- Special Heart Risks for Men
- Heart Risk Factor: Erectile Dysfunction
- Heart Risk Factor: Low Testosterone
- Cardiovascular Disease and Clinical Epidemiology
- Degree Programs
- Polyarteritis Nodosa
- Who gets Polyarteritis Nodosa (the “typical” patient)?
- Classic symptoms and signs of Polyarteritis Nodosa
- Gastrointestinal Tract
- What causes Polyarteritis Nodosa?
- How is Polyarteritis Nodosa Diagnosed?
- Treatment and Course of Polyarteritis Nodosa
- In medical terms, by David Hellmann, M.D
- Health Care Innovation Awards: Maryland
- ATLANTIC GENERAL HOSPITAL CORPORATION
- CHRISTIANA CARE HEALTH SYSTEM
- FOUNDATION FOR CALIFORNIA COMMUNITY COLLEGES
- GEORGE WASHINGTON UNIVERSITY
- JOHNS HOPKINS SCHOOL OF NURSING
- JOHNS HOPKINS UNIVERSITY
- The Global Health Security Index
Special Heart Risks for Men
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Men develop heart disease 10 years earlier, on average, than women do. They also have an early warning sign that few can miss: erectile dysfunction (ED). “It’s the canary in the coal mine,” says a Johns Hopkins expert. “Sexual problems often foretell heart problems.”
On the plus side, any risk factor—even ED—that gets your attention can put you on a path to better preventive care.
Heart Risk Factor: Erectile Dysfunction
“A lot of people think erectile dysfunction is the inability to get an erection at all, but an early sign of the condition is not being able to maintain an erection long enough to have satisfactory sexual intercourse,” says a Johns Hopkins expert. Erectile problems aren’t a normal part of getting older as many people think; rather, they almost always indicate a physical problem.
A key reason erectile dysfunction is considered a barometer for overall cardiovascular health is that the penis, the heart, is a vascular organ.
Because its arteries are much smaller than the heart’s, arterial damage shows up there first—often years ahead of heart disease symptoms.
Men in their 40s who have erection problems (but no other risk factors for cardiovascular disease) run an 80 percent risk of developing heart problems within 10 years.
Treatment tends to be successful when started as soon as you begin to notice erection problems over more than a couple of months. An ED workup by a doctor will address heart disease risk factors, such as prediabetes, high blood pressure or excess weight — hopefully, long before they result in a heart attack or stroke.
Heart Risk Factor: Low Testosterone
Having a low testosterone level is often thought of as just a diminished sex drive, but it’s increasingly seen as being linked to heart disease and type 2 diabetes, the expert says. He notes that a growing body of research indicates that “low T” can be considered a cardiovascular and metabolic risk factor.
“These ideas are still being studied, but we know, for example, that people with abdominal obesity [so-called ‘belly fat’] or metabolic syndrome often have low testosterone,” the expert says. Metabolic syndrome (which includes high blood sugar levels, unhealthy cholesterol levels, and too much weight in the midsection) and diabetes are leading risk factors for heart disease.
Low testosterone is simply one part of an overall picture of heart risk, the expert says. But it can be motivating, even lifesaving, to know that changes in your sexual function are closely interrelated to the rest of your body.
It’s worthwhile to get yourself checked out when something doesn’t seem right. “Men often don’t connect this problem to or get evaluated for stroke or heart attack risk until it happens,” he says.
“But sexual problems are a message they listen to.”
Men who have high levels of calcification in their arteries are more ly to develop erectile dysfunction, according to a Johns Hopkins–led study of nearly 1,900 men, aged 59 to 64, who were followed for nine years.
Calcification—calcium deposits in the arteries to the heart caused by damage—are a direct measure of blood vessel hardening, which indicates high cardiovascular disease risk. The men who were followed were heart-disease-free at the start of the study.
Those found to develop heavy calcium buildup were 43 percent more ly to develop erectile problems down the road.
The study emphasizes the importance of coronary calcium screenings, which are CT scans that measure calcium buildup in heart arteries.
Stress, anger and anxiety raise levels of blood pressure and stress hormones, and they can restrict blood flow to the heart. Some damage can be immediate. In the two hours after an angry outburst, for example, your risk of a heart attack is nearly five times greater and your risk of stroke three times higher, research has shown.
