This study aims to improve access to quality care and reduce poor health outcomes associated with cardiovascular disease generally and congestive heart failure in particular. The study will review public health data and conduct statistical analyses to understand factors related to excess hospitalization and death from heart disease in South Los Angeles. The findings will be used to inform prevention, early detection and treatment interventions.

1. Understanding the Burden of Congestive Heart
Failure and Cardiovascular Disease in South Los
Angeles: An Academic, Community, and
Safety Net Provider Collaborative Effort
October 18, 2012
Lark Galloway-Gilliam, MPA
Annie Park, MPH
Jessica Jew, MPH
Community Health Councils
Ami M. Shah, MPH
UCLA Center for Health Policy Research
Nina Vaccaro, MPH
South Coalition of Community Health Centers
Roberto Vargas, MD, MPH
Division of General Internal Medicine and Health Services Research,
David Geffen School of Medicine at UCLA,
Medical Sciences Institute, Charles Drew University and
RAND Health

2. Background
 South Los Angeles Healthcare Leadership Roundtable
 2011 retreat Office of Statewide Health Planning and
Development (OSHPD) data demonstrates high rates
of Congestive Heart Failure (CHF) admissions
 (706 per 100,000) in South LA compared to the rest
of Los Angeles County (350 per 100,000)
 2012 retreat breakout group targets reduction of
disparate CHF for future partnered activity
 Partnership pursued funding to collaboratively develop
an approach to address the excess burden of heart
disease in South LA
2

3. Los Angeles County
Service Planning
Areas SPA 6
and
Health Districts (26)
3
3

4. 4

5. Aims
 Aim 1: Engage the partner organizations to
shape exploratory analyses of descriptive
data on heart failure and its risk factors and
related outcomes
 Aim 2: Engage the partners to develop
consensus on selected cardiovascular
disease conditions and measures for risk
factor and CHF case identification in clinic
settings

6. Methods: Community Partnered
Participatory Research
Knowledge Exchange: Providers, academics
and community on the public health problem
 California Health Interview Survey (CHIS)
 Small area estimates
 Inpatient data (OSHPD)
 Discharges
 Quality indicators
 Additional support for case identification and
registry development

7. Methods: Community Partnered
Participatory Research
Knowledge Exchange: Share data with
providers and community on the public health
problem:
 What do safety net providers need to know in
order to drive change toward improved
health?
 What role can they play in reducing the
burden of disease?
 How do we support this role?

8. Methods: Community Partnered
Participatory Research
Delphi Method Approach
 Develop consensus on approach to reducing
burden of Congestive Heart Failure in the
South Los Angeles Community
 Review of populations health statistics
 Review clinic spectrum of disease
 Review evidence on disease detection and
treatment

9. Outcomes
 Knowledge Exchange:
 South Los Angeles Healthcare Leadership
Roundtable, September 13th and October 9th
 Medical Directors’ Meeting, South Side Coalition of
Community Health Centers, September 11th
 Review of secondary data sources and findings
 OSHPD data by Service Planning Area (SPA) and
Health Districts (HD)
 CHIS data by SPA, HD and small area estimates
 Iterative analyses and feedback

10. Heart Failure Prevention Quality
Indicator #8 RatesBy SPA
standardized rates per 100,000, OSHPD 2007-2009 average
ED Encounters Hospital Admissions
699
396
380 381
233
118
44 25 45 66
10
Metro West South East South Bay

11. Heart Disease Prevalence by SPA
among adults age 18 and over
Los Angeles County = 5.8%
7.0 6.8
6.2 6.2
5.0
Metro* West LA South LA East LA South Bay
Source: CHIS 2009, Ever diagnosed with heart disease
CHIS 2009 11
* Estimate is unstable

12. Risk Factors for Preventable Hospitalizations?
2009 CHIS Data
* Statistical Significance (95% CI’s do not overlap)
Take away messages
-SPA 6 is less confident in
managing heart disease
-SPA 6 more likely to be
diagnosed with HBP but less
likely to take meds
12

13. 13

14. Outcomes: Iterative analyses and
feedback
 Suggested Analyses
 “How does insurance (uninsured/Medi-Cal) affect
access to care, can you break down the data to show
payer source? Gender? Demographics?”
 “Problems of low medication adherence, are there
ways to improve compliance? Demographics of those
most at-risk and targeted outreach to these
populations?”
 “Can you provide more information on the cultural
background of patients presenting with heart
disease?”
 “Can this data be shown over time to see if there are
patterns/significant events that emerge?”

15. Outcomes: Iterative analyses and
feedback
 Examples of Barriers
 “There’s a disconnect at hospitalization between
community health center providers and hospital and
emergency departments care teams”
 “There is no access to Echocardiograms without
cardiologist referrals and subspecialist access is
limited”
 Provider workforce limitations both specialist and
primary care
 Uncertainty on best evidence or “low cost” evidence
based practices for heart failure detection and care

16. Outcomes: Iterative analyses and
feedback
 Suggested Intervention Targets
 “Diabetes is often a co-occurring chronic disease
and clinics need to have a better way of targeting at
risk patients through lab/billing data. Obesity is also
another risk factor, is there a way to systematically
track these risk factors and focus on prevention?”
 “How can safety net providers better track ischemic
heart disease? The quality improvement indicators
that would help to catch these patients often aren’t
used regularly in these settings. How to better
manage patients with co-occurring disorders such
as COPD, diabetes, obesity and heart disease? “

17. CERP Aims
 Promote and sustain bidirectional knowledge
sharing between community and academia
 Strengthen community infrastructure for
sustainable partnered research
 Drive innovation in community engagement that
accelerates the volume and impact of partnered
research in diverse communities.

18. CERP Aims
 Build health services research (HSR) methods
into partnerships to accelerate design,
production, and wide adoption of evidence-
based practice and behavior
 Establish a governance and operations
infrastructure that strengthens existing
partnerships and builds new bridges between
community and academia for research.

19. Understanding the Burden of Congestive Heart Failure and Cardiovascular
Disease in South Los Angeles: An Academic, Community, and Safety Net
Provider Collaborative Effort
Milestones Timeline in Months
3 6 9 12
Aim 1 Knowledge exchange and
descriptive database creation
Aim 2 Clinical condition and
indicator selection for registry and
protocol development
Community partner engagement
meetings, dialogue, and feedback
Complete analyses of secondary
data, generate final report and
manuscript

20. Added Value from CTSI
 Improved access to databases and supported
relevant secondary data analyses
 Increased engagement of research
community with safety-net providers and
community based organizations
 Supported continued dialogue
 Partnered hypothesis generation
 Intervention design suggestions

21. Next steps
 Complete knowledge exchange: Guidelines,
evidence reviews, and current research findings
 Additional grant support: National Institute for
Minority Health and Health Disparities and
Centers for Disease Control
 Patient engagement
 Extend work into other communities
 Implement registry
 Design and implement interventions
 Prevention, disease detection, treatment and care
coordination