Background: Heart disease is the leading cause of death in the United States; a person dies every 37 seconds from heart disease or 1 in every 4 deaths posing a population health risk for heart attack and stroke.

Local problem: According to clinical practice guidelines, adults should be screened for baseline cardiovascular disease (CVD) risk and every 4 to 6 years to guide decisions for primary preventive care interventions. A survey showed only 11% of participants reported CVD risk screening. This quality improvement initiative aimed to increase CVD screening and improve healthy lifestyle behaviors using a shared decision-making (SDM), client-centered approach for adults to 80% over 90 days.

Methods: This plan-do-study-act improvement process was implemented via an innovative virtual setting. Four, 2-week cycles included concurrent tests of change (TOC) related to risk screening, SDM, best practice care, and team engagement. Convenience sample demographics included an age range between 40 and 81 years old with a mean age of 58. Data were analyzed using run charts and aggregate data to assess the effect of interventions on outcomes.

Interventions: Clients were screened with the ASCVD risk calculator and the SDM process facilitated options for healthy lifestyle goals. Health indicators were tracked biweekly in a case management log to inform next cycle TOC and bimonthly surveys assessed team stress levels.

Results: The CVD screening rate was 97%. Only 17 (29%) clients had a risk score > 7.5% and the cohort mean risk score was 6.7% or borderline risk. The mean AIM score comprised risk screening and best practice care that finished at 88% and surpassed the goal of 80%. Team stress levels decreased to 24% by cycle four.

Conclusions: The ASCVD tool expanded access to preventive screening and showed an association with motivating clients to take action by choosing healthy lifestyle behaviors and meeting best practice care guidelines to mitigate CV risk factors. Learning involved the value of client partnerships. This project was approved by the Frontier Nursing University institutional review board. No outside funding was received for this project.

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Kimberly Couch DNP, CNM, FNP-BC

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