Implementation and Evaluation of the Maine HeartSafe Communities Initiative APHA 139th Annual Meeting and Exposition Washington, DC Session 3451.0, Rural

Implementation and Evaluation of the Maine HeartSafe Communities Initiative

APHA 139th Annual Meeting and Exposition Washington, DC

Session 3451.0, Rural Health: Needs and InitiativesMonday, October 31, 2011: 4:30 PM

Ruth Dufresne, MS; Center for Community and Public Health, University of New England, Portland, ME

Danielle Louder, Public Health Division, Medical Care Development; Maine CDC CVH Program, Augusta, ME

Patrick Madden, Market Decisions, Portland, ME

Nisha Kini, M.B.B.S., M.P.H; Sara Huston, PhD ; and Robyn Reynolds, MPH, Department of Applied Medical Sciences, University of Southern Maine, Portland, ME

Troy Fullmer, Diabetes Prevention & Control and Cardiovascular Health Programs, Division of Chronic DiseaseMaine CDC, DHHS, Augusta, ME

AcknowledgementsCenters for Disease Control and Prevention Division

of Heart Disease and Stroke Prevention: Jan Jernigan, Susan Ladd, Ron Todd

Research Triangle Institute: Karen Isenberg, Deb Osber, James Hersey, Karen Bandel, Pam Williams-Piehota

Maine CDC/DHHS Cardiovascular Health Program: Debra Wigand, Kathy Decker, Katie Meyer, Pat Hart

Maine State and Regional Emergency Medical Services: Jay Bradshaw, Donnie Carroll, Steve Corbin, Joanne LeBrun and Rick Petrie

APHA 2011, Session 3451.0, Rural Health: Needs & Initiatives 2

Presenter DisclosurePresenter DisclosureRuth Dufresne

No relationships to disclose


Background2006 – CDC Heart Disease and Stroke

Prevention (HDSP) Promising Practices Project

CDC solicited voluntary applications, 7 state programs selected for evaluation (including Maine HeartSafe Communities)

4APHA 2011, Session 3451.0, Rural Health: Needs & Initiatives

Background (cont.)

Maine HeartSafe CommunitiesMaine is a rural state, with many living in rural

areas per U.S. Census BureauBased on cardiovascular “Chain of Survival”;

adapted and expanded from MA HeartSafe Community Program

Developed by the Maine Center for Disease Control and Prevention’s Cardiovascular Health Program (MCVHP) and Maine Emergency Medical Services


Background (cont.)Requirements for Meeting Recognition LevelsRecognition Level Providers and/or their Community Partners Must...

Basic Offer cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) training to their community members.

Offer cardiovascular-related education and/or awareness activities in their community, including symptoms of heart attack and stroke/call 911.

Have at least one emergency response designated vehicle equipped with an AED.

Have placement of at least one permanent AED with AED-trained personnel in public or private areas where many people are likely to congregate or be at higher risk for cardiac arrest (such as shopping malls, large employers, airports).Dispatch Advanced Cardiac Life Support (ALS) units or personnel to all priority medical emergencies either as primary responders or as ALS backup. ALS backup may occur on-scene, en-route, or at the hospital emergency department.Have an ongoing process to evaluate and improve the “chain of survival” in their community.

Silver Pre-arrival instructions for Emergency Medical Dispatch (EMD) on heart attack and stroke calls.

Gold 12-lead EKG capability and service permitted at paramedic level or interceptor agreement in place.

Platinum Service licensed at paramedic level (paramedics are dispatched to 100% of calls).


Implementation (limited to education on heart attack and stroke symptom recognition)

2006: 7* HeartSafe Communities cover 20 communities & approx. 59,138 Maine residents

2007: 13* HeartSafe Communities cover 64 communities & 189,248 ME residents

As of August, 2011 – 59 HeartSafe Communities cover 267+ communities & 829,500 ME residents (64% of the population)

*There were more HSC initially, but this number remained at the time of analysis. Reapplication required every 2 years.


