February 2013
Vol 4 Issue 7
The Mission of the National Center for Health in Public Housing (NCHPH) is to strengthen the capacity of federally funded Public Housing Primary Care (PHPC) health centers and other health center grantees by providing training and a range of technical assistance.
NCHPH, a project of North American Management, receives funding through a cooperative agreement grant awarded by the U.S. Department of Health and Human Services Administration.
In This Issue
Program Requirement Review
February Health Observance: Heart Disease
Preventing Heart Disease
Heart Disease Prevention Among Minority Children
Heart Disease Treatment
Grantee Corner
Heart Disease Prevention Recommendations and Policy
Program Requirement Review

Program Requirement #2: Required and Additional Services


Health center programs are responsible for providing various services that meet the needs of their special populations. The Human Resources and Services Administration (HRSA) allows grantees to use a referral system to increase access to services and supports. Specific grants may specify that additional services are required such as grantees serving homeless patients must provide substance abuse services.


Some of the services that health centers are required to provide include primary health care, preventive care, and enabling health services. HRSA has outlined a list of required clinical and non-clinical health services health centers must offer. The clinical services include the provision of basic services for patients and non-clinical services include case-management and addressing some of the practical personal needs of patients such as transportation, insurance eligibility, and translation services.


In order for a health center to establish a referral system with other health providers, a formal written agreement is required. This agreement ensures that the patient's record will be completed, payment will be arranged, and the patient will continue to receive the best possible care with the new health provider. 

Program Requirement #6: Hospital Admitting Privileges and Continuum of Care

Health center programs need to forge partnerships with local hospitals to gain admitting privileges. Admitting privileges allow providers to continue to see and care for their patients even when they are in the hospital. If admitting privileges are not allowed, then health centers should create another formal agreement to provide care to their patients when hospitalized. HRSA welcomes and promotes health center collaborations. All arrangements should be formal written agreements between both parties and should allow for:


1)      Arrangements for hospitalization for patients

2)      Discharge planning 

3)      Patient tracking


The continuum of care condition applies to all patients but may have more specific ramifications for special populations such as homeless or migrant/seasonal farmworkers. Health centers need to be able to provide the best care consistently and should start by having systems in place to deal with various health situations. These systems should be realized by all staff members and health providers within the health center program and should be available in a written document as regulatory procedure. This ensures that issues such as hospital admission notification is arranged, discharge follow-up occurs by the primary physician as well, and that pertinent information is exchanged.


An example


A young man (age 42), who frequents a health center in his community, goes into cardiac arrest and is transported to a nearby hospital. The doctor that the patient has routinely seen at the health center has admitting privileges and is notified of the patient's hospital admission. After the patient receives corrective surgery and is cared for by the hospital physician, the patient's primary physician from the health center visits to update the patient's medical files and check his health status. The physician also develops a program that the patient can implement upon his release and talks with the patient's family about scheduling a follow-up appointment shortly after his discharge.


The primary physician is able to bill this consult as a medical visit and can report this in the Uniform Data System (UDS). After the patient is discharged from the hospital he has follow-up appointments with a cardiac specialist he was referred to but also has to make an appointment with his primary care physician at the health center. As the patient begins to see the cardiac specialist less, he is still in good health and managing his heart condition better because he is maintaining appointments with his regular physician. Therefore, there was no lapse in care during the patient's medical emergency.


Program Requirement #8: Quality Improvement/Quality Assurance

Quality Improvement and Quality Assurance are two forms of management practices that contribute to better care and services provided by health centers. This is achieved by regular assessments and optimum utilization of staff and resources within the health center to promote health and wellness. Management systems (including instituting a clinical director) are required to be in place for all staff, including licensed health professionals. Effective programs are known to collect data on current systems and practices and work to make improvements and adjustments that increase the ease of everyday tasks. Examples of areas that need functional systems in place are data collection and evaluation of patient records, patient protection (as outlined by Health Information Protection Accountability Act (HIPAA)), as well as proper billing and coding.


Other issues that fall under the QI/QA category are legal issues and ethical practice. HRSA has provided a Risk Management Policies and Procedures document that informs health centers of expectations and effective risk management programs. HRSA also provides a policy manual for health centers for the Federal Tort Claims Act (FTCA), (also known as Health Center FTCA Medical Malpractice Program) which is an important document that outlines legal proceedings and preparation in the event of a medical malpractice suit. Health centers should be familiar with policies and procedures outlined by HRSA to protect health center grantees and the public.


Performance Improvement


Another method that is capable of assessing health center performance is patient satisfaction surveys which ensure that the health center is meeting the needs of the target population. Health centers should consider steps needed to take to gain accreditation from a national medical accrediting body such as the Joint Commission. The governing board of the health center should review all assessments and results.


