence of elevated blood pressure continues to be high.
451
ABSTRACTS: HIGH BLOOD PRESSURE CONTROL
Efforts are being made in Maryland to bring individuals and organizations throughout the state together to plan and implement strategies to achieve a higher degree of success in controlling high blood pressure. This paper describes the part played by one major health sector, the acute general hospital, in providing a basis for measuring the impact of these statewide activities. This survey will be repeated in 1983 to identify any changes in hospital practices regarding high blood pressure. A-77 A Community Approach
to High Blood Pressure Detection
and Follow-Up.
SALLIE
J. SHANNON,
Community Action To Control High Blood Pressure, Kalamazoo, Michigan. Community Action To Control High Blood Pressure (CATCH) has been actively involved in blood pressure screening, detection, and follow-up in Kalamazoo County for the past 2 years. Funded by Michigan Department of Public Health, yet independent from the local health department, CATCH has screened over 10,000 employees in 100 industries, offices, plants, staffs of two separate school systems, and faculties of a local university and college. Our organization includes two volunteer directors, an R.N. coordinator, two specially trained screeners, and a follow-up coordinator. Yet, even working on a part-time level, we have had 60 to 100% participation in on-site screening, 80% successful referrals to a physician for all persons who showed evidence of high blood pressure levels at the screening site, and 70% maintenance on treatment over a 2-year period. Consistently, 10% of our Kalamazoo County employees have shown high blood pressure levels, i.e., 160 or above systolic, 96 or above diastolic. The average age of our screened population has been 39 years. We have barely begun to detect the projected 30,000 suspected hypertensives in the county population of 200,000; but, with minimal bureaucratic structure, deployment of available state funds has been excellent, approximately $1.70 per person for screening and follow-up which is a minimal amount in contrast with other programs. Our future goals include continued industrial-site screening; a broadened screening approach, i.e., churches, taverns, restaurant staffs, university student populations, car washes, anywhere people will congregate; and, to reach the rural population, the training of pharmacists to check blood pressures of their customers in the small rural towns. A-78 Evaluating
Success of Community
SHEPARD, Veterans LORENZ J. FINISON.
Programs
in Controlling
High Blood Pressure.
DONALD
S.
Administration Outpatient Clinic, 17 Court St., Boston, Massachusetts 02108;
Success at blood pressure (BP) control is an important outcome indicator for community hypertension programs. Evaluation is complicated, however, by the variability of an individual’s BP and the impracticability of control groups. Although comparisons between baseline and follow-up pressures are useful, their interpretation is confounded by the tendency of high pressures to decline just as a result of regression to the mean. We have developed statistical models to correct for this problem by calculating predicted regression effects from reliability data in the literature and baseline blood pressures in persons screened. When continuous BP measurements are used, the predicted decline in BP is subtracted from the actual decline to estimate the net program effect. In three community screening programs in Massachusetts, the overall mean decline in diastolic BP between the initial and second screen for 138 persons initially over 95 m m Hg was about 7 mm. The model estimates that regression accounts for 5 m m of this decline, so 2 m m is due to other reasons, particularly the pressor effect. The decline was 2 m m greater in persons who were not previously aware of being hypertensive compared to those already aware, as predicted by the model. When BP’s are categorized as controlled or elevated, the proportion estimated to become controlled due to regression should be subtracted from the actual proportion becoming controlled to estimate the net program effect. The model predicts, for example, that if 17% of persons screened had diastolic BP’s above 90 m m Hg at baseline, 44% of these persons will no longer be elevated at follow-up due to regression. The findings indicate that community programs can be evaluated with adjusted before and after comparisons, and that adjusted effects of screening and treatment may be much smaller than the crude changes.
ABSTRACTS: HIGH BLOOD PRESSURE CONTROL
180 age > 36) are contacted by mail and telephone to request attendance at a follow-up blood pressure clinic. To date, 25,085 ER records have been reviewed and 2,662 individuals had elevated blood pressures and have been contacted for secondary screening. To date, 770 have returned for rescreening. There were 237 individuals referred to their family physician due to elevated blood pressures; 100 reported no prior history of hypertension. Follow-up with clients and their physicians allows us to monitor progress toward achieving and maintaining blood pressure control. Of the 237 clients referred to a physician only 5 are out of follow-up. Of the remaining 232 clients, 164 have been successfully referred to their family physician. Complete physician reports on 93 clients indicate that 85% are under treatment for high blood pressure and 63% have achieved blood pressure control. Initial screening, in the form of ER chart review, costs $.28 per person. It costs $29.86 to follow-up each referral to physician and $168.52 per new hypertensive identified and placed under a physician’s care. Our experience indicates that the total annual costs of this program are approximately $6,300. This model hospital based program could easily be used for cost-effective blood pressure control in most communities. A-75 as an Indicator of High Blood Pressure Control Progrum Success. BELAVADI S. Maryland State Department of Health and Mental Hygiene, 201 W. Preston Street, Baltimore, Maryland 21201; JOHN W. SOUTHARD.
