A Community-Wide Collaboration to Reduce Cardiovascular Disease Risk: The Hearts of Sonoma County Initiative

A Community-Wide Collaboration to Reduce Cardiovascular Disease Risk: The Hearts of Sonoma County Initiative

IMPLEMENTATION EVALUATION — Volume 16 — July 11, 2019

Allen Cheadle, PhD1; Michelle Rosaschi, MPH2; Dolores Burden, MSN, RN3; Monica Ferguson, MD, MSHP4; Bo Greaves, MD5; Lori Houston6; Jennifer McClendon, MPH7; Jerome Minkoff, MD2; Maggie Jones, MPH1; Pam Schwartz, MPH8; Jean Nudelman, MPH8; Mary Maddux-Gonzalez, MD, MPH2 (View author affiliations)

Suggested citation for this article: Cheadle A, Rosaschi M, Burden D, Ferguson M, Greaves B, Houston L, et al. A Community-Wide Collaboration to Reduce Cardiovascular Disease Risk: The Hearts of Sonoma County Initiative. Prev Chronic Dis 2019;16:180596. DOI: http://dx.doi.org/10.5888/pcd16.180596external icon.

PEER REVIEWED

On This Page

• Abstract
• Introduction
• Purpose and Objectives
• Intervention Approach
• Evaluation Methods
• Results
• Implications for Public Health
• Acknowledgments
• Author Information
• References
• Tables

Summary

What is already known on this topic?

Clinical and community collaborations are foundational to primary care transformation efforts, but it has proved challenging to build sustainable, effective collaborations.

What is added by this report?

Several lessons from the experience of the successful Hearts of Sonoma County (HSC) collaborative, including 1) start small and focused to build trust among participants and demonstrate value, 2) work within the framework of a larger effort, and 3) providing long-term, open-ended backbone support.

What are the implications for public health practice?

The HSC experience may provide a roadmap for other, similar efforts.

Abstract

Purpose and Objectives

Collaboration across multiple sectors is needed to bring about health system transformation, but creating effective and sustainable collaboratives is challenging. We describe outcomes and lessons learned from the Hearts of Sonoma County (HSC) initiative, a successful multi-sector collaborative effort to reduce cardiovascular disease (CVD) risk in Sonoma County, California.

Intervention Approach

HSC works in both clinical systems and communities to reduce CVD risk. The initiative grew out of a longer-term county-wide collaborative effort known as Health Action. The clinical component involves activating primary care providers around management of CVD risk factors; community activities include community health workers conducting blood pressure screenings and a local heart disease prevention campaign.

Evaluation Methods

The impact of the clinical improvement efforts was tracked using blood pressure data from the 4 health systems participating in HSC. Descriptive information on the community-engagement efforts was obtained from program records. Lessons learned in developing and maintaining the collaborative were gathered through document review and interviews with key informants.

Results

Favorable trends were seen in blood pressure control among patients with hypertension in the participating health systems: patients with controlled blood pressure increased from 58% in 2014 to 67% in 2016 (P < .001). Between 2017 and 2019, the community engagement effort conducted 99 outreach events, reaching 1,751 individuals, and conducted 1,729 blood pressure screenings, with 441 individuals referred to clinical providers for follow-up care. HSC scored highly on 6 essential elements of an effective coalition and achieved a degree of sustainability that has eluded many other collaboratives.

Implications for Public Health

Factors contributing to the success of HSC include 1) starting small and focused to build trust among participants and demonstrate value, 2) working within the framework of a larger effort, and 3) providing long-term, open-ended backbone support.