Canadian Heart Health Strategy and Action Plan (CHHS-AP) Dr. Lyall Higginson, Member, CHHS-AP Steering Committee

Context for the CHHS-AP  CVD is Canada’s number one public health problem.  Risk factors (unhealthy eating, inactivity), as well as obesity, diabetes and hypertension are increasing.  Gaps between what we know and what we do exist in primary and secondary prevention as well as in treatment.  The health care system lacks integration – access is limited with significant disparities.  Health human resources are deficient.  Care delivery models have been relatively stagnant.  Canada lacks a surveillance system for CVD.

CHHS-AP How it began  Steven Fletcher,MP, introduced a private members bill calling for chronic disease strategies: cancer, heart and mental health (May 2005)  2005 federal budget included CVD specific resources  Representatives from CV community met in the fall of 2005 and with Steven Fletcher (April 2006)  Presentation at health caucus meeting (June 2006)  Verbal commitment for funding

CHHS-AP Purpose and Description  Purpose –To reduce the growing burden and loss due to CV disease in Canada  Description –Independent, stakeholder driven –Comprehensive, integrated strategy –Continuum of the health system: health policy/prevention to end-of-life care –Continuum of life: preconception to death –Respond to concerns of Canadians –Address inequities –Evidence-based/best practices

CHHS-AP Leadership  Leadership partners: –Heart and Stroke Foundation of Canada –Canadian Cardiovascular Society –Canadian Institutes of Health Research (Institute for Circulatory and Respiratory Health)  Funder: –Public Health Agency of Canada

CHHS-AP Management Group  Executive Committee of Steering Committee  Administrative body of CHHS-AP  Operational responsibilities CHHS-AP Steering Committee Primary policy decision-making body 29 thought leaders and experts Balance of expertise, knowledge, skills, regions, gender, research pillars, continuum of health care

Thinking About The Future  The point is not to predict the future but to prepare for it and to shape it

Predictions of Lord Kelvin, president of the Royal Society,  "Radio has no future"  "Heavier than air flying machines are impossible"  "X rays will prove to be a hoax”

Crossing the quality chasm A new health system for the 21st century Institute of Medicine, 2001

IOM report: 10 rules for redesigning health care  Care based on continuous healing relationships - care whenever its needed, not just through face to face visits  Customization based on patient needs and values  The patient as the source of control  Shared knowledge and free flow of information

IOM report: 10 rules for redesigning health care  Anticipation of needs  Continuous decrease in waste  Cooperation among clinicians

Framework for a Comprehensive Canadian Heart Health Strategy and Action Plan OUTCOMES The Vision Interventions Required Favourable environments Healthy behaviours Lower population risk Fewer acute events Less chronic disease Additional quality life years Policy and environmental change Behaviour change strategies Prevention, detection & management of risk factors Timely access to quality (acute) care Timely access to quality chronic disease manage- ment/rehab Timely access to end of life care 1.Healthier population 3.Added quality life years 4.Decreased burden of cardiovascular disease 5.Sustainable health system HEALTH PROMOTIONPRIMARYSECONDARY PREVENTION TREATMENT Information and MonitoringAccess to Services 2.Reduced inequities ResearchHealth Human Resources

IOM report: 10 rules for redesigning health care  Evidence based decision making  Safety as a system property  The need for transparency--all information available, including the system’s performance on safety, evidence based practice, and patient satisfaction

CHHS-AP Theme Working Groups 1.Strengthening information systems for monitoring, management, evaluation and policy development 2.Creating environments conducive to cardiovascular health 3.Preventing, detecting and controlling major risk factors 4.Addressing and enhancing Aboriginal / indigenous cardiovascular health 5.Timely access to quality (acute) care and diagnostics 6.Timely access to quality chronic disease management, rehabilitation services and end-of- life care

CHHS-AP Theme Working Groups  Co-chairs – (1 member of SC)  11 – 15 members per group selected on basis of expertise  ~ 80 members total  Two face-to-face retreats (Spring, Fall 07)  Provide theme specific advice and expertise  Commission synthesis research  Develop reports with key recommendations and priorities for action (associated costs, evaluation, surveillance etc.)  Innovative, implementable and practical  Based on evidence and best practices  Integration with existing strategies  Input from stakeholders

Emerging Broad Areas of Focus  Improve access to quality acute care and diagnostics with facilitated transitions between points of care: –Regional models of integrated care: multi-disciplinary teams with improved coordination and facilitated transitions (patient centered-care) –Address health human resource needs

Emerging Broad Areas of Focus  Apply chronic disease management model (multidisciplinary team approach) centred in primary care: –Apply CDM model to many aspects of ‘acute’ care –Facilitated patient transitions depending on care needs

Emerging Broad Areas of Focus  Address unique cardiovascular needs of Aboriginal/indigenous people: –Primary health care reform. –Research: foster development and application of First Nations, Métis, and Inuit controlled databases –Integrated primary health care, respectful of traditional knowledge, synergy with other CDs –Human resources: development of Aboriginal health service providers, improve cultural competency of non- Aboriginal