Healthy Hearts in Manufacturing: Improving Cardiovascular Care in Worksite Health Clinics - Heart disease is the leading cause of death in the United States and contributes to more than $320 billion annually in health care costs and lost productivity. Manufacturing communities, many of which are rural, have significantly higher rates of smoking, obesity, physical inactivity, diabetes, and cardiovascular deaths, compared to other communities. Similarly, manufacturing employment is associated with higher rates of hypertension and smoking. Two-thirds of manufacturing workers are male, and manufacturing workers are, on average, older than workers in other industries. Many large manufacturers provide health services to employees, spouses, dependents, and retirees through worksite health clinics, particularly in areas where there are shortages of primary care providers. Given their potential reach into manufacturing communities, worksite health clinics are well positioned to address deficiencies in small and rural communities. In this study, Healthy Hearts in Manufacturing (HHM), we propose to examine the use of worksite health clinics as a vehicle for improving cardiovascular care in manufacturing communities. We will adapt a package of evidence-based interventions related to hypertension and tobacco cessation, implemented with evidence-based supports, including on-site practice facilitation, health information technology support, and data feedback and benchmarking. In prior grants from AHRQ, our team has successfully implemented these cardiovascular interventions in small primary care physician practices. The specific aims are to: (1) Contextually adapt, for worksite clinics, evidence-based interventions for cardiovascular disease care, previously designed for implementation in small primary care practices; (2) Implement HHM in 12 randomly selected worksite clinics, identify facilitators and barriers to sustainable maintenance of HHM, and test whether HHM improves hypertension control and tobacco screening and cessation intervention; and (3) Estimate the budget impact of HHM and the potential health care savings to companies and Medicare. This study is innovative in its use of worksite health clinics as a means to improve care for a hard-to-reach, disproportionally rural population with high rates of smoking and chronic illness. It will also be a first effort to report on quality measures from worksite health clinics. Results may reveal an economically sustainable quality improvement strategy to address heart health for an at-risk population. The study will produce findings, tools, materials, and lessons that could aid other efforts to implement evidence-based quality improvement in worksite health clinics.