What’s more, the effects of chronic stress can build over time, damaging arteries. Men who have angry or hostile personalities, in particular, have a higher risk of developing heart disease. Sexual problems related to heart disease can cause added anxiety or relationship stress. Stress can also affect sleep, which in turn affects heart health.
“Physical, emotional and psychological factors are all related when it comes to heart health,” says a Johns Hopkins expert. “When someone has chronic stress, depression or anxiety, they should have a basic evaluation of all of the risk factors for heart disease.”
Cardiovascular Disease and Clinical Epidemiology
Home > Departments > Epidemiology > Tracks > Cardiovascular and Clinical Epidemiology
This track focuses on the use of rigorous epidemiologic methods as applied to clinical and translational research, with emphasis on cardiovascular disease.
Clinical and translational research encompasses a broad area of investigations that includes:
- Patient-oriented research
- Epidemiology and behavioral studies
- Clinical trials
- Health services and outcomes research
The Cardiovascular and Clinical Epidemiology track aims to develop creative and independent investigators who will be able to collaborate effectively with bench and applied scientists to improve disease prevention and treatment at both the clinical and population levels.
Coursework and mentorship emphasize the use of epidemiologic methods in clinical and translational research, as well as interdisciplinary training on the epidemiology of cardiovascular disease.
The track includes two groups of students – those with a focus on cardiovascular disease epidemiology and those with a focus on clinical epidemiology.
The track is geared toward students, including both research-oriented clinicians and non-clinicians, who seek to apply rigorous epidemiologic methods to strengthen clinical practice, advance the health of people and improve the health of populations.
The track offers both masters and doctoral degrees and is housed at the Welch Center for Prevention, Epidemiology and Clinical Research, a teaching and research center that bridges both the Schools of Public Health and Medicine.
Among other outstanding collaborations, the program benefits from close ties with the Johns Hopkins University divisions of General Internal Medicine, Cardiology and Endocrinology.
The strengths of the program include the existing depth of interest and expertise in cardiovascular disease and clinical epidemiology at the Johns Hopkins Medical Institutions, as well as the enthusiasm, commitment, and experience in training and mentorship of the program faculty.
Students engage in coursework and research applicable to the entire continuum of clinical epidemiology – prevention and screening, diagnosis, treatment, disease management, and prognostication.
Prior students, for example, have engaged in natural history studies, cohort studies, translational research studies, clinical trials, and meta-analyses.
Special emphasis is placed on the application of innovative and rigorous methods, and on the role of epidemiology in understanding risk factors for disease and developing and implementing prevention strategies. Specific areas of interest include, but are not limited to:
|Health Equity||Heart Disease|
|Primary Care||Substance Abuse|
The goals of the program can be effectively divided by year:
First year students master the material in the required courses, identifying a research mentor and project, and pass the comprehensive examination. Seminars and interaction with the academic advisor build the foundation for subsequent research.
In addition to classes, students attend seminars in the Department of Epidemiology and the Welch Center, such as the Welch Center Grand Rounds, Welch Center Journal Club and Research in Progress.
(Please visit the Welch Center for more details.
) Additional interest group meetings related to research projects are held in several topic areas, such as Diabetes and Obesity, Kidney Disease Epidemiology, Methods and Ideas in Cardiovascular Epidemiology (MICE) and Health Equity.
Second year students work on a research project with a faculty research mentor. The research is facilitated by faculty playing a leading role in seminal cardiovascular studies including ARIC, MESA, and Look AHEAD and who are experts in a wide range of research areas. Training grant opportunities are available in several disease areas as well as primary care.
- Current Research
Click here to learn about the Cardiovascular Disease Epidemiology Training Program
The first description of this disease dates back to 1866 when Kussmaul and Maier identified a condition that consisted of “focal, inflammatory, arterial nodules”. They termed this disorder “periarteritis nodosa” because of the inflammation they observed around the blood vessel wall.
The name was changed to polyarteritis nodosa (PAN) to underscore the fact that inflammation throughout the entire arterial wall – not just around the wall – is a major disease feature.
