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Improving Health Outcomes

The American Medical Association is galvanizing a new, bold professional movement in pursuit of healthier people, better health care and lower health care costs.

The AMA is committing its resources, expertise and reach to prevent heart disease and type 2 diabetes and to improve outcomes for those suffering from these diseases. The toll of these two diseases—both in dollars and human suffering—is staggering.

To improve health outcomes, we believe a new approach is required: by focusing on health as well as medical care, and by strengthening links between the clinic and community through novel strategies and collaborations, we can achieve a healthier nation.

  • Our Approach
  • Prediabetes
  • Hypertension
  • Collaboration
  • Our Approach

    Why the American Medical Association?

    The AMA is in a unique position to reach physicians in all practice settings and specialties. Our work to improve the health of the nation positions us to bring physicians together with communities and public and private sector organizations to prevent—and to achieve measurable improvements in health outcomes for—cardiovascular disease and diabetes.

    Why cardiovascular disease and diabetes?



    The American Medical Association chose to focus on cardiovascular disease and type 2 diabetes because these conditions impact millions of patients and nearly all physicians, cause enormous suffering and death, and add significant costs to our economy.

    In addition, the direct and indirect costs of cardiovascular disease and diabetes are more than $535 billion a year. With proper intervention, the effects of these conditions can be dramatically reduced, leading to a healthier nation and reducing health care spending.

    How is the AMA tackling prediabetes and high blood pressure?

    To address these risk factors, we are collaborating with other organizations to develop new approaches to prevent progression of prediabetes to diabetes and to achieve better control of high blood pressure.

    We have teamed up with the YMCA of the USA to help prevent the onset of type 2 diabetes among Medicare participants who have prediabetes. We collaborated with the YMCA to help increase the number of Medicare participants screened and referred by physicians to the YMCA Diabetes Prevention Program, with the longer-term goal of increasing referral of all adults who have prediabetes.

    We have also launched a new, multi-year initiative with the Centers for Disease Control and Prevention (CDC) called “Prevent Diabetes STAT: Screen, Test, Act – Today™.” We invite physicians and care teams, patients and their families, employers, insurers and community-based organizations to join us in this important effort.

    Learn more

    To prevent heart disease, the AMA is working with the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality and the Center to Eliminate Cardiovascular Health Disparities to create a nationwide professional movement by supporting practices and health centers in their efforts to improve hypertension control. Our efforts will work in concert with the U.S. Department of Health and Human Services' "Million Hearts®" initiative, for which a primary objective is to bring the high blood pressure of 10 million more American under control by 2017.

    Learn more
    Find out more about other important AMA Improving Health Outcomes alliances

    Resources:

    Improving health outcomes strategic focus
    About type 2 diabetes and prediabetes
    About hypertension (high blood pressure)

  • Prediabetes

    To address type 2 diabetes, we are focusing our attention and resources on prediabetes, a serious health condition that increases the risk of developing type 2 diabetes, heart disease and stroke.

    Evidence-based programs to address prediabetes can prevent or delay progression to diabetes.

    The problem

    Approximately 86 million Americans have prediabetes—that's about one in three people—and in U.S. adults aged 65 years or older, the percentage is even higher, at roughly 50 percent.

    And only about 10 percent of people who have prediabetes know they have it.

    How is the AMA improving health outcomes?

    We are creating innovative clinical-community linkages that leverage the existing, substantial body of evidence on diabetes prevention in order to make best practices easier to implement.

    To help prevent diabetes and its associated health complications, and in support of the Center for Disease Control and Prevention's National Diabetes Prevention Program, we collaborated with the YMCA of the USA to:

    • Increase education and awareness of prediabetes by promoting physician practice screening and testing of those at risk
    • Increase physician referrals of people with prediabetes to the evidence-based diabetes prevention program offered by the YMCA
    • Create feedback loops, linking the patient's progress in the program to the physician's practice so that information can be integrated into the patient care plans

    What's happening right now?

