What could be accomplished with Two Dollars?
In Ontario roughly 20% of the population is age 55 or older.
In a typical LHIN (Local Health Integration Network) with a population of 1,000,000
this represents about 200,000 people. A budget line based on $2.00 per age 55+
resident dedicated to raising awareness amongst older adults of how to recognize
and respond to cardiovascular emergencies would represent an annual expenditure of $400,000
of the best money ever spent on healthcare. Provincially that’s about $6.4 million
out of the $49 billion healthcare budget.
Managing the care and rehabilitation of patients that have
experienced Heart Attack and Stroke represents a multi-million dollar cost to any
healthcare system. Due to the extremely high cost of treating patients that have experienced
the worst possible outcomes every healthcare jurisdiction invests heavily in developing
facilities and teams of specialists that are tasked with achieving the best
possible outcomes. The tools and the techniques that these interventional teams
use are at the leading edge of medical technology representing the
culmination of billions of dollars of worldwide research and development costs.
The programs are so expensive and highly specialized that in Ontario only one
in eleven (15 of 165) hospitals are set-up to perform the cardiac procedures.
What I find fascinating is that the same billions of dollars
of research has shown conclusively that the independent variable with the strongest
association to good outcomes for Heart Attack and Stroke victims is time, specifically
the time from symptom onset to definitive treatment. In-hospital improvements
to programs may result in incremental improvements in time to treatment but the
potential for quantum improvement lies entirely in the pre-hospital realm and
specifically with the lay public - the patients, their families, coworkers and
friends.
The gold standard treatment times of 90 minutes for Heart
Attack (STEMI) and 180 minutes for Stroke will only be achieved consistently
when the majority of the adult population is knowledgeable around recognizing
and responding to observed symptoms. Every time the gold standard time to
treatment is achieved the healthcare systems saves tens perhaps even hundreds
of thousands of dollars. We should also pause to consider the human cost of
missing the 90 or 180 minute window.
Every month I teach CPR to between 50 and 100 older adults
across Ontario and we typically spend up to an hour discussing Heart Attack and
Stroke recognition and response. The
vast majority of the adults I meet are somewhat aware of the symptoms, totally unaware of how
to respond when symptoms are observed, unaware of the importance of a timely
response and most importantly unaware of the life altering difference in
patient (and family) outcomes for those that are treated within the gold
standard timeframes. Especially with
adult learners explaining the why of things, in this case significantly better patient
outcomes, is the most effective way to deliver the message.
If every LHIN in Ontario hired one fulltime Health Promoter,
with an appropriate program budget, dedicated to raising awareness amongst older
adults of how to recognize and respond to cardiovascular emergencies measuring
the impact of their efforts, in both economic and human terms, would likely be
the best news story that many LHIN’s would have to report on each year. Through stakeholder networking to create
opportunities for workshops and presentations and effective use of both
traditional and social media a little money could go a long way to
disseminating the “time is of the essence” message. Realizing the economic benefit of increasing
the number of Heart Attack and Stroke patients that arrive at Ontario’s world
class facilities within the target time from symptom onset is some of the
lowest hanging fruit in the healthcare system
Note: The
task of educating the public on Heart Attack and Stroke Recognition and
Response is entirely separate and distinct from promoting lifestyles that
contribute to good cardiovascular health. Programs aimed at lifestyle modification will
have little or no effect on “symptom onset to definitive therapy times” for
patients experiencing a cardiovascular emergency.
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