Polyarteritis nodosa is sometimes termed “systemic necrotizing vasculitis”, but this term is non-specific as other forms of vasculitis also have systemic and necrotizing features.
Who gets Polyarteritis Nodosa (the “typical” patient)?
Most cases of PAN occur in the 4th or 5th decade, although it can occur at any age. Men are twice as ly to be affected than women. A minority of patients with PAN have an active hepatitis B infection. In the rest of the cases, the cause(s) is presently unknown, and the disease is said to be “idiopathic” in nature.
Classic symptoms and signs of Polyarteritis Nodosa
PAN is a multisystem disease that may present with fever, sweats, weight loss, and severe muscle and joint aches/pains. PAN may develop in a subacute fashion, over several weeks or months.
Patients may have nonspecific complaints such as fever, malaise, weight loss, anorexia, and abdominal pain. The disease can affect nearly any site in the body, but it has a predisposition for organs such as the skin, kidney, nerves, and gastrointestinal tract.
Many patients with PAN have high blood pressure and elevated erythrocyte sedimentation rates (ESR).
The presentation of PAN may also include skin abnormalities (rash, ulcers) and peripheral neuropathy (pain, the sensations of burning, tingling, or numbness, or weakness in a hand or foot). However, the disease has a predilection for certain organs and tissues; these are described below.
- Gastrointestinal tract
- Peripheral neuropathies are very common (50 to 70%). This includes tingling, numbness and/or pain in the hands, arms, feet, and legs.
- Central nervous system (CNS) lesions may occur 2 to 3 years after the onset of PAN and may lead to cognitive dysfunction, decreased alertness, seizures and neurologic deficits.
- Skin abnormalities are very common in PAN and may include purpura, livedo reticularis, ulcers, nodules or gangrene.
- Skin involvement occurs most often on the legs and is very painful.
- Renal artery vasculitis may lead to protein in the urine, impaired kidney function, and hypertension.
- Small percentage of patients go on to require dialysis.
- Abdominal pain, gastrointestinal bleeding (occasionally is mistaken for inflammatory bowel disease)
- Hemorrhage, bowel infarction, and perforation are rare, but very serious
- Clinical involvement of the heart does not usually cause symptoms.
- However, some patients develop myocardial infarctions (heart attacks) or congestive heart failure.
- Scleritis or inflammation in the sclera (white part of the eye)
What causes Polyarteritis Nodosa?
Hepatitis B causes a minority of cases of PAN. With the availability of hepatitis B vaccine now, cases of PAN caused by hepatitis B are now rare in the developed world. It is possible that other infections contribute to other cases of PAN, but links between other infections and this disease remain conjectural at the present time.
How is Polyarteritis Nodosa Diagnosed?
Routine laboratory tests may provide important clues to PAN, but there is no single blood test that is diagnostic of this disease. Most patients with PAN have elevated ESRs. Proteinuria (protein in the urine) is common among those with kidney involvement.
If there is skin or muscle/nerve involvement, a skin or muscle/nerve biopsy can be extremely helpful in coming to a definite diagnosis of PAN. Nerve conduction studies are a non-invasive way of identifying nerves that are involved by the inflammation. (These nerves can then be biopsied to confirm the diagnosis).
The diagnosis is confirmed by a biopsy showing pathologic changes in medium-sized arteries. The biopsy site may vary. Most biopsies are taken from skin, symptomatic nerve, or muscle. An angiogram of the abdominal blood vessels may also be very helpful in diagnosing PAN.
Aneurysms most often affect the arteries leading to the kidneys, liver or gastrointestinal tract.
The American College of Rheumatology (ACR) has established criteria that should be fulfilled if a patient is to be included in a research study of PAN. The criteria are designed to differentiate PAN from other forms of vasculitis. Not all patients have all criterion.
Some, in fact, may have only 2 or 3 criteria, yet their physicians are still comfortable classifying their disease as PAN. A committee of ACR physicians selected 10 disease features (criteria) as being those that best distinguish PAN from other vasculitides.
In order to be classified as a PAN patient – for the purpose of research studies – a patient should have at least 3 of the 10 ACR criteria.
