Association Between Self-Reported Hypertension and Antihypertensive Medication Use and Cardiovascular Disease-Related Events and Expenditures Among Patients Diagnosed With Hypertension.

Objectives: Research suggests that persons who are aware of the risk factors for cardiovascular disease (CVD) are more likely to engage in healthy behaviors than persons who are not aware of the risk factors. We examined whether patients whose insurance claims included an (ICD-9) code associated with hypertension who self-reported high blood pressure were more likely to fill antihypertensive medication prescriptions and less likely to have CVD-related emergency department visits and hospitalizations (hereinafter, CVD-related events) and related medical expenditures than patients with these codes who did not self-report high blood pressure.

Methods: We used a large convenience sample from the MarketScan Commercial Database linked with the MarketScan Health Risk Assessment (HRA) Database to identify patients aged 18-64 in the United States whose insurance claims included an ICD-9 code associated with hypertension and who completed an HRA from 2008 through 2012 (n = 111 655).

Modeled Health and Economic Impact of Team-Based Care for Hypertension.

Introduction: Team-based interventions for hypertension care have been widely studied and shown effective in improving hypertension outcomes. Few studies have evaluated long-term effects of these interventions; none have assessed broad-scale implementation. This study estimates the prospective health, economic, and budgetary impact of universal adoption of a team-based care intervention model that targets people with treated but uncontrolled hypertension in the U.

Association of Antihypertensive Medication Adherence With Healthcare Use and Medicaid Expenditures for Acute Cardiovascular Events.

Objectives: We assessed the impact of antihypertensive medication (AHM) adherence on the incidence and associated Medicaid costs of acute cardiovascular disease (CVD) events among Medicaid beneficiaries.

Methods: The study cohort (n=59,037) consists of nonelderly adults continuously enrolled (36 mo and above) in a Medicaid fee-for-service program. AHM adherence was calculated using the medication possession ratio (MPR) and stratified to low (MPR<60%), moderate (60%≤MPR<80%), and high (MPR≥80%) levels.

Medication Adherence and Incident Preventable Hospitalizations for Hypertension.

Introduction: Potentially preventable hospitalizations (PPHs) for hypertension (HTN) is one indicator of possible failed ambulatory care. Rates of PPHs for HTN have remained fairly level since the late 1980s, which may reflect a lack of understanding of the drivers of these hospitalizations. Anti-HTN medication non-adherence has been studied as a potential risk factor for other cardiovascular disease outcomes but not for PPHs for HTN.

National trends in the prevalence and medical history of angina: 1988 to 2012.

Background: The prevalence of angina from 1971 to 1994 was relatively flat for whites and blacks. We ask whether the prevalence and medical history of angina have changed during 1988 to 2012.

Methods And Results: We used the National Health and Nutrition Examination Survey data from 1988 to 2004 and the data from the six 2-year surveys from 2001 to 2012.

National trends in visits to physician offices and outpatient clinics for angina 1995 to 2010.

Background: We asked whether visits to physician offices and hospital outpatient clinics for angina have changed over time and whether more frequent use of certain diagnostic techniques or referrals in this setting may account for such changes.

Methods And Results: We combined data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to study visits to physician offices and outpatient departments. We calculated both crude and standardized rates for these visits using a modified version of technical specifications published by the Agency for Healthcare Research and Quality.

Geographic and racial patterns of preventable hospitalizations for hypertension: Medicare beneficiaries, 2004-2009.

Objectives: Hypertension as the primary reason for hospitalization is often used to indicate failure of the outpatient health-care system to prevent and control high blood pressure. Investigators have reported increased rates of these preventable hospitalizations for black people compared with white people; however, none have mapped them nationally by race.

Methods: We used Medicare Part A data to estimate preventable hypertension hospitalizations from 2004-2009 using technical specifications published by the Agency for Healthcare Research and Quality.

Preventable hospitalizations and emergency department visits for angina, United States, 1995-2010.

