NMCSD POPULATION HEALTH PROGRAM NEWSLETTER

In an effort to improve patient navigation, education and utili-zation of NMCSD resources, we’ve launched a BRAND NEW Medical Home Port Website. Patients can easily navigate to this site from the NMCSD Home Page to learn about each provider group and departments within the Medical Home Port.

Benefits of the site:• Patient-focused content tailored to NMCSD• Appropriate for patient health literacy level• Standardized branding• Features website best practices

• Responsive design (can be used on mobile devices)

• Consolidated & streamlined information

• Greater web traffic to NMCSD website

• Increased utilization of Medical Home Port service providers

• Increased patient access to information

• Consistent messaging of clinic information for staff and

providers

Click here to view the site and please share this with your

patients today!

February: It’s American Heart Month!

According to the CDC, Heart Disease is the leading cause of death for both men and

women and most ethnicities in the United States. To prevent heart disease and in-

crease awareness of its effects, NMCSD is proudly participating in American Heart

Month. The Population Health Team created several tools and initiatives to support

both providers and patients to stay informed about Heart Health.

Below is data pulled from M2 that summarizes key highlights of beneficiaries at

NMCSD who’ve been diagnosed with heart disease. This information helps inform

our continued efforts to understand the population and implement best practices

for successful intervention.

As part of our continued efforts to

support patients with heart-related

illnesses and also, to give at-risk pa-

tients tools for prevention, we are

bringing Heart Health Classes to a

clinic near you! We are excited to announce that Heart Health Classes, led

by Health Educators, will be offered at several clinics in the San Diego area in

the coming months. This class will be ideal for patients who want to control

blood pressure, lower cholesterol or are at risk of heart disease. Simply refer

your patients to the Nurse Navigator to pre-enroll today. They can call her at

619-524-0113.

NEW MEDICAL HOME PORT WEBSITE!

MONTHLY HEALTH THEME

Your Health Is Our Mission!Follow Us

Heart Health Class Coming Soon!

Enroll Today! Call your Nurse Navigator at 619-524-0113

Your Health Is Our Mission#StartYourJourney @NMC_SD

CARE FOR YOUR HEART

FEBRUARY 2017

Same Day Visits with the Integrated Behavioral Health Consultants!

Integrated Behavioral Health Consultants (IBHC’s) are Clinical Psychologists embedded within each branch clinic, to assist pa-tients with a wide range of behavioral and medical conditions. Do you know the IBHC at your clinic?

In addition to having traditional appointments, IBHC’s are avail-able for SAME DAY appointments for high acuity patients, or patients interested in getting help after their primary care doc-tor’s visit. With the IBHC embedded into each clinic, patients can be walked-in, often very shortly after their primary care visit.

Common reasons to refer your patients to IBHC’s same day:• Stress, anxiety, depression• Feeling overwhelmed• Family trouble• Challenges with disease management• Weight loss

IBHC’s are trained to work closely with any medical providers, and their focus is on behavioral health. Seeing an IBHC is not considered going to Specialty Mental Health (SMH). When making a SMH referral, there is typically a delay before your patient can visit SMH because of their current patient volume. Some key differences between an IBHC visit and a SMH visit:

• IBHC visits are shorter, 25 minutes• IBHC’s are not diagnosing patients; they are focused on

short-term behavior change and have a lifestyle focus.• IBHC’s support patients in creating an action plan toward

healthier habits.• SMH will work with patients over a longer period of time.

Due to providers having a limited amount of time with patients, handing off your patient to an IBHC expands the continuum of care at NMCSD.

For patients needing additional support with their lifestyle, please try the SAME DAY appointment option, or refer them to the Nurse Navigator to schedule an appointment (619)-524-0113.

ENHANCING PATIENT CARE

New Patient Education Materials!

In an effort to educate patients we create standardized, evidence-based, patient education materials. These health-literacy appropriate materials help increase patient awareness and utilization of NMCSD resources. The materi-als are printed and disseminated in clinics and off-site areas, based on patient demographic by disease state. They are also emailed through RelayHealth and are posted on NMCSD social media channels.

Examples of Heart Health products distributed:

To receive the digital file of these products for print or digital distribution, download it here.

HEART HEALTH RESOURCES

COMING SOON!