The American College of Rheumatology 1990 criteria for the classification of Polyarteritis Nodosa
- Weight loss of > 4 kg since beginning of illness
- Livedo reticularis
- Testicular pain or tenderness
- Myalgias, weakness, or leg tenderness
- Mononeuropathy or polyneuropathy
- Development of hypertension
- Elevated BUN or creatinine unrelated to dehydration or obstruction
- Presence of hepatitis B surface antigen or antibody in serum
- Arteriogram demonstrating aneurysms or occlusions of the visceral arteries
- Biopsy of small or medium-sized artery containing granulocytes
Treatment and Course of Polyarteritis Nodosa
Treatment of PAN has improved dramatically in the past couple of decades. Before the availability of effective therapy, untreated PAN was usually fatal within weeks to months. Most deaths occurred as a result of kidney failure, heart or gastrointestinal complications.
However, effective treatment is now available for PAN. After diagnosis, patients are treated with high doses of corticosteroids. Other immunosuppressive drugs are also added for patients who are especially ill.
In most cases of PAN now, if diagnosed early enough the disease can be controlled, and often cured.
In medical terms, by David Hellmann, M.D
A discussion of Polyarteritis Nodosa written in medical terms by David Hellmann, M.D. (F.A.C.P.
), for the Rheumatology Section of the Medical Knowledge Self–Assessment Program published and copyrighted by the American College of Physicians (Edition 11, 1998).
The American College of Physicians has given us permission to make this information available to patients contacting our Website.
Polyarteritis nodosa is a small– and medium–sized arteritis affecting multiple organs, especially the skin, peripheral nerve, gut, kidney, and heart. The age of onset ranges from childhood to late adulthood but averages 40 years. Polyarteritis nodosa has been associated with active hepatitis B, hepatitis C, or both; therefore, the disease is more common in injection drug users.
Polyarteritis nodosa is probably mediated by deposition of immune complexes.
Evidence includes the observation that patients with polyarteritis nodosa associated with hepatitis B or hepatitis C have immune complexes consisting of immunoglobulin and viral antigens circulating in the blood and deposited in inflamed vessels. Moreover, antiviral therapy can remit the vasculitis in some of these patients.
The onset is gradual over weeks to months, and the initial symptoms are often nonspecific.
The earliest clues that the patient has vasculitis come usually from the skin (where vasculitis may appear as palpable purpura, livedo reticularis, digital gangrene, or tender nodules), or the peripheral nervous system (where infarction of one mixed motor and sensory nerve after another results in mononeuritis multiplex, one of the most specific clues that a patient has vasculitis). Renal involvement eventually develops in most and is accompanied by hypertension in half of patients, whereas Granulomatosis with Polyangiitis
rarely elevates the blood pressure. Polyarteritis nodosa also commonly involves the gut (abdominal angina, hemorrhage, perforation), heart (myocarditis, myocardial infarction), or eye (scleritis). Rupture of renal or mesenteric micoaneurysms can simulate an acute abdomen.
Confirming the diagnosis requires either biopsy specimen showing small– or medium–sized arteries, or mesenteric arteriography showing microaneurysms or alternating areas of stenosis and dilation.
Biopsy of a symptomatic nerve or a symptomatic muscle is 65% sensitive, whereas biopsy of an asymptomatic site is less than 30% sensitive. Because mesenteric angiography is 60% sensitive, it should be done when there is not a symptomatic site to biopsy.
Renal biopsy should be avoided unless angiography rules out microaneurysms susceptible to rupture.
Without treatment, almost all affected patients die within 2 to 5 years.
Treatment with prednisone (starting at 1 mg/kg daily) and cyclophosphamide (2 mg/kg daily) appeared to revolutionize the outcome of polyarteritis nodosa by achieving 70% 10–year survivals and established this combination of agents as the standard therapy.
However, newer studies suggest that prednisone alone may achieve the same high survival as prednisone and cyclophosphamide, although flares were less frequent in patients taking cyclophosphamide.
Other studies indicate that the traditional therapy with prednisone and cyclophosphamide should be abandoned in patients with polyarteritis nodosa associated with hepatitis B.