Introduction: Preventable hospitalizations for angina have been decreasing since the late 1980s - most likely because of changes in guidance, physician coding practices, and reimbursement. We asked whether this national decline has continued and whether preventable emergency department visits for angina show a similar decline.

Methods: We used National Hospital Discharge Survey data from 1995 through 2010 and National Hospital Ambulatory Medical Care Survey data from 1995 through 2009 to study preventable hospitalizations and emergency department visits, respectively.

Preventable hospitalizations for hypertension: establishing a baseline for monitoring racial differences in rates.

Introduction: Preventable hospitalization for hypertension is an ambulatory care-sensitive condition believed to indicate the failure of outpatient and public health systems to prevent and control hypertension. Blacks have higher rates of such hospitalizations than whites. The 2010 Patient Protection and Affordable Care Act (PPACA) seeks to implement higher quality health care, which may help close the racial gap in these rates.

Preventable hospitalizations for congestive heart failure: establishing a baseline to monitor trends and disparities.

Introduction: Preventable hospitalization for congestive heart failure (CHF) is believed to capture the failure of the outpatient health care system to properly manage and treat CHF. In anticipation of changes in the national health care system, we report baseline rates of these hospitalizations and describe trends by race over 15 years.

Methods: We used National Hospital Discharge Survey data from 1995 through 2009, which represent approximately 1% of hospitalizations in the United States each year.

Validation of AIDS-related mortality in Botswana.

Background: Mortality data are used to conduct disease surveillance, describe health status and inform planning processes for health service provision and resource allocation. In many countries, HIV- and AIDS-related deaths are believed to be under-reported in government statistics.

Methods: To estimate the extent of under-reporting of HIV- and AIDS-related deaths in Botswana, we conducted a retrospective study of a sample of deaths reported in the government vital registration database from eight hospitals, where more than 40% of deaths in the country in 2005 occurred.

Cost-effectiveness of a behavioral weight loss intervention for low-income women: the Weight-Wise Program.

Objective: Assess the cost-effectiveness of a 16-week weight loss intervention (Weight-Wise) for low-income midlife women.

Method: A randomized controlled trial conducted in North Carolina in 2007 tested a weight loss intervention among 143 women (40-64 years old, mean BMI=35.1 kg/m(2)).

Clinic-based nutrition and lifestyle counseling for Hispanic women delivered by community health workers: design of the California WISEWOMAN study.

Background: The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program in California, named Heart of the Family, implements and evaluates the effectiveness of lifestyle interventions to improve nutrition and physical activity while reducing cardiovascular disease (CVD) risk factors among low-income, uninsured or underinsured Hispanic women aged 40-64 who participate in the Cancer Detection Programs: Every Woman Counts (CDP:EWP). This paper reports the study design and baseline findings of the California WISEWOMAN program.

Methods: Heart of the Family, a within-site randomized controlled study at four community health centers in Los Angeles and San Diego, featured a unique set of strategies meeting the state population in implementing a California WISEWOMAN program.

Randomized trial of a behavioral weight loss intervention for low-income women: the Weight Wise Program.

Low-income women in the United States have the highest rates of obesity, yet they are seldom included in weight loss trials. To address this research gap, components of two evidence-based weight loss interventions were adapted to create a 16-week intervention for low-income women (Weight Wise Program), which was evaluated in a randomized trial with the primary outcome of weight loss at 5-month follow-up. Participants were low-income women (40-64 years) with a BMI of 25-45.

Recall of three heart disease risk factor diagnoses among low-income women.

Background: Success of interventions targeting heart disease risk factors depends largely on whether patients understand their risk factors, as awareness and acceptance are necessary steps in controlling and managing these conditions. The goal of this analysis was to assess whether women with identified heart disease risk factors are able to recall their diagnoses 1 year later.

Methods: The WISEWOMAN program provides heart disease screening and intervention services to low-income underinsured and uninsured women.

A lifestyle approach to reducing cardiovascular risk factors in underserved women: design and methods of the Illinois WISEWOMAN Program.