KNOW YOUR NUMBERSBlood Sugar

Blood Pressure

Blood Cholesterol

Ideal body weight varies by gender, age, height, and frame. Your body mass index (BMI) and waist circumference provide indicators of whether you are at a healthy weight. Check with your doctor to learn what numbers are right for you.

What should my number be? Less than 120/80

What should my number be? Before eating: Less than 100 Two hours after eating: Less than 140

This is the force of blood against your arteries when your heart beats (top number) and rests (bottom number).

This is the amount of sugar in your blood.

High blood cholesterol signals a higher risk of heart attack and stroke. Get your cholesterol checked and talk to your doctor about your numbers and how they impact your overall risk.

Body Weight

Name_______________________

Blood Sugar_______________________

Blood Pressure_______________________

Cholesterol_______________________

BMI_______________________

GET CHECKED!Call today for an

appointment with your doctor!

(619)-524-0113

NMCSD RESOURCES TO SUPPORT HEART HEALTH!Resources to refer your cardiovascular patients to, organized by intervention area:

For more detailed information refer your patients to the Nurse Navigator (619)-524-0113.

Lose Weight Quit Smoking Lower BP & Cholesterol Drink Alcohol in Moderation Get Active & Eat Healthy

Our Journey toward a High Reliability Organization By CAPT Andrea Petrovanie, RN, MSN, ACNS- BC

The Directorate for Branch Clinics kicked off its journey toward High Reliability on December 7th 2016 at the Naval Branch Clin-ic located at Naval Training Command. The momentum by all in attendance was evident by the teams’ engagement, motivation and transparency. The concept of High Reliability was developed in industries such as aviation and nuclear power that manage extreme hazards and risks, where rare errors could have disastrous results. Transform-ing High Reliability to health care constitutes a single-minded fo-cus by the entire workforce on identifying potential problems and high-risk situations, before they lead to an adverse event. High Reliability Organizations (HRO’s) are organizations where harm prevention and process improvement are second nature to all in the organization.

In May 2014, the Secretary of Defense issued a memorandum directing a 90-day comprehensive review of the MHS with regard to access to care, quality of care, and patient safety. The MHS Governance approved the following guiding principles on March 24, 2015. Collectively these principles form the foundation for an HRO, and are critical enablers for the MHS to achieve its strategic goals of the Quadruple Aim—to provide “Increased Readiness, Better Care and Better Health while Lowering Cost”.

First, Do No Harm

“First, do no harm” is a commitment by all members of the health care team at every level to first consider the risks and potential benefits of any clinical action or decision. A common-ly used phrase to describe this principle today is a “Focus on Failure,” a constant and proactive focus on identifying what can go wrong, learning from failure and near failure, and leadership attention to removing barriers to this focus. Sensitivity to Operations

Leaders and staff are constantly aware of the state of the sys-tems and processes that affect patient care. They use standards and standard work to mitigate errors, reduce undesired variabili-ty, and identify opportunities for improvement.

Deference to Expertise

Leaders of high-performing organizations seek out and “Defer to Expertise,” listening to and valuing the input of those with the most knowledge of and expertise on an issue, rather than relying on top-down direction to solve problems.

Reluctance to Simplify

Staff are “Reluctant to Simplify,” avoiding simple or easy explana-tions for mishaps; instead seeking to understand how complex, interdependent policies and processes can better support safe health care delivery.

Commitment to Resilience

Leaders ensure staff are trained, supported, and prepared to learn from failures in order to minimize the risk of reoccurrence. This “Commitment to Resilience” enables staff to continue to deliver high-quality care even after a major mishap.

Constancy of Purpose

By promoting “Constancy of Purpose” leaders agree on clear commitment to eliminating harm, and setting organizational goals based on a shared vision of safety. Over time and with much ef-fort, this collective mindfulness fosters a “Culture of Safety.”

Respect for People

High-performing organizations create a just culture, in which staff and patients are trusted, valued, and relied on to initiate improve-ments and innovations from the front lines. Every member of the health care team demonstrates respect for the patients and the families they serve, and for their professional colleagues.

