San Diegans unite to fight chronic disease

California’s battle against chronic disease has a new ground zero: San Diego County.

And if health officials there succeed, they will create a model to fight chronic disease that can be adopted by cities nationwide.

A thriving metropolis with a busy port and several high-tech employers, the sunny mecca of San Diego is also home to a handful of progressive healthcare providers determined to make the region a successful example of “healthy” cooperation.

Already managing a statewide initiative to reduce chronic disease, California’s Department of Managed Health Care in February further spotlighted San Diego in its war against chronic disease.

“In San Diego there are a very limited number of medical entities that together cover 80% of the population,” says Hattie Rees Hanley, project director for the statewide Right Care Initiative. “Getting the buy-in of ten key health delivery leaders can change the care of all of San Diego.”

Chronic diseases like obesity, diabetes, cardiovascular disease, arthritis and asthma affect more than 16 million Californians – about 44% of the population. Half of these suffer from more than one chronic condition.

The eventual goal, says Rees Hanley, is to lift San Diego county into the 90th percentile nationally for controlling blood pressure, cholesterol, and blood sugars.

But local health officials are aiming even higher. They want San Diego county to become the nation’s first “heart attack and stroke-free zone.”

Once a month, nearly a dozen San Diego area medical officials meet at a makeshift “University of Best Practices” to give case studies about chronic disease, share strategies, and hear inspirational speakers.

Like all metropolitan healthcare markets, San Diego is wildly competitive. To combat chronic disease, though, medical directors have set aside adversarial relationships to look beyond profits and break down barriers to seek a holistic solution. So far it’s worked.

“We’ve decided together we can have a broader impact impact than any of us could have individually,” says Dr. Nick Yphantides, the San Diego county liaison to the state’s Right Care Initiative.

“There are plenty of patients with high blood pressure, diabetes, heart attack and strokes to go around,” says Dr. Jerry Penso, director of Continuum of Care for Sharp Rees-Stealy Medical Group. We don’t need to compete for more patients. If I can help my competitors to do better, in the end we’ll all do better.”

“It’s a major breakthrough,” agrees R. James Dudl, diabetes lead for Kaiser Permanente’s Care Management Institute. “Right Care takes that to a new level.”

Health officials echo a common goal: transform San Diego’s health system from one that is reactive – focusing on sickness – into one that is pro-active – and prevents illness.

The area’s major medical participants include:

– Sharp Community Medical Group
– Scripps Health
– Kaiser Permanente
– University of California San Diego
– Arch Health Partners
– MultiCultural Primary Care Medical Group
– The United States Navy
– The Veteran’s Administration
– The Medical Society of San Diego Foundation
– Community clinics
– San Diego County Health Department

“This is an unprecedented team of experts, consumers, clinics, the Navy, the (Veterans Administration), the county, and the city who have all come together… to make San Diego a heart-attack and stroke-free zone.” says Liz Helms, chair of the California Chronic Care Coalition.

The Right Care Initiative focuses on improvements in three areas: engaging patients more actively to improve their health with diet and exercise; involving pharmacists as part of the patient’s care team; and taking prescription drug bundles consistently.

Chronic disease accounts for 57% of the county’s mortalities, according to Tracy Delaney, manager for Chronic Disease and Health Equities for San Diego County’s health department.

One goal of the initiative is simply following instructions: making sure patients take their prescribed medication. When doctors prescribe the proper bundles, and patients take them regularly, “we’ll see about a 60% reduction in heart attack and stroke,” says Rees Hanley.

“We’re implementing prevention like it’s never been implemented before,” says Helms, “and we’re starting with the heart.”

A long-time patient advocate, Helms is spearheading “patient activation” for what will become the “Be There San Diego” media campaign.

“It’s an emotional campaign,” says Penso. “We want you to be there for your grandkid’s wedding, or your kids graduation from high school.”

Helms says doctors, patients, and community organizations will be saturated with traditional and social media that stress the importance of knowing blood pressure, cholesterol and blood sugar levels. Patients will be encouraged to get physically active and eat healthier.

“Hopefully, this will become cocktail party conversation,” says Anthony DeMaria, who chairs the San Diego initiative’s steering committee.

Even if patients see their physicians for other reasons, doctors will discuss risk factors for chronic disease, adds DeMaria, also founding director UC San Diego’s Sulpizio Family Cardiovascular Center.

Significant funding needed for the “Be There San Diego” media rollout is still being raised.

Choosing San Diego in the fight against chronic disease comes on the heels of other health accolades for the city, which has received more than $15 million in federal funding as one of 17 “beacon communities” to improve its health information technology (HIT).

Kaiser’s Dudl says chronic care prevention and the HIT grant have come together at an opportune time.

“We will need data to show we are implementing medication treatments, and dropping heart attack and strokes,” says Dudl. “Electronic records are allowing us to do that for a first time. The beacon grant (HIT) could help us focus on achieving that data retrieval in a meaningful way.”

Health officials are working closely with the RAND Corporation research institute to identify chronic disease hot spots in San Diego county – many of them in underserved communities.

Local philanthropists Jack and Judy White stepped forward to support the monthly “University of Best Practices” meetings and other efforts with a multi-million dollar contribution after funding by the National Institutes of Health ended in August.

“It’s wonderful that they’re cooperating,” said Jack White, a patient of DeMaria’s who suffered a heart attack 10 years ago. “It’s one of the big reasons we got involved.”

Are San Diego’s efforts unique in the state?

“There are some really great programs,” says Helms, “but nothing as big as taking on the entire community with everybody at the table.”

Public health officials in San Diego county are also taking a firm stand against chronic disease. Last October’s report The Economic Burden of Chronic Disease in San Diego County warned that in 2007 chronic disease cost the county $4.6 billion.

The county has positioned itself as a leader in fighting chronic disease since the 2006 creation of the San Diego County Childhood Obesity Initiative.

The public-private partnership, says the health department’s Delaney, further enhanced San Diego’s progressive reputation. Last year, the county received the largest ever Communities Putting Prevention to Work grant given to any county by the national Centers for Disease Control. The two-year grant – more than $16 million – targets obesity in residents of all ages.

The county also last year launched a 10-year plan to prevent chronic illness, reduce healthcare costs, and save lives.

The Live Well San Diego plan uses the formula 3-4-50, which targets three behaviors (poor diet, physical inactivity, and tobacco use) that contribute to four chronic diseases (cancer, heart disease / stroke, type 2 diabetes, and pulmonary diseases such as asthma) which cause over 50 percent of all deaths.

San Diego area health officials cite both cooperation and commitment as important factors for future success in a region of 3.2 million people — nearly 1% of the nation’s population.

“Every major health care group has agreed to that,” says Dudl, who hopes to involve the rest of San Diego in fighting chronic disease – government, business, community groups and individuals. “We need the entire community to help with a task so large and beneficial.”

“If not San Diego, where?” reflects Yphantides. “We are a jewel of a community.”

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