    We are concluding our pilot work with physician practices and YMCAs in pilot sites in Delaware, Indianapolis, Minneapolis/St. Paul, and St. Petersburg and Venice, Fla. In these communities, a federal grant allows qualifying seniors who have prediabetes to participate in the YMCA Diabetes Prevention Program at no cost.

    Program eligibility

    Through a grant from the Center for Medicare & Medicaid Innovation, qualifying seniors in 17 communities can enroll in the YMCA Diabetes Prevention Program at no cost through March 2015.

    Qualifying seniors are 65 and older with Medicare coverage and no previous diagnosis of diabetes, and meet the following criteria:

    • BMI of 25 or greater (22+ for Asian individuals) AND
    • Blood values of:
      • A1c: 5.7%–6.4% OR
      • Fasting plasma glucose: 100–125 mg/dL OR
      • Two-hour (75 gm glucola) plasma glucose: 140–199 mg/dL

    Adults under the age of 65 who have prediabetes can also participate in the YMCA Diabetes Prevention Program, but they may have to pay a fee.



    Why the YMCA Diabetes Prevention Program?

    The YMCA Diabetes Prevention Program is part of the Centers for Disease Control and Prevention's evidence-based National Diabetes Prevention Program. The YMCA is the largest provider of the diabetes prevention program, offering the lifestyle intervention program through YMCAs in more than 40 states.

    The diabetes prevention program offered by the YMCA is a one-year community-based program led by a trained lifestyle coach. Participants gather in a relaxed classroom setting and work together in small groups for 16 weekly sessions, then eight monthly sessions to incorporate healthier eating and moderate physical activity into their daily lives.

    The YMCA Diabetes Prevention Program is based on research funded by the National Institutes of Health that showed, among adults with prediabetes, a 58 percent reduction in the number of new cases of diabetes overall, and a 71 percent reduction in new cases among those over age 60.

    An article in American Medical News provides a valuable overview of the impact the YMCA Diabetes Prevention Program has on patients, providers and communities.

    What can physician practices do right now?



    All practices can start screening for prediabetes right now, to prevent type 2 diabetes before it starts.

    Visit the Prevent Diabetes STAT: Screen, Test, Act – Today™ initiative to download the AMA and CDC co-developed toolkit that serves as a guide for physicians and other health care providers on the best methods to screen, test and refer high-risk patients to diabetes prevention programs in their communities.

    For practices in communities where a Healthcare Innovation Award allows Medicare beneficiaries to enroll in the YMCA’s Diabetes Prevention Program at no cost through March 31, 2015, the AMA guide to refer patients to the YMCA’s Diabetes Prevention Program is targeted to make screening, testing and referral easy.

    Physician practices can place this poster in their waiting rooms to start the conversation with their patients.

    Download this poster in 8"x11" printable format for display in your office.

    Physician practices in Delaware, Indianapolis, Minnesota/St. Paul, or St. Petersburg and Venice, Fla. can download customized patient referral forms to their local YMCA Diabetes Prevention Program.

    What can patients do right now?

    • Ask your doctor if you are at risk for prediabetes.
    • Know your risk– take this risk test. It only takes a few moments.
    • If you are at risk, or suspect you may be, request a simple test by your doctor.
    • Eat a healthy diet, be physically active, maintain a healthy weight and don't smoke.
    • Visit Prevent Diabetes STAT to learn more about resources for patients.

    Stats and resources

    Diabetes statistics

    • Diabetes affects 29.1 million people, 9.3 percent of the U.S. population (all ages, 2012 data; 95 percent is type 2 diabetes)
      • Diagnosed 21 million people
      • Undiagnosed 8.1 million people
    • Diabetes was the seventh leading cause of death in the United States in 2010, and more than 234,000 American deaths in 2010 included diabetes as a primary or contributing cause
    • The total estimated costs of diagnosed diabetes have risen from $174 billion in 2007 to $245 billion in 2012
      • $176 billion in direct medical expenses
      • $69 billion in reduced productivity
      • This figure represents a 41 percent increase over a five year period between 2007-2012
      • 27 percent of the increase is attributed to growth in prevalence of diagnosed diabetes and 14 percent to growth in average cost per case