Fostering a Culture of Safety

Individual staff members view themselves as LEADERs, commit-ted to Learning from feedback, Engaging in effective teamwork, Anticipating the unexpected, Deferring to expertise, being Ex-tra-sensitive to operations, and being Reluctant to simplify. Both leaders and staff in organizations achieving high levels of patient safety recognize that this is a never-ending improvement process.

We are excited to embark on this journey and appreciate the sup-port of our leadership, patients, staff, and subject matter experts, who will be helping guide us along this journey. We remain com-mitted to delivering better care and better health to all entrusted to our care, as we transform toward a high reliability organization.

Sources: Department of Defense (DoD). (2014August). Military Health System Review: Final Report to the Secretary of Defense.Military Health System (MHS) High Reliability Task Force Report: A Resource Guide for Achieving High Reliability in the MHS.

PROVIDER BLOG

(P4I, Health IT, Facilities, Strategic Communications,Organizational Structure, Assessment)

READINESS

HRO Guiding Principles

Organization Enablers

Respect for PeopleEducation & Training

Patient-Centered Culture

Teamwork

Lower Cost

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LATEST HEART HEALTH RESEARCH

BECOME A CONTRIBUTOR

In the News: Heart Health Research

More aggressive treatment of high blood pressure saves lives in study.

Article from American Heart Association News, summarized:

Blood pressure is a potent determinant of cardiovascular risk, but the most appropriate targets for blood-pressure lowering have long been debated.

Observational studies with a low risk of confounding have shown a linear relationship between blood pressure and cardiovascular risk down to 115/75 mm Hg,1 but some observational studies with a greater potential for confounding, involving persons at increased risk, have suggested a J-shaped curve — that is, below a given blood pressure, risk would increase. When trials of blood-pressure–lowering drugs have shown benefits in patients without hyperten-sion, these effects have often been ascribed to alternative mecha-nisms. The widespread uncertainty about blood-pressure targets was increased when the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial showed no significant overall difference in cardiovascular events between patients with type 2 diabetes as-signed to a systolic blood-pressure target of less than 120 mm Hg and those assigned to a target of less than 140 mm Hg.2

The eagerly awaited results of the Systolic Blood Pressure Inter-vention Trial (SPRINT), now reported,3 are certain to have far-reach-ing implications.

SPRINT randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk to a target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). People with difficult-to-control blood pressure were excluded and will require separate study.

The mean blood pressure at baseline was 139.7/78.2 mm Hg in the intensive-treatment group and 139.7/78.0 mm Hg in the standard-treatment group, and the mean pressure at 1 year was 121.4/68.7 mm Hg and 136.2/76.3 mm Hg in the respective groups. During follow-up, the average difference in systolic pressure was 13.1 mm Hg, and the mean number of blood-pressure medica-tions was 2.8 in the intensive-treatment group and 1.8 in the stan-dard-treatment group.

The trial was stopped early, after a median follow-up of 3.26 years. Overall, participants assigned to the intensive-treatment group, as compared with those assigned to the standard-treatment group, had a 25% lower relative risk of major cardiovascular events (95% confidence interval [CI], 11 to 36), with consistent results across subgroups defined according to age, sex, race, medical history,

and baseline blood pressure. In addition, the intensive-treatment group had a 27% lower relative risk of death from any cause (95% CI, 10 to 40). Rates of some serious adverse events, including hy-potension and acute kidney injury or failure, were higher in the in-tensive-treatment group than in the standard-treatment group, but these higher rates appear unlikely to outweigh the benefits overall.

Clearly, our current concept of hypertension is insufficient to de-termine who benefits from blood-pressure lowering or how far to lower blood pressure. SPRINT strongly supports pharmacotherapy decisions based on absolute risk levels, in a similar way to current recommendations for lipid lowering. For people at high cardiovas-cular risk, a systolic goal of less than 120 mm Hg is appropriate.

Even with intensive lifestyle modification and medical therapy, blood pressure will remain above target in many patients, which suggests the need for population-level initiatives (e.g., reduced so-dium content in food), new therapies, and multifactorial interven-tion. In SPRINT, less than half the patients were taking statins, 13% were still smoking, and most were overweight or obese. SPRINT redefines blood-pressure target goals and challenges us to improve blood-pressure management.