Background: Few lifestyle intervention programs address the needs of financially disadvantaged, low literacy populations. The overall goal of the Illinois WISEWOMAN Program (IWP) was to design such a program and test its effectiveness in reducing cardiovascular disease (CVD) risk, specifically physical activity and nutrition factors. The purpose of this paper is to describe the IWP study design and methods, development of the evidence-based curriculum appropriate for a low socioeconomic status (SES) population, and baseline characteristics of IWP participants.

Best practices in implementing lifestyle interventions in the WISEWOMAN program: adaptable strategies for public health programs.

Purpose: Describe best practices for implementing a variety of lifestyle interventions targeting cardiovascular disease risk factors.

Approach: A mixed-methods approach was used to collect and analyze data. The study was guided by the RE-AIM framework.

Randomized trial of a clinic-based, community-supported, lifestyle intervention to improve physical activity and diet: the North Carolina enhanced WISEWOMAN project.

Objective: To determine if a clinic-based behavioral intervention program for low-income mid-life women that emphasizes use of community resources will increase moderate intensity physical activity (PA) and improve dietary intake.

Methods: Randomized trial conducted from May 2003 to December 2004 at one community health center in Wilmington, NC. A total of 236 women, ages 40-64, were randomized to receive an Enhanced Intervention (EI) or Minimal Intervention (MI).

The WISEWOMAN program: reflection and forecast.

The WISEWOMAN program targets low-income under- and uninsured women aged 40-64 years for screening and interventions aimed at reducing the risk of heart disease, stroke, and other chronic diseases. The program enters its third phase on June 30, 2008. Design issues and results from Phase I and Phase II have been published in a series of papers.

Cardiovascular disease risk factor screening among Alaska Native women: the traditions of the heart project.

Objectives: To describe tobacco use, obesity and overweight, high blood pressure, high blood cholesterol and impaired glucose tolerance in Alaska Native and American Indian women living in the Anchorage area.

Study Design: Cross-sectional evaluation of women enrolled in the Traditions of the Heart program.

Methods: Traditions of the Heart was a randomized controlled trial of an intervention to reduce risk factors for cardiovascular disease.

A combined approach to women's health is associated with a greater likelihood of repeat mammography in a population of financially disadvantaged women.

Introduction: Integrating one or more public health programs may improve the ability of programs to achieve common goals. Expanding knowledge on how program integration occurs, how it benefits each individual program, and how it contributes to the achievement of common goals is an important area of inquiry in public health.

Methods: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program combined data from 10 of their overlapping state or tribal programs to calculate prevalence estimates of repeat mammography at 18 months.

A captive audience: bringing the WISEWOMAN program to South Dakota prisoners.

Purpose: This analysis compares the baseline heart disease risk profile of WISEWOMAN participants screened in the South Dakota Women's Prison with the general WISEWOMAN population in South Dakota and explores the potential benefits of lifestyle intervention programs to reduce heart disease risk factors among women during incarceration.

Methods: Using baseline data for WISEWOMAN participants in South Dakota, we compared participants who were enrolled in prison (n = 261) with nonincarcerated participants enrolled throughout the state (n = 1,427). Using regression analysis and adjusting for demographics, we assessed differences in baseline prevalence of risk factors (hypertension, high cholesterol, smoking, and obesity), awareness and treatment of hypertension and high cholesterol, and attendance at lifestyle intervention sessions.

Ethnicity and nutrient intake among Arizona WISEWOMAN participants.

Background: Diet quality and risks of chronic disease have been identified, yet nutrient intakes from older uninsured populations have been scarcely described.

Methods: Using the dietary intake profiles of an older, uninsured, and mostly Hispanic sample of Arizona WISEWOMAN participants, two ethnic groups were compared: Mexican American and non-Hispanic white women. Sociodemographic data related to nutrient intakes were identified.

The impact of medication use in a multicomponent intervention: results from the WISEWOMAN program.

Purpose: To assess the impact of medication use on improvements in coronary heart disease (CHD) risk among WISEWOMAN participants.

Design: Pre-post analysis.

Setting: WISEWOMAN projects operating at the local level in 8 states.