Source: HRSA

February Health Observance: Heart Disease


Heart Disease in Public Housing


February is heart disease awareness month and is celebrated all across the US. Heart disease and heart health issues are the most common health issues in the U.S.  "Heart disease" most often refers to coronary heart disease (including heart attack and other effects of restricted blood flow through the arteries that supply the heart muscle) or to heart failure. Other times, this term refers to several conditions or all diseases affecting the heart (e.g., "heart disease deaths") (Centers for Disease Control, n.d.).  Although heart related diseases most often affect older adults (65+), younger populations are increasingly facing heart health issues. People as young as 30 are experiencing cardiovascular diseases because of being overweight or obese, not managing their blood sugar and blood pressure, and because of living a predominantly sedentary lifestyle. Other contributing factors to heart disease include tobacco smoke exposure and a heavy consumption of alcohol. 


The body of research shows that minorities and low-income individuals are at increased risk of heart-related health issues and are more likely to possess a risk factor for heart disease than other individuals. People such as public housing residents and the uninsured, face severe health issues if they do not or cannot manage their health and existing conditions well.


Adults and heart disease


Heart disease poses a serious health threat to all Americans. In the U.S, 385,000 people die from heart disease every year, and almost 935,000 people have a heart attack. Unfortunately, of the 935,000 people who have heart attacks annually, almost a third are not experiencing a heart attack for the first time. Heart disease is extremely costly and totals about $108.9 billion in health care and related-costs every year.  Some of the main heart disease risk factors are influenced by genetics and other health conditions, but unhealthy behaviors are the most common cause of disease. Source: CDC


Try this Challenge with the American Heart Association


The American Heart Association designed a program to help people lower their blood pressure but exchanging salty foods for less salty foods. The 3-Week Sodium Swap Challenge is a way to change your palate so eating less salty foods is more enjoyable. Simple steps such as limiting the amount of meat and cheese on pizza or getting low-sodium cold cuts is a start.


Children and heart disease


Children's health is often overlooked with heart disease issues, but children today possess more risk factors for heart disease than ever before. In 2008, almost 20% of children ages 6-11 were obese compared to 7% of children in 1980. Obesity in children greatly increases their risk of heart disease and diabetes among other health conditions. Children and aging adults are more hypertensive and diabetic than future generations. Unhealthy behaviors account for the majority of heart disease cases and preventive health interventions could potentially decrease heart disease incidence. Source: American Academy of Pediatrics


Health Disparities and Data


Data collected shows that heart disease is the leading cause of death in the U.S. However, some populations have higher mortality rates from heart disease than others.

  • An example is the mortality rates of blacks from conditions such as hypertension and diabetes are higher than in white populations.
  • In addition, adults with lower socioeconomic status and education are more likely to have heart disease.


Source: Office of Minority Health and Health Disparities (OMHD)

Preventing Heart Disease


For adults 


Healthy People 2020: The Healthy People 2020 goals and initiatives plans to address the top causes of heart disease, which are: 

  • High cholesterol
  • High blood pressure
  • Diabetes
  • Smoking
  • Poor diet and lack of exercise
  • Overweight and obesity.


Healthy People 2020 also listed emerging issues within cardiovascular disease (CVD) reduction plans which include cognitive impairment, depression, and surveillance data for CVD. Through the help of UDS, public housing grantees are capturing information about public housing residents but more data is needed for gender and age differences, as well as documentation of other environmental factors that influence heart disease prevalence.


Effective strategies for tackling nutrition related to heart-health issues are: school-based care, worksite programs, faith based interventions, and culturally competent programs. 



For children: Let's Move! Initiative


Click here to visit the site.

Early testing for high cholesterol in children who are at risk 


The American Academy of Pediatrics recommends testing children who are at risk to undergo lipid tests at age brackets 9-11 and again at 17-21 years. High cholesterol is a risk factor for heart disease and other health problems. A person in good health should have a low level of low density lipoproteins (LDL) and a high level of high density lipoproteins (HDL). Overall the score should be below 130 mg/dL in children (those under the age of 18).


Tobacco Free Kids


More people below the federal poverty level (FPL) smoke than people above the level. Low-income people are also less likely to have health insurance coverage for smoking cessation. Tobacco use abstinence and tobacco cessation are important components to preventing heart disease. Smoking has been linked to lowering good cholesterol or HDL and increasing bad cholesterol or LDL. High levels of LDL and low levels of HDL cause plaque to form in the arteries which increases blood clots. When the flow of blood is blocked to the heart, the risk of heart attack dramatically increases.  Smoking can also cause irregular heart rhythms and heartbeat.


Sources: KidsHealth, American Academy of Pediatrics


Free Resource


Free Inographic  


Access a free infographic for public housing residents in English and Spanish

Heart Disease Prevention Among Minority Children


Low-income children are at increased risk of obesity due to the same reasons low-income adults are at risk. Children who live in low-income neighborhoods have fewer safe places to play, greater access to unhealthy food options and less access to grocery stores. Many low-income children live in large urban areas and may not have the same freedoms as children who live in areas surrounding metropolitan centers.


Other data shows that when low-income children play outside less, they watch TV more. On average black, low-income children watch TV more than white children who are not from households with a low socioeconomic status. These issues all present environmental factors that need to be changed in low-income communities. Issues such as food deserts, which are areas that have limited access to fresh and nutritious foods, and rundown, unsafe playgrounds need to improve before behavior changes can be sustained in low-income populations.


