How San Diego cut AMI admissions by 22%, saved $86M
A population health collaborative in San Diego County contributed to a 22 percent reduction in hospital admissions for acute myocardial infarction (AMI), according to new research published in Health Affairs. Compared to the rest of California—which saw an 8 percent drop in AMI admissions—the program was estimated to prevent nearly 4,000 hospitalizations and save $86 million in its first six years.
The collaboration, called Be There San Diego (BTSD), was conceptualized in 2010 and launched in 2011. Before launch, AMI rates were similar in San Diego as in the rest of the state, according to the authors led by Allen Fremont, MD, PhD, a natural scientist and sociologist at the RAND Corporation in Santa Monica, California.
BTSD aimed to establish connections between clinical and community stakeholders to share best practices for managing hypertension, lipid levels and blood sugar—all risk factors for cardiovascular disease and AMI. Some of the specific components of the program include:
- Implementing a simplified approach to hypertension treatment.
- Distributing medication bundles with the goal of improving adherence among patients with diabetes or at risk of diabetes.
- Establishing partnerships with black churches to facilitate cardiovascular education, nutrition coaching and clinical visits for hypertensive patients, and to encourage walking groups and other church-sponsored healthy activities.
- Linkages between clinicians and community-based health organizations and pharmacists.
- Monthly meetings with stakeholders to discuss best practices and review key clinical metrics, which were collected as part of a data-sharing project.
Fremont and colleagues compared age-adjusted hospitalization rates for AMI from 2007 to 2010—before the intervention—to rates from 2011 to 2016.
Assuming the intervention hadn’t occurred, the researchers estimated 162 per 100,000 residents would be hospitalized each year with AMI. Following BTSD, the rate dropped to 136 AMI admissions per 100,000 residents.
If the entire state achieved a similar reduction, Fremont et al. noted, it would be expected to save 41,706 hospitalizations and $935 million over the six-year period.
“The results of our study suggest that the collaborative known as Be There San Diego and related activities were associated with a substantial reduction in AMI hospitalization rates within San Diego County, compared to the rest of California,” the researchers wrote. “The impact of BTSD may extend beyond AMI to other chronic disorders, such as chronic obstructive pulmonary disease or renal failure, in the future. The collaborative has helped enable a range of other population health improvement activities.”
The authors noted best practices meetings in Los Angeles and Sacramento Counties didn’t achieve similar reductions in AMI hospitalizations, potentially because the San Diego intervention contained more features and had a data-sharing component to guide behaviors. San Diego is also somewhat isolated geographically—bordered by the ocean and desert on either side, a Marine base to the north and Mexico to the south—so the countywide collaboration may be more focused than in other locations.
Finally, Fremont and colleagues acknowledged other national and local health initiatives aimed at cardiovascular disease could have supplemented the BTSD collaboration.
“BTSD featured these other preventive efforts in its activities, and the efforts were seen by participants as synergistic and part of BTSD’s strategy to align initiatives to magnify collective outcomes,” they wrote. “Because BTSD leaders and participants worked in concert with or directly participated in these other initiatives, it is difficult to separate the impact of BTSD from that of other initiatives.”
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.