    Prediabetes statistics

    • 86 million adults had prediabetes in 2012
      • 37 percent of adults aged 20 or older had prediabetes based on A1c between 2009-2012
      • 51 percent of adults aged 65 or older had prediabetes based on A1c between 2009-2012
    • Awareness of this high-risk condition is very low where only 9 out of 10 know they have prediabetes.
    • A diabetes prevention program lifestyle intervention reduced the incidence of diabetes among adults by 58 percent in approximately three years and 34 percent in 10 years
      • People with prediabetes can prevent or delay the onset of type 2 diabetes by losing 5–7 percent of their body weight and getting at least 150 minutes per week of moderate physical activity
      • The program often spans one year with once-a-week sessions over the course of 16 weeks and 6-8 additional sessions meeting once a month
      • Most individuals achieve their maximum weight loss within the first 20-24 weeks
    • The cost of prediabetes increased 74 percent to $44 billion over a five-year period between 2007-2012

    Links to additional resources:

    CDC Prediabetes Screening Risk Test
    American Diabetes Association Type 2 Diabetes Risk Test
    AMA Prediabetes Awareness Poster
    AMA guide to refer patients to the YMCA Diabetes Prevention Program
    Delaware YMCA Referral Form
    Twin Cities YMCA Referral Form
    Indianapolis YMCA Referral Form
    About Type 2 diabetes and prediabetes
    Adapting the Diabetes Prevention Program Lifestyle Intervention for Delivery in the Community : The YMCA Model
    Translating the Diabetes Prevention Program into the Community – The Deploy Pilot Study
    AM News article about the impact of the diabetes prevention program
    CDC diabetes prevention fact sheet
    CDC video about the National Diabetes Prevention Program

  • High blood pressure (Hypertension)

    We seek to address heart disease and stroke by focusing on high blood pressure, a major contributor to cardiovascular disease, which is the leading cause of death in the United States.

    The problem

    One in every three American adults (78 million or 33 percent) has high blood pressure, which can lead to heart attack, stroke, kidney failure, blindness and heart failure.

    Direct medical spending to treat hypertension totaled $44 billion in 2010, with almost half ($20 billion) in the form of prescription medications.

    More than 30 million Americans have both hypertension and a usual source of medical care—but their blood pressure is still too high.

    How is the AMA improving health outcomes?

    We are tackling high blood pressure in clinics and communities, leveraging the existing, substantial body of evidence on blood pressure management, and making best practices easier to implement for patients and doctors alike.

    We are focusing on improving health outcomes for the 30 million people with hypertension who are receiving medical care but do not have their blood pressure under control.

    We are collaborating with the U.S. Department of Health and Human Services' "Million Hearts®" initiative. We have adopted the initiative's goal of preventing one million heart attacks and strokes, including helping 10 million more Americans get their blood pressure under control.

    We are working with the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality and the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities to improve care for patients by developing and spreading a model for better detection and management of high blood pressure, both in the clinic and in the community.

    What's happening right now?

    To engage practices, people and communities in addressing hypertension control, we undertook prototyping with physician practices in two states.

    Illinois prototyping sites

    Quality Primary Care
    Niva Lubin-Johnson, MD
    Chicago

    Erie Family Health Center
    Deborah Midgley, MD
    Chicago

    Northwestern Medical Group
    Eleanor Smith, MD
    Evanston

    Advocate Medical Group–Midwest Heart Specialists
    Mary Nashert, NP
    Downers Grove

    Advocate Medical Group–Metrodocs
    Stephen Sproul, MD
    Mount Prospect

    Maryland prototyping sites

    Johns Hopkins Community Physicians–Frederick
    William Convey, MD
    Frederick

    MedStar Franklin Square Medical Center
    Matthew Burke, MD
    Baltimore

    Drs. Edwards and Stephens, LTD
    Willarda Edwards, MD
    Baltimore

    Power Street Medical Center
    Lower Shore ACO (MedChi)
    Alon Davis, MD
    Salisbury

    Mitchell S. Gittelman, DO, PA
    Lower Shore ACO (MedChi)
    Mitchell S. Gittelman, DO
    Salisbury

    These 10 diverse clinical sites in Illinois and Maryland, physicians and care teams helped us develop and test a framework we call the "M.A.P. for improving blood pressure control."

