A killer of people in their prime

I’d like to acknowledge a program that has been run for CGH for the last 33 months without much fanfare by Ellen Lockwood Cook, Director of Rehabilitation Services.[1] It’s an important community outreach program for people at high risk of heart disease. The point is to identify individuals at risk, to help them get the health care they need, and to encourage them in making lifestyle changes to reduce their chances of having a heart attack or stroke.

CGH has operated the cardiac risk reduction program in cooperation with the Syracuse Community Health Center (SCHC) since September 2004. SCHC is a federally-qualified primary care provider, headquartered at 819 S. Salina Street, offering primary care services at ten city and rural locations, including the Onondaga Nation and four Syracuse elementary and middle schools.[2]

New York State has one of the country’s highest rates of heart disease, and the State Department of Health has identified ccardiovascular disease as the leading cause of death. According to the state, cardiovascular disease “is a killer of people in the prime of life, with more than half of all deaths occurring among women.[3]

Of the 1,200 individuals screened by CGH and the SCHC, 65% have been women.[4] Where elevated risk factors exist, the participants have been educated and referred to follow-up care.

Other organizations have helped with the screenings, such as Wegman’s Food Markets which donated “healthy heart” gift baskets as raffle prizes to encourage participation. The Spanish Action League helped by translating documents used in the screenings, and the screenings are also tied into outreach efforts by the Food Bank of CNY. Assisting the effort have been CGH cardiologists – Drs. Lou Wasserman and Ron Caputo – who have provided educational sessions to SCHC and its medical staff.

As part of the cardiac risk reduction effort, CGH staff have provided information on the cardiac risk outreach services to Delta Sigma Theta Sorority and to the Men’s and Women’s Health Forums at SCHC. They have also made presentations at Hopps Memorial Church, the Northeastern Baptist Association’s regional meeting of ushers and nurses, and at State Senator John DeFrancisco’s Senior Citizen’s Health Fair.

Because cardiovascular disease strikes individuals “in the prime of life,” the CGH-SCHA screenings have focused on younger people – some 58% of participants have been under 50 years of age. The screenings have also reached a population that, in the words of SCHC’s mission statement, “might otherwise be excluded from the health care system.” Participants in the risk screenings have been 33% African Americans, 13% Hispanics, and 16% Native Americans, Asians, and other minority populations.

A lot of disease risk has been identified.

According to last year’s report, 71% of the participants have personal or family risk histories of heart disease, and 81% had risk scores in the moderate to high range. Some 31% were smokers, and another 40% were exposed to second-hand smoke. Most (80%) were concerned with their weight, and a body mass index (BMI) of 30 or more[5] was identified in 46% of the participants. There were 77% who had hypertension or pre-hypertension.

Identifying disease risk is one thing. It is another thing to help people at risk get care and make the long-term risk reducing changes needed. That’s why tracking tools have been started, and that’s why the CGH-SCHC work plan for 2007 seeks to document how cardiac care has been affected by the program to date.

This is a promising and worthwhile program. Because it has not had a lot of visibility, I’d like to shine the light on this community service – and thank all at CGH and the SCHC who are making it possible.[6]

[1] Ellen Lockwood Cook is also serving as acting executive director of the Community General Foundation, while a search for an executive director in underway.

[2] For a list of Syracuse Community Health Center locations, see its website: http://www.schcny.com/locations.php

[3] See the Department of Health website at http://www.health.state.ny.us/nysdoh/heart/heart_disease.htm

[4] The statistics presented here are from the Executive Summary of the 2006 Final Report by Ellen Lockwood Cook, based on a sample of 604 participants.

[5] BMI means “body mass index,” and it is a measure of body fat, based on the height and weight of adults. Normal BMI scores are between 18.5 and 24.9. A BMI under 18.5 is considered underweight. Overweight is considered to be a BMI of 25 to 29.9, and obesity is indicated by BMI scores greater than 30. To determine your BMI, use the calculator at the National Heart Lung and Blood Institute: http://www.nhlbisupport.com/bmi/bmicalc.htm

[6] In 2005 CGH honored Dr. Ruben Cowart, the President and CEO of the Syracuse Community Health Center, at the Community General Foundation Gala for his service to the community.

