Franklin Cardiovascular Health Program (FCHP)

Evidence-level

Effective (About evidence-level criteria)

Description

Local community groups teamed up in an effort to develop a program that focuses on hypertension, cholesterol, smoking, diet, and physical activity in rural Maine. This program tracked the movement between detection and treatment over a 40-year period in order to evaluate appropriate screening methods. Residents of Franklin County were the main focus of the program.

To overcome the cardiovascular issues facing this low-income community, the Franklin Cardiovascular Health Program (FCHP) implemented a community-wide intervention model. This emphasis on community involved finding the right person for the right task at the right place for each patient. The program revealed that a person's socioeconomic status played a significant role in the condition of one's cardiovascular health. Due to this finding, FCHP developed community-based education with respect to residents' local cultures and education levels.

With this information, FCHP set out to build a sustainable cardiovascular awareness program that collected people's health data and measured it over time to better tailor feedback to each person. Many factors contributed to the program's high participation, including:

• Integration between health services and social services
• Intentional blending of public health, community health, and medicine
• Public communications written in simple language
• Social services through the outreach system that reinforced prevention in the home and community
• Encouragement of collaboration among organizations
• Constant communication among local groups and institutions

Services offered

FCHP reached out to Franklin residents by:

• Meeting people where they regularly go, such as work:
  • Engaged with owners or management for financial support
  • Scheduled weekly or monthly consultations at the worksite
  • Completed one-on-one individual assessments
  • Utilized LPNs, community health workers, and volunteers
• Using the workplace to conveniently initiate cardiovascular risk screenings with motivational interviewing techniques:
  • Blood pressure
  • Weight
  • Cholesterol Finger Sticks (lipids)
  • Lifestyle Questions:
    • Eating/Nutrition
    • Physical Activity
    • Alcohol
    • Drugs
    • General feeling of wellness
• Designing creative, engaging ways to help patients become aware of their healthcare needs
• Targeting prevention activity across a risk continuum in multiple settings
• Developing shared information systems to target and track individuals and groups with active follow-up to those at risk
• Minimizing geographic, financial, and reading levels as well as other barriers to health and healthcare
• Adopting scientifically validated methods, measures, and outcomes relating to cardiovascular health

Results

Throughout the program:

• 50% of county adults were screened and evaluated.
• FCHP cholesterol screening increased cholesterol control to 28.5% within 40% of adults.
• Smoking quit rates increased 21% after smoking cessation projects were created.

In addition, FCHP coordinators saw the following results:

• Decline in hospitalizations per capita
• $5,450,362 in reductions for in- and out-of-area hospital charges per year
• Decreased mortality rates and cardiovascular-specific mortality rates
• Better healthcare access
• Improved detection and control of hypertension, high cholesterol, and smoking

For more in-depth information about this program and its outcomes:

Record, N.B., Onion, D.K., Prior, R.E., Dixon, D.C., Record, S.S., Fowler, F.L., ... & Pearson, T.A. (2015). Community-Wide Cardiovascular Disease Prevention Programs and Health Outcomes in a Rural County, 1970-2010. JAMA, 313(2), 147-55.

Replication

In order to replicate this program, it is crucial to have:

• A strong local not-for-profit group with organizational strength
• Capacity to access grant funds
• Ability to work with a local health system
• Local health system's commitment to completing the triennial ACA-mandated Community Health Needs Assessments (CHNAs)
• Maximizing involvement capacity of professionals, volunteers, patients, and families