Patients treated with the traditional combination respond, but almost all survivors become chronic carriers of hepatitis B and may die later of cirrhosis or variceal bleeding. The newly propsed regimen consists of 2 weeks of prednisone to control the vasculitis, followed by plasmapheresis to remove immune complexes, and accompanied by antiviral therapy with lamivudine to rid the patient of the hepatitis B infection. The long–term value of anti–viral therapy for polyarteritis nodosa associated with hepatitis C is not established.
Health Care Innovation Awards: Maryland
Notes and Disclaimers:
- Projects shown may have also operated in other states (see the Geographic Reach)
- Descriptions and project data (e.g. gross savings estimates, population served, etc.) are 3 year estimates provided by each organization and are budget submissions required by the Health Care Innovation Awards application process.
- While all projects were expected to produce cost savings beyond the 3 year grant award, some may not achieve net cost savings until after the initial 3-year period due to start-up-costs, change in care patterns and intervention effect on health status.
ATLANTIC GENERAL HOSPITAL CORPORATION
Project Title: “Expand Atlantic General Hospital’s infrastructure to create a patient-centered medical home”
Geographic Reach: Delaware, Maryland
Funding Amount: $1,097,512
Estimated 3-Year Savings: $3,522,000
Summary: Atlantic General Hospital Corporation, which serves largely rural Worcester County, Maryland, is working to improve care for Medicare beneficiaries through a patient centered medical home (PCMH) care model.
Through a partnership with the Worcester County Health Department (WCHD), Atlantic General has implemented PCMH standards and principles in all seven of its primary care practices, increasing access for patients needing non-emergency episodic care to reduce hospital admission rates and emergency department visits for these Medicare beneficiaries. The original intent of the grant-funded project was to focus on patients with either a primary or admitting diagnosis of congestive heart failure, chronic obstructive pulmonary disease (COPD), or diabetes, who currently rely on high-cost ER visits and acute care admissions. However, the PCMH team has been able to expand the program to offer services to patients with additional diagnoses.
Project Title: “Medicare and CareFirst’s total care and cost improvement program in Maryland”
Geographic Reach: Maryland
Funding Amount: $24,000,000
Estimated 3-Year Savings: $29,213,838
Summary: CareFirst BlueCross BlueShield received an award to expand its Total Care and Cost Improvement Program (TCCI), which includes its Patient-Centered Medical Home to approximately 25,000 Medicare beneficiaries in Maryland.
This approach will move the region toward a new health care financing model that is more accountable for care outcomes and less driven by the volume-inducing aspects of fee-for-service payment.
The TCCI Program will enhance support for primary care, empowering primary care providers to coordinate care for Medicare beneficiaries with multiple morbidities and patients at high risk for chronic illnesses.
TCCI will result in less fragmented health care, reducing avoidable hospitalizations, emergency room visits, medication interactions, and other problems caused by gaps in care and ensuring that patients receive the appropriate care for their conditions. The TCCI Program will create an estimated 36 jobs. The new workforce will include local care coordinators, and program consultants.
CHRISTIANA CARE HEALTH SYSTEM
Project Title: “Bridging the Divides”
Geographic Reach: Delaware, Maryland, New Jersey, Pennsylvania
Funding Amount: $9,999,999
Estimated 3-Year Savings: $376,327
Summary: Christiana Care Health System, serving the state of Delaware, received an award to create and test a system that uses a ”care management hub” and combines information technology and carefully coordinated care management to improve care for post-myocardial infarction and revascularization patients, the majority of them Medicare or Medicaid beneficiaries. Christiana Care will integrate statewide health information exchange data with cardiac care registries from the American College of Cardiology and the Society of Thoracic Surgeons, enabling more effective care/case management through near real time visibility of patient care events, lab results, and testing. This will decrease emergency room visits and avoidable readmissions to hospitals and improve interventions and care transitions. The investments made by this grant are expected to generate cost savings beyond the three year grant period. Over a three-year period, Christiana Care Health System will create an estimated 16 health care jobs, including positions for nurse care managers, pharmacists, and social workers.
FOUNDATION FOR CALIFORNIA COMMUNITY COLLEGES
Project Title: “Transitions clinic network: linking high-risk Medicaid patients from prison to community primary care”
Geographic Reach: Alabama, California, Connecticut, District of Columbia, Maryland, Massachusetts, New York, Puerto Rico
Funding Amount: $6,852,153
Estimated 3-Year Savings: $8,115,855
Summary: City College of San Francisco (CCSF), University of California at San Francisco, and Yale University are collaborating to address the health care needs of high risk/high cost Medicaid and Medicaid-eligible individuals with chronic conditions released from prison.
