credo - Coalition to Reduce Disparities in CV Outcomes

credo State Disparity Reports Now Available

credo, has produced state-specific cardiovascular disease (CVD) reports to raise awareness of CVD disparities at the state level. Through the use of nationally recognized data sets, members can localize differences in CVD prevalence and outcomes among their patient populations and use this tool to implement chapter educational programs or activities that will specifically address the needs of these groups. For further information regarding these reports, or for a copy of the reports, please contact credo@acc.org.

credo Presents at American Heart Association's QCOR Meeting

At the American Heart Association's Quality of Care and Outcomes Research 2011 Scientific Sessions, credo presented a poster titled "Non-White Males Show Less Satisfaction with Atrial Fibrillation Care." Using over 1300 patient surveys from A New ERA: Evidence-based Stroke and Symptom Reduction in Atrial Fibrillation, a performance improvement continuing medical education, credo showed disparities in patient satisfaction with care which may ultimately lead to poor patient outcomes.

credo at ACC.11 - Resources for Culturally-Competent CVD Care

At the 60^th Annual Scientific Session, credo presented a Lunch with the Experts Session entitled "Making the Case for Culturally-Competent Cardiovascular Disease Care: Case-Based Training for Cardiology: A credo Initiative." The session provided an overview of common issues that challenge clinicians in treating diverse patient populations, a description of the key tools that assist clinicians in optimally communicating with diverse patient populations, and two case-based, interactive modules that permit attendees to view and practice applying cultural competency tools.

credo White Paper in JACC

In the January 18^th, 2011 Journal of the American College of Cardiology (JACC), ACC reviews the rationale for credo, which seeks to give health care providers information and tools to equitably treat their diverse patient populations with or at risk of cardiovascular disease.

Meetings on Demand

Heart of Women's Health Meeting on Demand™ Program

Through these selected presentations from the Heart of Women's Health program, listen to the experts discuss and debate such timely topics as the impact of hypertension on cardiovascular disease risk in women, acute coronary syndromes and the latest guidelines, and other gender-based disparities facing women patients today.

Reducing Racial and Ethnic Disparities in Cardiovascular Disease Outcomes: Understanding the Need for credo and How it Can Work for You

An online certified educational program with a variety of tools and information that clinicians can use to better understand the nature of disparities and reduce them for their patients.

Patient Education Resources

Cardiac Rehabilitation: Your Journey Back to Heart Health

A patient education video that conveys—from the perspective of patients—the importance of cardiac rehabilitation.

CardioSmart™ En Español

Find fact sheets in Spanish on heart disease here.

General Resources

Agency for Healthcare Research and Quality: National Healthcare Disparities Report, 2010

For the eighth year in a row, AHRQ has produced the National Healthcare Disparities Report (NHDR). This reports measure trends in effectiveness of care, patient safety, timeliness of care, patient centeredness, and efficiency of care and summarizes health care quality and access among various racial, ethnic, and income groups and other priority populations, such as residents of rural areas and people with disabilities. New this year are chapters on care coordination, health system infrastructure.

CDC Health Disparities and Inequalities Report — United States, 2011

The CDC has released its first Health Disparities and Inequities Report for 2011 (CHDIR). CHDIR consolidates the most recent national data available on disparities in mortality, morbidity, behavioral risk factors, health care access, preventive health services, and social determinants of critical health problems in the United States by using selected indicators. The report provides morbidity and mortality data on 22 topic areas, including coronary heart disease stroke deaths, obesity, diabetes and prevalence of hypertension and controlled hypertension.

HRET Disparities Toolkit: A Toolkit for Collecting Race, Ethnicity, and Primary Language Information from Patients

A toolkit for collecting race, ethnicity, and primary language data from your patients.

Office of Minority Health Resource Center

The Office of Minority Health (OMH) operates the OMH Resource Center (OMHRC), which serves as a free information and referral service on minority health issues for community groups, consumers, professionals, and students.

Health Literacy

Health Literacy - Health.gov

This site provides an overview of health literacy, tools and resources for clinicians, reports and research, and related resources on health literacy.