Stroke Mortulity SHANKAR,
Age-adjusted stroke mortality rates (for persons age 35 and older) between 1969 and 1977 show interesting trends among different race and sex groups and among HSA Regions in Maryland. While rates generally declined over the period in all groups, the trends and the magnitude of decrease are, by no means, uniform. Blacks in the state experienced a stroke mortality rate reduction of almost onethird, while whites enjoyed only a 15% drop. In Baltimore City, decline was about 32% for both races and both sexes. The two suburban counties surrounding Washington, D.C. show striking differences. Although Prince George’s County shows a higher decline overall as compared to Montgomery County, blacks in the Prince George’s County experienced an increase in their rates. These differences and similarities are examined in the light of geographic and population characteristics, availability and utilization of health services, etc. Regression analysis techniques are used in an attempt to identify the variables (from among more than twenty-five independent variables) that could influence stroke mortality rates. The results of these analyses will be used in developing the Statewide High Blood Pressure Coordination Plan as well as in the assessment of the impact of statewide activities to control high blood pressure. This mortality study is part of continuing research at the Maryland State Department of Health and Mental Hygiene. A-76 Role of Hospital Discharge Statistics in E\uluuting the Impact oj’statewide Coordination of High Blood Pressure Control Programs. BELAVADI S. SHANKAR, Maryland State Department of Health and
Mental Hygiene, 201 W. Preston Street, Baltimore, Maryland 21201; R. W. SCHURMAN;JOHN W. SOUTHARD.
PATTERSON RUSSELL;
EARL
A systematic random sample of 5% from all patients 18 years and older discharged during 1978 from 50 hospitals in the state has been selected. Minimum data, such as age, race, sex, blood pressure, diagnostic and treatment procedure, advice, and follow-up regarding high blood pressure, were abstracted. Twenty-two thousand abstracts from about 500,000 discharges are included in the analysis. Preliminary analysis shows that about 8% of patients had diastolic blood pressure measurements of 100 or more at admission, and about 18% had at least one diastolic blood pressure measurement of 100 or more while in the hospital. Only 23% of those with diastolic of 100 or more were diagnosed as hypertensive and only 60% of those diagnosed were given medication and 30% were instructed regarding hypertension. Practices of diagnosis, treatment, and advice for these patients are described. Evidence from recent studies shows that almost everyone has had his blood pressure taken within 3 years and that people are increasingly becoming aware of the problem. Yet high blood pressure control rates are still not satisfactory, and the prevalence of elevated blood pressure continues to be high.
451
ABSTRACTS: HIGH BLOOD PRESSURE CONTROL
Efforts are being made in Maryland to bring individuals and organizations throughout the state together to plan and implement strategies to achieve a higher degree of success in controlling high blood pressure. This paper describes the part played by one major health sector, the acute general hospital, in providing a basis for measuring the impact of these statewide activities. This survey will be repeated in 1983 to identify any changes in hospital practices regarding high blood pressure. A-77 A Community Approach
to High Blood Pressure Detection
and Follow-Up.
SALLIE
J. SHANNON,
Community Action To Control High Blood Pressure, Kalamazoo, Michigan. Community Action To Control High Blood Pressure (CATCH) has been actively involved in blood pressure screening, detection, and follow-up in Kalamazoo County for the past 2 years. Funded by Michigan Department of Public Health, yet independent from the local health department, CATCH has screened over 10,000 employees in 100 industries, offices, plants, staffs of two separate school systems, and faculties of a local university and college. Our organization includes two volunteer directors, an R.N. coordinator, two specially trained screeners, and a follow-up coordinator. Yet, even working on a part-time level, we have had 60 to 100% participation in on-site screening, 80% successful referrals to a physician for all persons who showed evidence of high blood pressure levels at the screening site, and 70% maintenance on treatment over a 2-year period. Consistently, 10% of our Kalamazoo County employees have shown high blood pressure levels, i.e., 160 or above systolic, 96 or above diastolic. The average age of our screened population has been 39 years. We have barely begun to detect the projected 30,000 suspected hypertensives in the county population of 200,000; but, with minimal bureaucratic structure, deployment of available state funds has been excellent, approximately $1.70 per person for screening and follow-up which is a minimal amount in contrast with other programs. Our future goals include continued industrial-site screening; a broadened screening approach, i.e., churches, taverns, restaurant staffs, university student populations, car washes, anywhere people will congregate; and, to reach the rural population, the training of pharmacists to check blood pressures of their customers in the small rural towns. A-78 Evaluating
Success of Community
SHEPARD, Veterans LORENZ J. FINISON.
Programs
in Controlling
High Blood Pressure.
DONALD
S.
Administration Outpatient Clinic, 17 Court St., Boston, Massachusetts 02108;
Success at blood pressure (BP) control is an important outcome indicator for community hypertension programs. Evaluation is complicated, however, by the variability of an individual’s BP and the impracticability of control groups. Although comparisons between baseline and follow-up pressures are useful, their interpretation is confounded by the tendency of high pressures to decline just as a result of regression to the mean. We have developed statistical models to correct for this problem by calculating predicted regression effects from reliability data in the literature and baseline blood pressures in persons screened. When continuous BP measurements are used, the predicted decline in BP is subtracted from the actual decline to estimate the net program effect. In three community screening programs in Massachusetts, the overall mean decline in diastolic BP between the initial and second screen for 138 persons initially over 95 m m Hg was about 7 mm. The model estimates that regression accounts for 5 m m of this decline, so 2 m m is due to other reasons, particularly the pressor effect. The decline was 2 m m greater in persons who were not previously aware of being hypertensive compared to those already aware, as predicted by the model. When BP’s are categorized as controlled or elevated, the proportion estimated to become controlled due to regression should be subtracted from the actual proportion becoming controlled to estimate the net program effect. The model predicts, for example, that if 17% of persons screened had diastolic BP’s above 90 m m Hg at baseline, 44% of these persons will no longer be elevated at follow-up due to regression. The findings indicate that community programs can be evaluated with adjusted before and after comparisons, and that adjusted effects of screening and treatment may be much smaller than the crude changes.