Targeting eleven community health centers in seven states and Puerto Rico, the program will work with the Department of Corrections to identify patients with chronic medical conditions prior to release and will use community health workers trained by City College of San Francisco to help these individuals navigate the healthcare system, find primary care and other medical and social services, and coach them in chronic disease management. The outcomes will include reduced reliance on emergency room care, fewer hospital admissions, and lower cost, with improved patient health and better access to appropriate care. Over a three-year period, this innovation will create an estimated 22 jobs and train an estimated 49 workers. The new workforce will include 12 community health workers, 11 part-time panel managers, two part-time project coordinators, one research analyst and two part-time project staff.
GEORGE WASHINGTON UNIVERSITY
Project Title: “Using Telemedicine in peritoneal dialysis to improve patient adherence and outcomes while reducing overall costs”
Geographic Reach: District of Columbia, Maryland, Virginia
Funding Amount: $1,939,127
Estimated 3-Year Savings: $1,700,000
Summary: George Washington University received an award to improve care for 300 patients on peritoneal dialysis in Washington, D.C., and eventually in Virginia and Maryland. The intervention will use telemedicine to offer real-time, continuous, and interactive health monitoring to improve patient safety and treatment.
The model will train a dialysis nurse workforce in prevention, care coordination, team-based care, telemedicine, and the use of remote patient data to guide treatment for co-morbid, complex patients.
This approach is expected to improve patient access to care, adherence to treatment, self-management, and health outcomes, while reducing cost of care for peritoneal dialysis patients with complex health care needs by reducing overall hospitalization days with estimated savings of approximately $1.7 million.
Over the three-year period, George Washington University’s program will train an estimated three health care workers and create an estimated three new jobs. These workers will provide clinical support and health monitoring via the web to home dialysis patients.
JOHNS HOPKINS SCHOOL OF NURSING
Project Title: “CAPABLE for frail dually eligible older adults: achieving the triple aim by improving functional ability at home”
Geographic Reach: Maryland
Funding Amount: $4,093,356
Estimated 3-Year Savings: $6,800,000
Summary: The Johns Hopkins School of Nursing received an award for a Medicare/Medicaid dual eligibles program (Community Aging in Place, Advancing Better Living for Elders –“CAPABLE”) that uses a care management team to improve the everyday functioning of complex, frail patients in their own homes. The program will reduce difficulty with activities of daily living and improve medication management, mobility, and health-related quality of life, an individualized package of interventions including home visits from occupational therapists and nurses and other services.CAPABLE will reduce nursing home admissions and hospitalizations and improve quality of life for these beneficiaries of Medicare and Medicaid. Over a three-year period, the John Hopkins School of Nursing will retrain an estimated eight occupational therapists and registered nurses and as well as engage other services.
JOHNS HOPKINS UNIVERSITY
Project Title: “Johns Hopkins Community Health Partnership (J-CHiP)”
Geographic Reach: Maryland
Funding Amount: $19,920,338
Estimated 3-Year Savings: $52,600,000
Summary: Johns Hopkins University, in partnership with Johns Hopkins Health System and its hospitals, community clinics and other affiliates, the Johns Hopkins Urban Health Institute, Priority Partners MCO, Baltimore Medical System (BMS) – a Federally Qualified Health Center, and local skilled nursing facilities, received an award to create a comprehensive and integrated program, the Johns Hopkins Community Health Partnership (J-CHiP). J-CHiP is designed to increase access to services for high-risk adults in East Baltimore, MD, especially those with chronic illness, mental illness, and/or substance abuse conditions. The intervention improves care coordination across the continuum and comprises early risk screening, interdisciplinary care planning, enhanced medication management, patient/family education, provider communication, post-discharge support and home care services, including self-management coaching, and improved access to primary care. The program will target inpatients at The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, expanding to nearly all adult admissions by the end of year 3. The intervention will also include a specific focus on high risk Medicare and Medicaid beneficiaries who receive primary care from Johns Hopkins clinics and a BMS clinic adjacent to these hospitals. The program will reduce avoidable hospitalizations, emergency room use, and complications and increase access to care and other services. Over a three-year period, Johns Hopkins University will train and hire more than 75 new health care workers, including nurse educators, nurse transition guides, case managers, community health workers, and health behavior specialists, and will retrain care coordinators, patient access line case managers, clinical pharmacy specialists, community health workers, and physicians already on staff.
