African American infant mortality and the Genesee County, MI REACH 2010 initiative: an evaluation of the Undoing Racism Workshop.

The authors examine African American African American and White socioeconomic and infant mortality outcomes in Genesee County, Michigan, assess the stated effects of the Undoing Racism Workshop (URW) on its participants and the greater-Genesee County community, and introduce the ecological approach to the cycle of socialization as a tool to help identify sources of racially linked tension and sites for ameliorative intervention. Findings show that African Americans in Flint are geographically and socioeconomically isolated, have fewer resources to sustain health, and experience higher rates of infant mortality when compared to Whites in Flint's surrounding suburbs. Between two thirds and three fourths of URW follow-up survey respondents endorse the belief that the URW can help reduce infant mortality, and results suggest the workshop helps elicit individual and institutional/policy-related changes intended to lessen the disparity.

Recommendation of low-salt diet and short-term outcomes in heart failure with preserved systolic function.

Background: Dietary sodium indiscretion frequently contributes to hospitalizations in elderly heart failure patients. Animal models suggest an important role for dietary sodium intake in the pathophysiology of heart failure with preserved systolic function. The documentation and effects of hospital discharge recommendations, particularly for sodium-restricted diet, have not been extensively investigated in heart failure with preserved systolic function.

Prolonged electrocardiogram QRS duration independently predicts long-term mortality in patients hospitalized for heart failure with preserved systolic function.

Background: Prolonged electrocardiogram (ECG) QRS duration (>or=120 ms) is a risk factor for death in systolic heart failure, but its effects in heart failure with preserved systolic function (HFPSF) have not been extensively studied. We hypothesized that prolonged ECG QRS duration would independently predict long-term mortality in hospitalized HFPSF patients.

Methods And Results: We analyzed 872 HFPSF patients (defined as left ventricular ejection fraction >or=50%) admitted to Michigan community hospitals between 2002 and 2004 and followed for a median of 660 days.

Using a community-based health survey as a tool for informing local health policy.

Background: The Speak to Your Health! community survey is a biennial community-based survey designed and implemented by the Prevention Research Center of Michigan whose central mission is to strengthen the capacity of the community to improve health.

Method: The survey was developed collaboratively by the university and community partners that comprise the Prevention Research Center of Michigan and focuses on health and social issues at the heart of the community of Genesee County, Michigan.

Findings: The results of this survey have been used to shape policy changes and strategic planning at the county health department and in local health intervention programs.

The association between guideline-based treatment instructions at the point of discharge and lower 1-year mortality in Medicare patients after acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice (GAP) initiative in Michigan.

Background: The American College of Cardiology's Guidelines Applied in Practice (GAP) initiative for acute myocardial infarction (AMI) has been shown to increase the use of guideline-based therapies and improve outcomes in patients with AMI. It is unknown whether hospitals that are more successful in using the standard discharge contract--a key component of GAP that emphasizes guideline-based medications, lifestyle modification, and follow-up planning--experience a proportionally greater improvement in patient outcomes.

Methods: Medicare patients treated for AMI in all 33 participating GAP hospitals in Michigan were enrolled.

Sex differences in the application of evidence-based therapies for the treatment of acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice projects in Michigan.

Background: Studies have shown that women with acute myocardial infarction (AMI) are less likely to receive evidence-based care compared with men. The American College of Cardiology's AMI Guidelines Applied in Practice (GAP) program has been shown to increase the rates of evidence-based medicine use and reduce mortality in patients with AMI. The objective of this study was to investigate the relative benefits of the GAP program in men and women.

Guideline-based standardized care is associated with substantially lower mortality in medicare patients with acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice (GAP) Projects in Michigan.

Objectives: We sought to assess the impact of the American College of Cardiology's Guidelines Applied in Practice (GAP) project for acute myocardial infarction (AMI) care, encompassing 33 acute-care hospitals in southeastern Michigan, on rates of mortality in Medicare patients treated in Michigan.

Background: The GAP project increases the use of evidence-based therapies in patients with AMI. It is unknown whether GAP also can reduce the rate of mortality in patients with AMI.

Enhancing quality of care for acute myocardial infarction: shifting the focus of improvement from key indicators to process of care and tool use: the American College of Cardiology Acute Myocardial Infarction Guidelines Applied in Practice Project in Michigan: Flint and Saginaw Expansion.

Objectives: This project evaluated if by focusing on process changes and tool use rather than key indicator rates, the use of evidence-based therapies in patients with acute myocardial infarction (AMI) would increase.

Background: The use of tools designed to improve quality of care in the American College of Cardiology AMI Guidelines Applied in Practice Pilot Project resulted in improved adherence to evidence-based therapies for patients, but overall, tool use was modest.

Methods: The current project, implemented in five hospitals, was modeled after the previous project, but with greater emphasis on tool use.