Health Literacy - National Library of Medicine

This webpage provides an overview of health literacy and a comprehensive list of resources on health literacy for both health care professionals and patients. Resources include tutorials for patients on improving health literacy, journal articles on health literacy, glossaries of common health terms, statistics on health literacy, and guides for children and seniors.

Innovations in Health Literacy: Institute of Medicine Workshop Summary

Nearly nine out of 10 adults have difficulty using everyday health information to make good health decisions. The IOM Roundtable on Health Literacy held a meeting on May 27, 2010, to explore areas for research in health literacy, the relationship between health literacy and health disparities, and ways to apply information technology to improve health literacy.

Cultural and Linguistic Competence

Think Cultural Health: Bridging the Health Care Gap through Cultural Competency Continuing Education Programs

This site, sponsored by the Office of Minority Health, offers the latest resources and tools to promote cultural competency in health care. You may access free online courses accredited for continuing education credit as well as supplementary tools.

Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care

The Joint Commission has developed a monograph for hospitals to incorporate cultural competence into the health care setting. The Roadmap for Hospitals provides recommendations to help hospitals address unique patient needs, meet the new Patient-Centered Communication standards, and comply with existing Joint Commission requirements.

National Center for Cultural Competence

The mission of the National Center for Cultural Competence is to increase the capacity of health care and mental health care programs to design, implement, and evaluate culturally and linguistically competent service delivery systems to address growing diversity, persistent disparities, and to promote health and mental health equity.

Women and Heart Disease

WomenHeart: The National Coalition for Women with Heart Disease

WomenHeart: The National Coalition for Women with Heart Disease is the nation's only patient centered organization serving the 42 million American women living with or at risk for heart disease – the leading cause of death in women. WomenHeart is solely devoted to advancing women's heart health through advocacy, community education, and the nation's only patient support network for women living with heart disease. WomenHeart is both a coalition and a community of thousands of members nationwide, including women heart patients and their families, physicians, and health advocates, all committed to helping women live longer, healthier lives. To receive a free on line heart health action kit or to donate visit www.womenheart.org/kit.

Women's Health.gov — Heart Truth

The Heart Truth® is a national awareness and prevention campaign about heart disease in women sponsored by the National Heart, Lung, and Blood Institute (NHLBI). The Heart Truth Professional Education Website provides information for clinicians and educators about the prevention of heart disease in women including links to consumer information, patient education materials, evidence-based references for clinical decision-making, web-based CME learning modules and other educational materials.

Putting Women's Health Care Disparities on the Map

Putting Women's Health Care Disparities on the Map: Examining Racial and Ethnic Disparities at the State Level is a unique state-level look at disparities among women of different races and ethnicities on a broad range of indicators of health and well-being. A profile of each state is available by clicking on the map provided on the site with full access to state-by-state comparison tables.

credo Interview

I made the decision to study women and heart disease when I was in medical school and saw the lack of research on heart disease in women. Perhaps my motivation was a little selfish because I am a woman; if I come in with a heart attack, I want my physician to know what to do with me and not only me but my sister or niece or any woman close to me as I am sure is the case for anyone.

But I am driven by the questions that still exist for women. There is still so much we need to know. I am inspired by my colleagues and I am just one of many people contributing to this field. So many people before me have all done amazing things and contributed to this ongoing work. Many of these people have served as mentors for me and guided my research and helped me make this my passion. If creating an award like this motivates our cardiology community to be cognizant of disparities in care and work to find solutions, then this is a great thing. I am absolutely honored and thrilled to be chosen as its first recipient.

Q: Why do you believe that addressing health disparities is important? Can you recall a specific incident that motivated you to work to redress disparities?

It is incredibly important to address these disparities. We have been treating heart disease well for many years but mostly to the benefit of white men. In terms of outcomes in heart disease, it is worse to be a woman but even worse to be a black woman. We have to understand the root cause of this and work to make sure all patients have equitable outcomes.

Q: As someone who works to understand heart disease in women, what value do you see an initiative like credo having in redressing disparities?

credo is pointing out that we are not doing a good job for some groups of people. To create an initiative like this is to bring an important issue to the forefront of members' attention. We are doing well with some groups but not others. Is it because we are not treating all of our patients in the same way? Could it be because of differential access to care? Surely many factors play a role so we first need to understand what is happening then treat and teach our patient populations accordingly.