Burdette, H., Whitaker, R. (2004). Neighborhood playgrounds, fast food, restaurants, and crime: relationships to overweight in low-income preschool children. Preventive Medicine, 38(1): 57-63.


Kumanyika, S. Grier, S. (2006). Targeting interventions for ethnic minority's low-income populations. The Future of Children, 16(1): 187-207.

Heart Disease Treatment


There are several effective ways to treat heart disease. Some treatment options may include medication, surgery, or alternative curative methods. People with heart conditions are often placed on statins (lowers cholesterol), insulin (lowers blood sugar), or beta blockers (lowers blood pressure).  Even if a doctor suggests exercising more and eating healthier (usually the first form of prevention and treatment) this method may still need to be supplemented with prescription drugs.


A study published in the Journal of General Internal Medicine that analyzed the effects of language on medication adherence in patients with diabetes, found that minority patients are less likely to adhere to treatment plans than white patients. In black diabetic patients, those who had a doctor of the same race adhered to medication better than those who did not. This result provided more support for the race concordance theory than the language concordance theory. However, in Hispanic patients, those who had a Spanish-speaking doctor were more likely to adhere to medication than Hispanic patients who did not. Overall the study found that Hispanic patients were least likely to adhere to CVD medications when language and race concordance was controlled for. 


Information such as this can help health center programs improve their overall performance. Cultural competence and linguistic compatibility are necessary in order to provide the best care possible to special populations. Click here  to access an archived webinar on cultural competence and workforce diversity titled, "How to Recruit & Retain a Diverse Workforce".


Source: National Library of Medicine

Grantee Corner
Click above to visit site.


Feature: Mountain Family Health Centers


Mountain Family Health Centers, located in Colorado serves 3 communities in the surrounding area. The health center regularly offers cardiovascular disease screenings to anyone. 


The health center's community health advisor is available to make calls and visits to places of employment, churches, and other venues to conduct free screenings. The screening is only about 10 minutes long and measures height and weight for BMI calculations, obtains a blood pressure reading, measure cholesterol through a simple blood sample (finger prick), and the person is given an overall risk score.


To contact the health center or to schedule a free screening, please see information below. 


562 Gregory St, Black Hawk, CO 80422
Phone:(303) 582-5276
Heart Disease Prevention Recommendations and Policy


Healthy People 2020 Goals: Heart Disease and Stroke


Healthy People provides science-based national objectives over a ten year period aimed at improving the health of Americans. This is achieved by providing benchmarks and monitoring progress over time of health and prevention activities. The current heart disease and stroke goal is to: "improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke; early identification and treatment of heart attacks and strokes; and prevention of repeat cardiovascular events." The risk of Americans developing and dying from cardiovascular disease would be substantially reduced if major improvements were made across the U.S. population in diet and physical activity, control of high blood pressure and cholesterol, smoking cessation, and appropriate aspirin use. More information on specific heart disease and stroke risk reduction objectives can be found on the Healthy People website.


Million Hearts - The Initiative


In September 2011, the Department of Health and Human Services launched the Million Hearts initiative. The purpose of this national initiative is to prevent 1 million heart attacks and strokes over five years. The Million Hearts™ initiative plans to achieve this goal by emphasizing cardiovascular health across patients, providers, communities, and other stakeholders. "Million Hearts™ will bring together a number of programs, policies, and campaigns designed to make a positive impact across the spectrum of prevention and care, promoting the "ABCS" of clinical prevention (appropriate aspirin therapy, blood pressure control, cholesterol management, and smoking cessation) as well as healthier lifestyles and communities."




Utility of Biomarkers in the Differential Diagnosis of Heart Failure in Older People: Findings from the Heart Failure in Care Homes (HFinCH) Diagnostic Accuracy Study



Trend in the prevalence of overweight and obesity among urban African American hospital employees and public housing residents.


Associations between the built environment and physical activity in public housing residents 


Socioeconomic Status and Coronary Heart Disease Risk: The Role of Social Cognitive Factors 


Depression and History of Attempted Suicide as Risk Factors for Heart Disease Mortality in Young Individuals 


Socioeconomic indicators and the risk of acute coronary heart disease events; comparison of population-based data from the United States and Finland 


Low-income Supplemental Nutrition Assistance Program participation is related to adiposity and metabolic risk factors


Weight Perceptions and Perceived Risk for Diabetes and Heart Disease Among Overweight and Obese Women, Suffolk County, New York, 2008 


Job Strain, Job Insecurity, and Incident Cardiovascular Disease in the Women's Health Study: Results from a 10-Year Prospective Study 


Knowledge of young African American adults about heart disease: a cross-sectional survey 

The National Center for Health in Public Housing (NCHPH), a project of North American Management, is supported in part by a cooperative agreement grant awarded by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA). 
This publication was made possible by grant number U30CS09734 from the Health Resources and Services Administration, Bureau of Primary Health Care and its contents are solely the responsibility of the authors and do not necessarily represent the official views of HRSA.
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