Infection rates & more

Maybe you saw the story in last Sunday’s Post-Standard ¹ about the annual report card on New York State hospitals that was issued by the Niagara Health Quality Coalition² The Coalition reports on mortality rates, blood clots after surgery, and hospital infections, using a risk-adjustment technique that makes for fair comparisons among hospitals, despite differences in the mix of patients they care for.

From the Coalition’s website, I collected comparison data on hospital infections for the four Syracuse hospitals and placed them in the accompanying chart. This shows hospital 2005 infection rates per 1,000 patients for infections occurring due to medical care (that is, primarily intravenous (IV) lines and catheters) and for postoperative sepsis (a bloodstream infection caused by toxin-producing bacteria occurring after surgery).

Naturally I was proud to see that CGH’s infection rates were below the state average and below the rates of other hospitals. In some cases our infection rates were one-half those of others. As the Coalition reports on its website: “Hospitals following the appropriate procedures, such as washing hands before working with a patient…should show a lower level of infections due to medical care³

May 2 was “Hand Hygiene Day” at CGH, and at the start of each shift hospital managers stood at each entrance to greet employees, volunteers, and physicians. They handed out more than 1,000 pocket-size bottles of Purell® that were donated to CGH by the company – to reinforce awareness about the importance of safe-hand practices here.

A number of people wore buttons reading, “Ask me if I washed my hands.” That is part of a campaign to encourage patients to be aware of (and to speak up about) hospital hand-washing practices and to discourage caregivers from being defensive when patients ask about hand-washing. As I wrote in last week’s letter,⁴ medical professionals have been more than a tad defensive about hand cleanliness for 150 years or so.

When a patient or family members asks, “Did you wash your hands,” the correct response is: “Thank you for asking. Yes, I did!” Or, “I am going to do that right now! Thank you for asking.”

And patients are speaking up. I recently received a letter from a patient who said, “I hate to beat a dead horse, but the only person I saw washing his hands was my attending physician (…kudos to him!) I think I saw my nurse do it, and I never once saw an aide do it. Now perhaps they did it down the hall or something, but…I want to make sure they have not touched anything (including and especially door handles) between the act of hand washing and doing anything to me (original emphasis).”

That’s Dennis Trepanier, Vice President – Operations, with volunteer Grace Easton and a supply of hand sanitizers on Hand Hygiene Day, May 2. Another patient wrote me to say she doesn’t trust hospitals so she brought to CGH her own supply of Clorox® wipes. During her stay she asked to speak with the Environmental Services management, and because of her concerns, a supervisor visited her several times during her stay, which she appreciated. The woman wrote me a very kind and complimentary letter about the staff who kept her room clean – but she did not hesitate to offer several pointed comments and observations about how we could improve our cleanliness.

Our patients are speaking up, and – with reports like that of the Niagara Coalition – more are likely to do so. Let’s encourage them to ask us about hand washing and infection control, and let’s be as responsive and as supportive as possible about cleanliness.

Thanks to the “green volunteers” who collected dozens of bags of litter from the CGH campus on Earth Day, May 3.From microorganisms to the environment, it’s been clean-up week at CGH. The day after Hand Hygiene Day, about 20 CGH “green volunteers” celebrated CGH’s own “Earth Day, May 3” by spreading out on the campus and picking up a season’s collection of discards and debris. It’s amazing what was found in parking lots, at the curbside, and along the tree line. The green volunteers filled dozens of trash bags with litter – cigarette butts, drinking cups, candy wrapper, old sneakers, glass and plastic bottles, plastic bags, car parts, and other detritus.

Thanks, everyone, for your ongoing help in keeping CGH clean – and safe.

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[1] “Hospital Report Card: Heart attack death rate high at University,” Post-Standard, April 29, 2007. For a copy of the story, go to: http://www.syracuse.com/poststandard/stories/index.ssf?/base/business-8/1177835843214811.xml&coll=1

[2] To see the report of the Niagara Coalition, go to: http://www.myhealthfinder.com/
(Click on “New York State Hospital Report Card” to find the area where you can compare hospital scores on 33 different measures.)

[3] http://www.myhealthfinder.com/newyork07/psi-full.php?table=07#REG

[4] “Weird, glowing substances,” April 28, 2007