I read the recent credo white paper publication in JACC with interest, especially the use of patient race, ethnicity and gender data in performance improvement activities. For me, it made the case that, just like ICD incentives, all hospitals should have to report cardiac outcome data by race and ethnicity – there should not be any more stopgaps. We have done all this good research and work and now we need to make sure that everyone benefits from it, by implementing it into our practices.

credo Interview - Gordon Fung, MD, MPH, PhD, FACC

Q: Why do you believe that addressing health disparities is important? Can you recall a specific incident that motivated you to work to redress disparities?

I can remember a particular instance when I was coming onto a service. The person who was attending before me had transferred a patient who was an elderly woman that was admitted with chest pain. They wanted to do a catheterization but she refused all medical care and didn't want anything done. I took the opportunity to speak with her since we happened to speak the same dialect of Chinese and she revealed to me that no one told her what was wrong. As we spoke, she understood and agreed to surgery and bypass and had a good outcome. I saw two main things in that situation: the disparity in language barrier and her being stereotyped as an older person who did not want to be operated on.

That and other similar incidents led me to start a private practice in the Chinatown community in San Francisco 15 years ago. I got lots of comments from surgical and medical colleagues that the Asian population was considered the "model minority" and had few health problems and yet found myself busy in practice – there was certainly a disconnect. I suspected that they were being seen later with complications because of the perception that they did not have many health problems.

With the support of the administration at UCSF and various advocates of quality care for all, I was able to set up the Asian Heart & Vascular Center at UCSF. We have been able to not only provide services and consultations in the various languages of the community but have also conducted educational outreach to the public with seminars with attendance of 200 to 300 community members. We have seen lots of success with the center as it has demonstrated increased acceptance.

Q: As a credo advisory board member, what value do you see an initiative like credo having in redressing disparities?

I was pleased when credo came together to address issues of disparities in the entire population, including all ethnic populations, genders and age groups. Dr. [Clyde] Yancy [co-chair of the credo advisory board] has indicated an approach to use data, especially in the ACC's NCDR (National Cardiovascular Data Registry) to show that what we are doing is inadequate. It's a stain to say we have the best HC system of the world when these disparities continue to exist and are clearly demonstrated in the data registries.

Q: What would you say to encourage your colleagues to work toward the elimination of racial, ethnic, gender, or age disparities in CV care?

One of the things I think about is what we would actually need to make an impact. We are a very mobile society – both providers as we go from place to place, and the communities that we serve are constantly changing and evolving. There is no longer a situation where you find a community with a homogeneous static population. With that, we need to remember that there are places where these communities need to go to get care and we have a duty to provide that care and should constantly strive to treat them to the best of our ability.

credo Interview - Marcus L. Williams, MD, FACC

Q: Why do you believe that addressing health disparities is important? Can you recall a specific incident that motivated you to work to redress disparities?

I believe addressing health care disparities is important on several fronts. First, many physicians in CV disease and care are aware of differences between groups in terms of prevalence of CV disease, mortality, in-hospital outcomes, and other indicators of disparities. As an African American male who should be at high risk for CV disease, I have a personal interest in seeing that disparities are reduced, especially for my family and community.

Secondly, the US is a diverse country but unfortunately, there is not equal opportunity and access to healthcare. There are groups that carry a higher risk and burden of disease and that threatens the quality of healthcare as a whole in the US. We have excellent and innovative approaches to health care and it is my belief personally and that of ABC that these approaches should be extended to all.

Lastly, as a personal example, I have two adult daughters; one who is in graduate school and one who is working. Both could not afford health insurance so we have had to supplement their income to cover them. For me, this brings home the some of the challenges of our healthcare system – what happens to families who do not have the resources I have to provide health care for their adult family members who could not afford it?

Q: As a leading cardiologist, what value do you see an initiative like credo having in redressing disparities?

To accomplish our mission at ABC to champion the elimination of CV disparities through education, research and advocacy, we need more than just ABC. The ACC and AHA (American Heart Association) carry tremendous weight and if they are paying attention to issues of disparate care, others will surely come on board because we know we cannot achieve these goals alone. I like to use a football analogy to describe this. The ACC and AHA are like big linemen while smaller organizations like ABC are like running backs. We all need to work as a team and if the linemen can open a hole to allow the running back into the end zone, then we all win.