Project Title: “Multi-community partnership between TransforMED, hospitals in the VHA system and a technology/data analytics company to support transformation to PCMH of practices connected with the hospitals and development of “Medical Neighborhood”
Geographic Reach: Alabama, Connecticut, Florida, Georgia, Indiana, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Mississippi, Nebraska, North Carolina, Oklahoma, South Dakota, West Virginia
Funding Amount: $20,750,000
Estimated 3-Year Savings: $52,824,000
Summary: TransforMED received an award for a primary care redesign project across 15 communities to support care coordination among Patient-Centered Medical Homes (PCMH), specialty practices, and hospitals, creating “medical neighborhoods.
” The project will use a sophisticated analytics engine, provided by a vendor, Phytel, to identify high risk patients and coordinate care across the medical neighborhood while driving PCMH transformation in a number of primary care practices in each community.
Truly comprehensive care will improve care transitions and reduce unnecessary testing, leading to lower costs with better outcomes. TransforMED will work with VHA to capture learnings from leading performers. Cost trends will be identified via claims data using an analytic tool provided by a vendor, Cobalt Talon.
Over a three-year period, TransforMED’s program will train an estimated 3,024 workers and create an estimated 22 jobs.
Return to the Project Profiles main page.
The Global Health Security Index
1. Prevention: Prevention of the emergence orrelease of pathogens2. Detection and Reporting: Early detection and reporting for epidemics of potential international concern3. Rapid Response: Rapid response to and mitigation of the spread of an epidemic4.
Health System: Sufficient and robust health system to treat the sick and protect health workers5. Compliance with international norms: Commitments to improving national capacity, financing plans to address gaps, and adhering to global norms6. Risk Environment: Overall risk environment and country vulnerability to biological threats.
NOTE: All data are normalized to a scale of 0 to 100, where 100 = best health security conditions.
The average overall GHS Index score is 40.2 a possible 100. While high-income countries report an average score of 51.9, the Index shows that collectively, international preparedness for epidemics and pandemics remains very weak.
- 40.2: average overall Global Health Security Index score of a possible score of 100
- 116: high- and middle-income countries not scoring above 50
- National governments should commit to take action to address health security risks.
- Health security capacity in every country should be transparent and regularly measured, and results should be published at least once every two years.
- Leaders should improve coordination, especially linkages between security and public health authorities, in insecure environments.
- New financing mechanisms should be established to fill preparedness gaps, such as a new multilateral global health security matching fund; and expansion of World Bank International Development Association (IDA) allocations to include preparedness.
- The Office of the United Nations (UN) Secretary-General should designate a permanent facilitator or unit for high-consequence biological events.
- Countries should test their health security capacities and publish after-action reviews, at least annually.
- Governments and donors should take into account countries’ political and security risk factors when supporting health security capacity development.
- The UN Secretary-General should call a heads-of-state-level summit by 2021 on biological threats including a focus on financing and emergency response.
Read more on the Report & Model page.
- 81% of countries score in the bottom tier for indicators related to deliberate risks (biosecurity)
- 66% score in the bottom tier for indicators related to accidental risks (biosafety).
- Fewer than 5% of countries provide oversight for dual-use research
Zero: Number of countries that have legislation or regulations in place that require companies to screen DNA synthesis
- 92% of countries do not show evidence of requiring security checks for personnel with access to dangerous biological materials or toxins
- Governments and international organizations should develop the capabilities to address fast-moving pandemic threats.
- Governments should include measurable biosecurity and biosafety benchmarks in national health security strategies and track progress on an annual basis.
- A dedicated international normative body should be developed to promote the early identification and reduction of biological risks associated with advances in technology.
- Public and private organizations should invest a percentage of their sustainable development and health security portfolios in the area of biosecurity.
