Living for Health® (L4H) is a cardiovascular community health program that targets underserved and uninsured adults throughout Miami-Dade County. Faced with high rates of poverty, hospitalizations and deaths due to stroke, heart attack and diabetes, as well as high rates of uninsured residents in Miami-Dade, this program was developed to reach those most at risk and in need of education and medical treatment. Florida Heart Research Institute (FHRI) coordinates free screenings in underserved areas with teams that match the racial and ethnic makeup of the populations. These screenings include blood pressure testing and quick finger stick to check blood for Total Cholesterol, HDL (Healthy Cholesterol), and Glucose (Blood Sugar) Levels as well as a baseline lifestyle survey. Participants are then provided with free counseling to discuss results and health coaching to learn how healthy lifestyle choices (diet and exercise) can reduce risk. Educational information is provided in English, Spanish and Creole.
L4H identifies those at-risk for heart disease, stroke, diabetes and obesity BEFORE they have a life threatening event and encourages them to make healthy lifestyle changes and seek medical treatment for their condition.
L4H takes the typical mobile cardiovascular risk factor screening program two steps further. First, screeners connect those identified as needing follow up care who have no physician to a collaborating Federally Qualified Health Center (FQHC) that will treat them on a sliding fee scale. This collaboration requires Business Associate Agreements so that HIPAA protected information can be shared and post clinical data obtained. Second is the extremely effective phone survey follow-up component for at-risk participants. Aside from providing post-lifestyle data, these phone surveys are an opportunity to once again urge participants to seek treatment as well as re-educate them on the importance of making diet and physical activity improvements. These surveys are conducted at one, three, six and 12 month intervals from the initial screening event.
Analysis of pre and post clinical and lifestyle data show significant improvements in both. Results of the L4H program were reported nationally as our poster abstract was accepted for the Art & Science of Health Promotion Conference on March 23 - 25, 2011 in Colorado Springs, CO. L4H was also featured at the American Public Health Association's Annual Conference on October 29 - November 2, 2011 in Washington, DC in a Roundtable presentation on Underserved Populations: Innovative Health Promotion Program.
Since the spring of 2008, we have received over $300,000 in grant funding for this project.
By June 2011, after 3 years of the program, we screened 6,682 adults in designated high poverty and medically underserved zip codes in North and South Miami-Dade. Outcomes from the project through June 2011 show the following results:
- Of the 6,682 total participants screened, 4,008 or 60% were referred to a physician for follow up treatment due to their high risk clinical values for Blood Pressure, Cholesterol and/or Glucose.
- Statistically significant positive changes were shown consistently in five out of seven lifestyle measures at three different intervals within 12 months. Of the total participants referred for follow-up and reached in our survey, 48% were able to increase and sustain their daily fruit and vegetable consumption for 3 months. After 6 and 12 months, it was found that 50% and 52% of those reached, respectively, were able to increase and sustain their daily fruit and vegetable consumption, all at the urging of screeners or a physician.
- Of the overall number of people referred for medical follow-up who sought treatment at a participating FQHC and for whom we could correlate post 3 month clinical data, 38% moved from high risk to borderline or normal levels as a result of that treatment or lifestyle changes.
- Of those referred for medical evaluation as new patients to a participating FQHC, 11% were successfully matched to a new medical home. These are people who previously used emergency rooms or did not go for primary healthcare.
Epidemiologist's Statement |
To date, L4H has been 100% grant funded. With each new grant proposal, FHRI strives to widen our outreach and work with different populations and FQHCs that serve them. Impressive program outcomes, combined with the strength of the model, the ease with which it can be replicated as well as FHRI's expertise in screening, education, data tracking and reporting makes L4H an attractive program to support.
We believe L4H can become a best practice model for cardiovascular community health. This model should be easy to replicate in any medically underserved or poverty designated area in which services to the uninsured are provided by community health centers or FQHCs. Health departments or other community based organizations with chronic disease prevention programs that provide mobile cardiovascular risk factor screenings could adopt this community based model which is extremely cost effective at less than $50 per person. The compatible collaborative "win-win" relationship between the screening / education provider (that receives grant funding for services) and the FQHC that provides treatment (which is underwritten by Federal programs) will work anywhere in the nation.
We are grateful to our funders for making this all possible: Health Foundation of South Florida, United Way of Miami-Dade County, Florida Heart Research Foundation, and the Aetna Foundation, and to our community partners who support the program: Health Choice Network, Community Health of South Florida, Miami Beach Community Health Center, and Jessie Trice Community Health Center. |
