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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 AMA 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 high blood pressure and prediabetes?

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

    We have teamed up with the YMCA of the USA to help prevent the onset of diabetes among Medicare participants who have prediabetes. We are beginning our work by collaborating with the YMCA to help increase the number of Medicare participants referred by physicians to the YMCA Diabetes Prevention Program, with the longer-term goal of increasing referral of all adults who have prediabetes.

    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 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 79 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 are working with the YMCA of the USA to:

    • Increase education and awareness of prediabetes by promoting physician screening 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?

    Our first step is working with physician practices and YMCAs in pilot sites in Delaware, Indianapolis and Minneapolis/St. Paul. 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 participate in the YMCA Diabetes Prevention Program at no cost until June 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 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. Use the chart shown above, and the CDC Prediabetes Screening Test, the American Diabetes Association Type 2 Diabetes Risk Test or a claims-based risk test based on valid criteria. Practices can use the AMA guide to refer patients to the YMCA Diabetes Prevention Program

    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 or Minnesota/St. Paul can download customized patient referral forms to their local YMCA Diabetes Prevention Program.

    Find out more about our diabetes prevention efforts and how you can participate.

    What can patients do right now?

    Stats and resources

    Diabetes statistics

    • Diabetes affects 25.8 million people, 8.3 percent of the U.S. population (all ages, 2010 data; 95 percent is type 2 diabetes)
      • Diagnosed 18.8 million people
      • Undiagnosed 7 million people
    • More than 230,000 American deaths in 2010 included diabetes as a primary or contributing cause Source: National Center for Health Statistics, November 2012
    • The total costs of diagnosed diabetes have risen from $174 billion in 2007 when the cost was last examined to $245 billion in 2012

    Prediabetes statistics

    • $176 billion in direct medical expenses
    • $69 billion in lost productivity
    • This figure represents a 41 percent increase over a five year period
    • About 33 percent of U.S. adults (approximately 79 million) have prediabetes but awareness of this high risk condition is very low; about 50 percent of U.S. adults aged 65 years or older have prediabetes
    • 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


    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 (67 million or 31 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 have initiated 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 Memorial Physicians Group
    Mike Rakotz, MD
    Evanston

    Advocate Medical Group–Midwest Heart Specialists
    Michael O'Toole, MD
    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

    At 10 diverse clinical sites in Illinois and Maryland, physicians and care teams are helping us develop and test a framework we call the "M.A.P. for achieving optimal hypertension control."

    Measuring blood pressure accurately, every time it's measured

    Acting rapidly to address high blood pressure readings

    Partnering with patients to promote self-management

    We will take what we learn about improving control of high blood pressure from expert advisors and our pilot clinical sites, including how to work with community partners, 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?

    AMA 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 physician practices do right now?

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



    We're creating tools as part of the framework we call the "M.A.P. for achieving optimal hypertension control."

    Measuring blood pressure accurately, every time it's measured

    Acting rapidly to address high blood pressure readings

    Partnering with patients to promote self-management

    Download this document to see the draft checklists that support each concept of the MAP. Share the checklists with your team and apply them in your practice. Then give us your feedback. Physicians can also visit the "Million Hearts®" website for resources you can use in your practice 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.
    • Advocate for accuracy - partner with your physician 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, are further examples of strategic alignment toward shared goals.

    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.