Diabetes and Heart Disease & Stroke Prevent Programs-Improving the Health of Americans through Prevention and Management of Diabetes and Heart Disease and Stroke CDC-RFA-DP18-1815
Project Abstract Summary
Heart disease, stroke and diabetes are the first, third and seventh leading causes of death in Texas. In 2016, these three largely preventable and often comorbid conditions accounted for 31 percent of all deaths in Texas. Nearly three million adults in Texas have diabetes, 663,000 of whom are undiagnosed. If left unaddressed, that number will grow to eight million within the next decade. In addition to its numerous complications – blindness, neuropathy, amputations, etc. – diabetes also increases the risk of developing heart disease. Of the 48,458 persons who experienced heart attacks in Texas between 2008 and 2016, 40 percent had diabetes, 78 percent had hypertension and 61 percent had high cholesterol. Among the general adult population of Texas, more than 1 in 3 have been told they have hypertension and/or high blood cholesterol by a healthcare provider.
As part of its strategic plan to address the current and future burden of chronic disease in Texas, the Texas Department of State Health Services (DSHS) will support statewide implementation of cross-cutting approaches to promote health and prevent and control diabetes, heart disease and associated risk factors by leveraging the expertise of two categorical programs: The Diabetes Prevention and Control Program and the Heart Disease and Stroke Program. Activities will address health system interventions to improve the effective delivery and use of clinical and other high-value preventive efforts and community programs linked to clinical services to improve and sustain management of diabetes and heart disease.
DSHS has chosen 10 health systems intervention and community-clinical linkage strategies to improve the prevention and self-management of high blood pressure or hypertension, cholesterol, and diabetes among populations at disproportionate risk for these conditions over the project period: 1) improve access to and participation in diabetes self-management education and support (DSME/S) programs in underserved areas; 2) engage pharmacists in provision of medication management or DSME/S for people with diabetes; 3) implement systems within healthcare organizations to identify people with prediabetes and systematically refer them to CDC-recognized lifestyle change programs; 4) collaborate with payers and relevant public/private sector organizations to expand availability of the National Diabetes Prevention Program as a covered benefit; 5) increase enrollment in CDC-recognized lifestyle change programs; 6) promote adoption and use of electronic health records and health information technology interventions to better identify, treat and manage patients with hypertension; 7) support engagement of non-physician team members in hypertension and cholesterol management in clinical settings; 8) promote adoption of medication therapy management between pharmacists and physicians for the purpose of managing hypertension, high blood cholesterol and lifestyle modification support; 9) facilitate use of self-measured blood pressure monitoring with clinical support among adults with hypertension; and 10) implement systems to facilitate systematic referral of adults with hypertension and/or high blood cholesterol to community programs and resources.
By the end of the performance period and beyond, DSHS aims to decrease the proportion of people with diabetes with an A1c greater than 9; increase the number of people with prediabetes enrolled in CDC-recognized lifestyle change programs who achieve 5-7 percent weight loss; and increase the control among adults with unknown high blood pressure and high blood cholesterol.