One Million Part III Higher Priorities

One Million Hearts Saved or 160 Million Lives Improved

Part II: Choices for Higher Priority Areas That Could Make a Difference

National leaders have chosen a campaign to prevent deaths. This appears to make sense except for higher priority areas that represent a choice for better life and a better nation.

National gold standards for interventions should involve better nurturing, better child development, and better early education - the most bang for the buck in any number of better outcomes for children, education, health, health outcomes, numerous budgets public and private, and a nation. Better outcomes for millions of children year after year in a number of areas should be the top focus.

A Million Hearts Campaign that hopes to change human behavior should realize that the easiest and best way to change human behavior is changing humans during birth to age 8.

To have people decide to improve their health, they must be invested in a better future. Children reduced to growing up in survival mode may never be able to focus on a better future.

Child well being is a travesty in our nation as is lowest GDP expenditures for birth to age 6. Child poverty is the single greatest measure of lack of a great nation and is related to all of the areas that make it less than great.

Another top priority would be universal health care coverage for primary care and public health (not all health care, at least not without about 10 years of this first) - Primary care and public health also become inseparable due to universal coverage. Designs can also take out profiteers that profit over lack of convenient health access due to current US designs.

Single payer for primary care fits well with universal coverage. All patients can go in, pay a co-pay, get care, and get on with their life and work and family.

The changes could also move the primary care nurse into a more effective direct care role. Instead of working for insurance companies to save them money, primary care nurses can help with best use of aspirin, cuts in aspirin use in those not appropriate, and best management of BP, cholesterol, smoking, diet, obesity, and stressors. The primary care nurse can also put the longitudinal track MD, DO, NP, PA, and RN students to work efficiently and effectively in health care teams, working for more care delivered at lower cost and where needed. Adding substantial workforce via student team training and facilitating greater care delivering by the most numerous primary care workforce (270,000 primary care nurses) should be a top priority.

And to actually come close to a Million Hearts safely, efficiently, and effectively, more basic health access will be required.

More and Better Primary Care Workforce Is Needed

·         to use aspirin more correctly and less incorrectly,

·         to address HBP, smoking, salt, and diet more correctly and less incorrectly.

Immediate Help for Primary Care Shortages Growing Shorter By the Day

We should be harnessing the energies of RN, MD, DO, NP and PA students to make primary care more efficient and effective. Student training that is SMART or specific for primary care can make a difference. With 9 – 12 months spend working in continuity primary care teams, substantial accomplishments are possible directly and indirectly that address Million Hearts and any number of other preventive efforts.

We need leaders that understand and promote long term student training rotations serving where primary care is needed - instead of traditional short rotations and exposures

·         that are a burden upon those delivering most needed primary care

·         that drive students and residents away from primary care

·         that are far too short to address any care at all

·         that are far too short to aid in understanding of health care team function.

And we might just delay the deaths of countless Americans in these and many other areas and in the process save millions for hospitals.

Hospital readmissions is just one area. Hospitals have been incented to dump patients too soon and student interventions can cut readmissions and result in better cost, quality, and access. In heart patients the students can work with dieticians or other health personnel to cut readmissions from 20% to less than 8% by working with diet, activity, smoking, salt, and needed connections between patients and their care givers. One glance at the food, freezer, refrigerator, and home situation can do much that a visit to a cardiologist or primary care practice can never accomplish.

WE WASTE TRAINING WORKFORCE and frustrate students that want to make a difference and chafe under designs that limit their ability to make a difference just as this limits their training. They can train in the most important areas of all - on the front lines working with those that deliver the care.

We need health care leadership that presents workable plans to government as Virchow promoted - not more of the same that has not been working - and certainly not MEDPAC recommendations for a ten year freeze on primary care reimbursement.

Any number of areas can yield a year of useful life for low cost expenditures - if we are not distracted from these areas by leaders focusing elsewhere - areas where the usual suspects are focused and have been for 100 years.

The Million Hearts Campaign has been shaped by those leading health care – government, associations, business, and insurance. Million Hearts is not a poor choice in itself. It is what Million Hearts represents that is the problem. Million Hearts represents numerous choices past, present, and future that have not worked for most Americans. These continued choices distract and divert attention from what works. A focus upon diseases and risk factors is quite different when compared to specific focus upon the basic needs of most Americans.

• One Million Hearts Saved or 160 Million Lives Improved   Million Hearts is another attempt to turn risk factors into saved lives - specifically reductions in heart attacks and strokes. The targets are once again human behavior changes (patient and provider) regarding aspirin, blood pressure, salt, cholesterol, and transfats. The campaign involves a number of federal agencies and health leaders, but the campaign will not address the top issues facing most Americans in their life, death, or health.
•  Part I Million Hearts Limitations of Awareness  We demonstrate little understanding of what is preventable or not, the limits of risk factor modification (including the limits in the populations in need of modification), what it requires to accomplish greater prevention and greater proportions with prevention, what can result in fewer deaths (or what can result in more deaths).
•  One Million Part III Higher Priorities A Million Hearts Campaign that hopes to change human behavior should realize that the easiest and best way to change human behavior is changing humans during birth to age 8. To have people decide to improve their health, they must be invested in a better future. Children reduced to growing up in survival mode may never be able to focus on a better future.
•  Rearranging the Deck Chairs: Death Displacement Saving lives sounds quite heroic, but the reality is that we are at best only displacing or delaying death for a few years. We will all die. We will all die. We will all die…… We spend the most health care dollars at the end of life in ways that are wasted. We spend the most on just a few and the least on the most. We spend so much at the end of life for few that the quality of life is impaired for many.