The ABC has recently launched the ABC 2020 Goal to reduce the CV disease disparity gap by 20% by 2020. The goal is to decrease mortality from coronary heart disease and stroke and reach treatment targets for those with hypertension and diabetes. We see credo as a valuable resource in this goal because it draws attention to the fact that disparities exists and works to find solutions.

Q: What would you say to encourage your colleagues to work toward the elimination of racial, ethnic, gender, or age disparities in CV care?

We should all care about reducing disparities because in the end, if all people benefit, it's a win-win situation. The reality is that the level and quality of care needs to be raised for everyone. I would encourage anyone who is interested in the issues of health disparities to reach out to the ABC (www.abcardio.org) to see how we might partner together. ABC is made up of a diverse group of physicians, health care professionals and lay members of the community of all religions, races and genders focused on eliminating CV health disparities for all people and we encourage everyone to join us in our fight to stamp out CV disease disparity.

For me personally, it's also a moral issue – we have to care for our fellow man. As physicians, we have to follow the Hippocratic Oath. We should promote whatever works that allows people to have a great quality of life because that is what is ultimately important.

credo Interview - Diane Wallis, MD, FACC

Q: What motivated you to actively work to address health disparities? Why do you believe that addressing disparities are important?

I see a lot of women in my practice, and many are ethnic minorities from eastern and southeastern Asia. Often times, they present with chest pain and once ischemic heart disease is excluded, other causes of chest pain are no longer considered. I have discovered that many of my patients with nonischemic chest pain actually are suffering from osteomalacia due to Vitamin D deficiency, which is often missed in minority communities.

A December 2003 article by Plotnikoff and Quigley found that in a clinic serving equal immigrant and non-immigrant populations, profoundly low Vitamin D levels existed among the minority groups. After reading that article, I began checking Vitamin D levels consistently among all my patients and have incorporated it into my routine care.

Q: What value does an initiative like credo have in redressing disparities? Can you share an experience from your practice that illustrates the need for credo?

I see credo as an opportunity to share information with other providers and to promote studies that address cardiovascular disease in women and minorities and to look at them critically. Promoting equitable care and understanding disparities is so important. credo is a good opportunity to share papers around issues of diversity and share relevant links.

Many physicians believe they provide the same care to all of their patients regardless of race, and do not believe that racial disparities are present in their practice. It's important to understand that addressing disparities isn't about discrimination, it's about the lack of understanding of physiologic differences we can better understand with more research among these groups.

Q: Why are tools or resources that can promote equitable care important?

I believe that we need to call for more research in this field. Sharing information that results from that research and other resources is very important. Once I understood the impact I could make in reducing the burden of vitamin D deficient diseases, including hypertension, hypertensive heart disease, and diastolic heart failure in populations at the greatest risk, I came to understand racial disparities differently, not as a socioeconomic issue, but a physiologic one.

Q: What would you say to encourage your colleagues to work toward the elimination of racial and ethnic, gender-based, and age disparities in CV care?

Once physicians understand that racial disparities may not be so much a socioeconomic issue as a vitamin D absorption issue, they will start to understand that addressing disparities is fundamentally a health issue and physicians should be leading the charge.

Suggested Resources:

• Vitamin D Council
• The "sunshine deficit" and cardiovascular disease
• Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain
• Role of vitamin D in cardiovascular health
• Vitamin D, race, and cardiovascular mortality: Findings from a national US sample

credo Subcommittee

• Relevance to healthcare providers who treat patients with or at risk of CVD
• Relevance to the promotion of equitable CVD care and outcomes in all patients regardless of race, ethnicity, gender, age, literacy, language preference or proficiency, disability, sexual orientation, or socio-economic status
• High quality:
• Evidence-based
• Shown to reduce disparities or conforms to principles associated with reductions in disparities
• Consistent with ACC guidelines and performance measures
• Patient-centered
• Respectful of cultural and individual differences
• Abidance by ACC's Principles for Relationship with Industry