- Funders and researchers should provide incentives to identify and reduce biological risks associated with advances in technology and should invest in technical innovations that can improve biosecurity.
- Leaders should prioritize the development of operational linkages between security and public health authorities for biological crises.
- Countries and international organizations should prioritize the development of national biosurveillance capabilities and a global biosurveillance architecture.
Read more on the Report & Model page.
- 85% show no evidence of having completed a biological threat–focused International Health Regulations (IHR) simulation exercise with the World Health Organization (WHO) in the past year
- Fewer than 5% show a requirement to test their emergency operations center at least annually
- 77% do not demonstrate a capability to collect ongoing or real-time laboratory data
- 24% show evidence of a nationwide specimen transport system
- 89% do not demonstrate a system for dispensing medical countermeasures during a public health emergency
- 19% demonstrate at least one trained field epidemiologist per 200,000 people
- Countries should test their health security capacities and publish after-action reviews, at least annually. By holding annual simulation exercises, countries will show commitment to a functioning system. By publishing after-action reviews, countries can transparently demonstrate that their response capabilities will function in a crisis and can identify areas for improvement.
- Health security financing, evaluations, and planning should prioritize functional capability and regular exercises.
Read more on the Report & Model page.
- 5% score in the top tier for financing
- One country, Liberia, has published a description of specific funding from its national budget for gaps identified in existing assessments and/or national action plans
- 10% show evidence of senior leaders’ commitment to improve local or global health security capacity
- Health security preparedness financing should be tracked by a specific, globally recognized entity and briefed annually to heads of state.
- Domestic financing for health security should be urgently increased, made transparent, and tied to benchmarks within national action plans.
- Decision makers should create new health security preparedness financing mechanisms that incentivize measurable improvements, such as a such as a new multilateral global health security matching fund, and expansion of IDA allocations to include preparedness.
- International leaders should examine the availability of financing to support rapid and complete outbreak response. The UN should track and publish outbreak-related costs and contributions.
Read more on the Report & Model page.
- Higher overall score: Countries with effective governance and political systems
- 55% score in the bottom and middle tiers for political and security risks indicators
- 15% score in the highest tier for public confidence in government
- 23% score in the top tier for political system and government effectiveness, representing approximately 14% of the global population
- Plans should be developed to assist countries with challenging risk environments and to bolster preparedness in countries bordering those at increased risk.
- National governments and donors should assess political and security risk factors when making resources available to support capacity development.
- The UN Security Council should urgently convene a series of meetings aimed at the development of rapid response capabilities, strategies, workforce, and protections necessary for outbreaks that originate in or spread to countries with high political or security risks.
Read more on the Report & Model page.
- Lowest scoring category: for health systems, average score of 26.4; 131 countries in the bottom tier; weaknesses among even high-income countries
- 27% demonstrate the existence of an updated health workforce strategy
- 3% show a public commitment to prioritizing healthcare services for healthcare workers who become sick as a result of participating in a public health response
- Low scores: physician and nurse/midwife density per 100,000 population
- 11% show plans to dispense medical countermeasures during health emergencies
- Decision makers should measure and take into account health system capabilities as an integral part of all health security planning, investments, and financing strategies.
- Leaders should take steps to build and maintain robust healthcare and public health workforces that play a major role in biological crises.
- National Action Plan for Health Security (NAPHS) should take into account specific benchmarks to improve and finance the overall health system and its workforce.
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- 30% demonstrate existence of mechanisms for sharing data among relevant ministries for human, animal, and wildlife surveillance
- 8% demonstrate a cross-ministerial unit dedicated to zoonotic disease
- 51% offer field epidemiological training programs that explicitly include animal health professionals
- 62% have not submitted a report to the World Organisation for Animal Health on the incidence of human cases of zoonotic diseases for the past calendar year
- National public and animal health authorities should coordinate during the development of NAPHS and should incorporate a One Health approach as part of pandemic planning and national disaster preparedness and response efforts.
- Countries should identify an agency and grant it authority to coordinate training and information sharing among human, animal, and environmental health professionals for outbreak preparedness and response.
- Decision makers should consider infectious disease risks when developing policies and plans related to climate change, land use, and urban planning.
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