Implementation (cont.)In FY 2008, CDC HDSP/RTI evaluation

found HeartSafe Communities increased the number of community education events provided in their communities

In FY 2010, HeartSafe Communities reported 182 community education activities


Implementation (cont.)As of FY 2011, 82% of local Healthy

Maine Partnerships (local public health infrastructure) partnered with 482 worksites & their HeartSafe Community on education strategies


Other Statewide Educational Efforts: Heart Attack

“In A Heartbeat” train-the-trainers have trained over 130 local EMS, nurses, health educators, etc. which have in turn provided heart attack education (symptom recognition/call 911) to more than 2,000 Maine residents in 50 different towns


Other Statewide Educational Efforts: StrokeOngoing: State-wide partners provide

stroke symptom recognition/call 911 awareness education in community, healthcare, school & worksite settings

May - Stroke Awareness month: Stroke signs awareness media campaign in Southern ME with WGME News 13 (2007 & 2008) and statewide (2009)


EvaluationEvaluation Question (related to symptom recognition) Indicator

Short-term Outcome: Is there an increase in the number of educational programs conducted by HeartSafe Communities on stroke and heart attack symptom recognition & 9-1-1(CDC HDSP indicator 3.2.1)

Reapplication/ HeartSafe database

Intermediate outcome: Is there increased stroke and heart attack symptom recognition & 9-1-1 among people in HeartSafe Communities(3.4.1, 3.4.2)

BRFSS module, HeartSafe database


MethodsBRFSS data analyzed using SUDAAN &

weighted to be representative of Maine’s adult population (age, gender, & race)

Pulled out respondents from communities designated as HeartSafe in 2006 or 2007 (per evaluation/analysis plan to provide time for education programs and changes in knowledge)


Sample Size

For various signs, decoy and call 911 -

Heartsafe Community Since 2007: n=1,001 to 1,004

All other: n=2,731 to 2,744


Key FindingsHeart AttackHeartSafe Communities designated in 2006

& 2007 had higher heart attack symptom recognition in 2009 than in 2005 (baseline)

HeartSafe Communities (2006 & 2007) showed greater improvement between baseline and follow-up in heart attack symptom recognition compared to others (and this group also improved, as desired, given other statewide education efforts)



Pain in the jaw, neck, or back

Feeling weak, lightheaded, or

faintChest pain Pain in arms or

shoulder Shortness of breath Sudden trouble seeing (decoy)

Year 2005 2009 2005 2009 2005 2009 2005 2009 2005 2009 2005 2009

Heartsafe Community

(2006 & 2007) 49% 62% 61% 66% 90% 96% 86% 91% 82% 89% 46% 39%

Other 52% 62% 62% 66% 94% 96% 90% 88% 86% 88% 43% 42%

Symptom and Decoy Recognition:2005-2009Heart Attack



Correctly Identified All Symptoms and Decoy 2005-2009: Heart Attack

2005 2009 Change 2005-2009

Heartsafe Community(2006 & 2007) 12.9% 15.6% 2.6%

Other 13.6% 16.4% 2.8%

• Difficult to correctly identify all symptoms & decoy

• An improvement, but still a long way to go


Correctly Identified All Symptoms, Decoy, and 911: 2005-2009Heart Attack

2005 2009 Change 2005-2009

Heartsafe Community(2006 & 2007) 11.9% 14.9% 3.1%

Other 12.5% 15.2% 2.7%


Key FindingsStroke

HeartSafe Communities designated in 2006 & 2007 had higher stroke symptom recognition in 2009 than in 2005 (baseline)

HeartSafe Communities’ (2006 & 2007) improvement varied compared to others



Symptom and Decoy Recognition:2005-2009Stroke

Sudden confusion or

trouble speaking

Sudden numbness or weakness of face, arm, or

leg…

Sudden trouble seeing in one or

both eyes

Sudden trouble walking,

dizziness, or loss of balance

Severe headache with

no known cause

Sudden chest pain or

discomfort (decoy)

Year 2005 2009 2005 2009 2005 2009 2005 2009 2005 2009 2005 2009

Heartsafe Community

(2006 & 2007) 86% 93% 92% 97% 66% 75% 81% 88% 52% 63% 37% 39%

Other 89% 93% 94% 96% 69% 76% 86% 89% 56% 58% 38% 42%



Correctly Identified All Symptoms and Decoy: 2005-2009Stroke

2005 2009 Change 2005-2009

Heartsafe Community (2006 & 2007 18.6% 24.0% 5.3%

Other 19.9% 22.9% 3.0%

• Difficult to correctly identify all symptoms and decoy

• An improvement, but still a long way to go


Correctly Identified All Symptoms, Decoy, and 911: 2005-2009Stroke

2005 2009 Change 2005-2009

Heartsafe Community (2006 & 2007) 16.9% 21.1% 4.2%

Other 18.1% 20.6% 2.5%


Thank you

Contact:Ruth Dufresne, MSResearch Associate for Evaluation (CVH & Diabetes)Center for Community and Public HealthUniversity of New EnglandPortland, ME 04103Phone: 207.221.4571Fax: 207.523.1914Email: [email protected]://www.une.edu/ccph/


Documents

Implementation and Evaluation of the Maine HeartSafe Communities Initiative APHA 139th Annual Meeting and Exposition Washington, DC Session 3451.0, Rural