To learn more visit: http://news.heart.org/more-aggressive-treatment-of-high-blood-pressure-saves-lives-in-study/

Sources: 1. Law MR, Morris JK, Wald NJ. Use of blood pressure low-

ering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009;338:b1665-b1665

2. Cushman WC, Evans GW, Byington RP, et al. Effects of inten-sive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010;362:1575-1585

3. The SPRINT Research Group. A randomized trial of inten-sive versus standard blood-pressure control. N Engl J Med 2015;373:2103-2016

We want to share your patient success stories, health tips and expertise with both patients and providers at NMCSD. We can utilize your content in a future newsletter, on social media or videos shown in our clinics.

We are looking for contributors to share the experience of care at NMCSD and to help patients learn more about healthy living practices. Please reach out to Alyssa.a.brown.ctr@mail.mil to learn more.

Meet members of your Care Team who take their healthcare beyond the walls of NMCSD! These practitioners inspire by leading a healthy and active lifestyle.

Ms. Helen Metzger is the Department Head of Health & Well-ness at NMCSD. We asked her how she incorporates wellness into her daily life, this is what she shared.

1. START SMALL. Focus on making gradual, but meaning-ful changes in areas of your life that you are working to improve.

2. PRACTICE GRATITUDE. Give from yourself everyday be-yond what you are paid to do, give to others out of kindness.

3. EAT TO NOURISH YOUR BODY. Incorporate lots of raw foods into your diet. Fuel yourself with foods that nourish and protect your body, choose unprocessed, chemical –free options when possible.

4. MOVE EVERYDAY. Choose activities that you truly enjoy! For Ms. Metzger, mixing it up is key! She plays on several

sports teams, does resistance training, yoga and other cardiovascular exercises.

5. STRIVE FOR GREAT VITAL SIGNS. Know your numbers and work towards optimal vitals and lab values.

6. GET OUT AND PLAY WITH YOUR CHILDREN. Kids shouldn’t be an excuse to be sedentary, but rather a rea-son to be outside playing!

7. SOCIALIZE AND LAUGH OFTEN. Meaningful and uplift-ing relationships are important for your overall health.

8. STAY HYDRATED. Eight glasses of water a day is a must!

9. MEDITATE AND STRETCH. These activities are hugely beneficial for stress reduction, incorporate them into your daily routine.

MODEL THE WAY

AROUND THE NEIGHBORHOODFleet & Family Services

Fleet & Family Services empowers individuals, families and units to strengthen their resiliency by providing optimized fleet and family programs and services. They have eight offices in the San Diego area and they are prepared to support your pa-tients with the following services:

• Deployment support• Relocation support

• Workshops in• Parenting• Conflict resolution• Stress• Anger management • Retiree support• Sexual assault prevention & response

Learn more about Fleet & Family services here.

Edamame Salad with Orange-Balsamic Dressing

Ingredients (Makes 4 Servings)

• 1 1/2 cups shelled edamame (green soybeans)

• 1/4 cup fresh orange juice

• 2 Tbsp. Dijon mustard (lowest sodium available)

• 2 Tbsp. balsamic vinegar

• 1 Tbsp. balsamic vinegar (divided use)

• 1 tsp. olive oil (extra virgin preferred)

• 1/4 pepper

• 15.5 oz. canned, no-salt-added navy beans (rinsed, drained)

• 1/4 tsp. salt

• 2 oz. mixed salad greens, torn into bite-size pieces (about

2 cups)

• 1/4 medium cucumber (sliced crosswise)

• 1 medium Italian plum (Roma) tomato (diced)

• 1/4 cup shredded carrot• 1/4 cup sliced radishes

Directions

1. Prepare the edamame using the package directions, omit-ting the salt. Meanwhile, in a small bowl, whisk together the orange juice, mustard, 2 tablespoons vinegar, oil, and pepper. Set aside.

2. In a medium bowl, stir together the edamame, navy beans, salt, and remaining 1 tablespoon vinegar. Let stand for 10 minutes at room temperature or cover and refriger-ate until needed, up to five days.

3. At serving time, put the salad greens on plates. Top, in or-der, with the cucumber, tomato, carrot, radishes, and bean mixture. Pour the dressing over all.

SOURCE: American Heart Association

HEART HEALTHY RECIPE FOR YOUR CARDIOVASCULAR PATIENTS