MODELS FOR PRACTICE
FOCUS AREA: HEART DISEASE AND
STROKE
Program Name:
Location:
Healthy People 2010 Objective: 12-1, 12-11, 12-15
Web Address: http://www.fchn.org (click “Heart Health”) and
http://www.franklinscorekeeper.org
Blueprint: WMCHH, an individual
department in a not-for-profit hospital, works with other entities, such as
physician practices, school systems, employers, insurers, Bureau of Health,
Maine Cardiovascular Health, universities, and research departments. The
center’s mission is to develop coordinated community approaches to reduce the
health and economic burdens of cardiovascular disease in rural
WMCHH is composed of four main divisions: HeartWarmers,
Franklin ScoreKeeper, Research and Development, and Consultation and Training.
The Franklin HeartWarmers program offers education, supervised exercise, lifestyle
modification, and emotional support following a heart attack, bypass surgery,
unstable angina, or congestive heart failure through a unique program that
integrates traditional cardiac rehabilitation and sustained nurse-managed
telephonic contacts with enrolled clients. The program began four years ago,
and the model has been adopted by 34 of
The Franklin ScoreKeeper system is an innovative
cardiovascular disease prevention program based on decades of documented
success by the Franklin Cardiovascular Wellness Program in reducing cardiovascular
mortality in West Central Maine. The program is founded on research endorsed by
the American Heart Association and focuses on identifying five risk factors
specific to cardiovascular disease: high blood pressure, high total cholesterol
and/or low HDL cholesterol, smoking, physical inactivity, and overweight. The
program works by promoting five behaviors for heart healthy living including: a
heart healthy diet, regular physical activity, being tobacco free, using
medications as directed, and improving coping skills and managing stress.
Franklin ScoreKeeper software reflects the “Franklin Health Model” of care; has
guidelines based on internal logic; is intuitive and easy to use; and
efficiently shapes, tracks, documents, reports, and evaluates both process and
outcomes of risk factor screening and control in multiple settings. ScoreKeeper
nurses and other counselors provide one-on-one screening, counseling, and
follow-up services in many community settings, including schools, worksites,
medical practices, hospital, and community. The client/patient leaves the
session with an individualized cardiovascular risk and behavior “ScoreCard,” an
action plan for heart-healthy living, pertinent educational materials, linkage
to community resources, and an appropriate follow-up strategy.
The
Consultation and Training portion of the center involves leaders and staff of
the center welcoming the opportunity to share their knowledge and expertise
based on over a quarter of a century of experience in developing and implementing
successful community programs that integrate public health and medical
practice. Consultation may be provided at a location and via media of the
client’s choice, i.e., face-to-face, telephone, electronically, or by mail.
The
center treats citizens of West Central Maine of all ages and ethnicities. No
patient is turned away, and insurance is not a consideration. Currently, the
center has eight full and part-time employees, including two co-directors. In
addition, students do preceptorships and internships from
Making
a Difference: The death rate in
Beginnings: In
the early 1970s, a group of idealistic, young doctors with new ideas about
health care and medical organization assembled in
The idea of the group innovation was underscored
by the formation of the state’s first HMO in the late 1970s. Designed to give
more people health care, it failed financially in the mid-1980s because it did
not achieve sufficient scale.
Dr. Burgess Record, one of the young RHA
doctors, wanted to do more than help people when they became ill. He and his
wife, Sandy, a nurse, decided to take their blood-pressure cuffs and other
equipment to grocery stores, businesses, and fairs to screen for problems and
talk about prevention measures. The number of screenings grew when Record, who
had Army Reserve duty every month in Auburn, asked if he could spend half of
his required time performing screenings and counseling back in Franklin County.
His superiors agreed but asked him to get approval of the hospital’s medical
staff. The medical staff’s endorsement provided a foundation for the program to
develop medical community support and minimal political opposition.
Thus the Franklin Cardiovascular Health Program
has served the region continuously for 29+ years. The high blood pressure
program was implemented in 1974; cholesterol was added in 1986, smoking in
1988, and Center for Heart Health in 1998. The mortality impact of this
integrated community program has been reported in the American Journal of
Preventive Medicine (Record, N.B.; et al. American Journal of Preventive
Medicine 19(1):30-38, 2000) and highlighted by the American College of
Cardiology in the report of its 33rd Bethesda Conference (Task Force
#3, Preventive cardiology: How can we do better? Presented at the 33rd
Bethesda Conference, Bethesda, MD, December 18, 2001, Journal of the
American College of Cardiology 40:579-651, 2002).
Challenges and Solutions: Paul Judkins, former RHA
head, asserts that the program is completely replicable. In addition, he points
out that the biggest ingredient for any area trying to replicate the program is
for community leaders to have the will. Lastly, he points out that the RHA
doctors were community leaders and were interested in doing this for the
people, not to make “bundles of money.”
Other issues that may be encountered include funding and physician/administrator buy-in. The Center is constantly looking for funds. Originally, funding was 33 percent fee-for-service, 33 percent external state grants, and 33 percent in-kind contributions. Now, with its focus on environmental and policy changes, Maine’s Bureau of Medical Services no longer provides financial support for direct one-on-one service. A three-year Rural Health Outreach Grant just ended, and currently the center is without grant funding. The center hopes to become financially self-sufficient by providing consultation and training and selling licenses for its innovative Franklin ScoreKeeper software. Nurturing supportive relationships with community physicians is an ongoing process. Having active health professional champions and institutional support have been crucial for program success.
Burgess
Record, MD, Co-Director
Western
Maine Center for Heart Health
Franklin
Memorial Hospital
111
Franklin Health Commons
Farmington,
ME 04938
Phone:
(207) 779-2720