    Measuring blood pressure accurately, every time it's measured

    Acting rapidly to address high blood pressure readings

    Partnering with patients, families and communities to promote self-management

    Many of the pilot practices are continuing to help us refine the “P” in the M.A.P., connecting patients and family members with community resources that can help with blood pressure control outside the clinical setting.

    We will take what we learn about improving control of high blood pressure from expert advisors and our pilot clinical sites, and spread effective models and methods to more practice settings and communities.

    (See "what can physicians do right now" to engage with AMA on developing tools and resources to implement the MAP framework.)

    How many lives could be saved by controlling high blood pressure?

    American Medical Association data analysts offer new estimates of the additional lives that need to be saved between 2015 and 2020 to maintain the 60-year trend decline in U.S. ischemic heart disease and stroke death rates.

    That number is 28,000–41,000.

    We will use these data in setting goals for our work in hypertension management and, ultimately, cardiovascular disease prevention.

    Read the full issue brief, which also breaks out death rates from ischemic heart disease and stroke.

    What can physicians and care teams do right now?

    Measuring accurately is the first step to improving hypertension control. Did you know….?



    We've created tools as part of the framework we call the "M.A.P. for improving blood pressure control."

    Measuring blood pressure accurately, every time it's measured

    Acting rapidly to address high blood pressure readings

    Partnering with patients, families and communities to promote self-management

    Download this document to see the evidence-based checklists that support each concept of the M.A.P. framework. Share the checklists with your team and apply them in your practice.

    The M.A.P. framework consists of many helpful tools to help you evaluate your practice or health center and make positive changes in terms of:

    • Hypertension control rates
    • Team communication and approach to quality improvement
    • Workflow processes and resources needed to improve

    Related downloads -

    Proper patient positioning when taking blood pressure [poster] Measuring your blood pressure at home [patient handout]

    Physicians can also visit the "Million Hearts®" website for resources you can use in your practice or health center and with your patients to prevent and control high blood pressure.

    What can patients do right now?

    • Talk with your doctor about your risk for high blood pressure.
    • Get your blood pressure checked and then monitor it regularly.
    • Download a handout you can use to help you correctly measure your blood pressure outside the doctor’s office
    • Advocate for accuracy–partner with your physician and care team to be sure your blood pressure is accurately measured (see chart on this page)
    • Eat a healthy diet, be physically active, don't smoke, and maintain a healthy weight.
    • Visit the "Million Hearts" website to learn how to prevent or control high blood pressure.


    Stats and resources

    Statistics about hypertension:

  • Collaboration

    Collaboration is essential to our success.

    The AMA is interested in collaborating with organizations whose efforts are aligned with our "Improving Health Outcomes" Initiative and our strategies around controlling high blood pressure and preventing diabetes.

    Our collaborations with the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality and the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities (to support the goal of improving blood pressure control in people with hypertension), and with the YMCA of the USA (to support the goal of reducing the incidence of type 2 diabetes) represent the beginning stages of a long-term effort toward accomplishing our vision.

    Our engagement with the U.S. Department of Health and Human Services' "Million Hearts®" initiative, and with the Centers for Disease Control and Prevention's National Diabetes Prevention Program to Prevent Diabetes STAT: Screen, Test, Act – Today™, are further examples of strategic alignment toward shared goals.

    We have also formed a collaboration with AmeriCares aimed at helping delay the onset of type 2 diabetes through the “Transforming Prediabetes Care” initiative, which awards $10,000 grants to seven free and charitable clinics across the United States. These selected clinics will establish evidence-based diabetes prevention programs.

    The AMA improving health outcomes team wants to learn about what is happening in your community or state to improve health outcomes in our two key areas of focus.


    Send a description of your organization's efforts around hypertension and/or prediabetes to Marsha.Kaufman@ama-assn.org Please include as many details as possible and let us know if you are collaborating with other partners on your efforts.