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Missouri State Profile and Policy Report

Missouri State Profile and Policy Report

Table of Contents

Heart Disease and Stroke Burden

Missouri - State Deaths for Heart Disease and Stroke

  • More than 1 out of 4 deaths in Missouri are due to heart disease.

  • 14,749 Missourians died from heart disease in 2006 (27 percent of total deaths in Missouri).

  • 3,247 Missourians died from stroke in 2006 (5.9 percent of total deaths in Missouri).
    Source: National Vital Statistics Report, 2009.

Missouri - 2007 State Risk Factors for Heart Disease and Stroke

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Missouri - 2003 State Costs for Cardiovascular Disease

In October 2007, the Milken Institute, an independent research group, released a study, An Unhealthy America: The Economic Impact of Chronic Disease. The study details the economic effects of treatment costs resulting from chronic disease in the United States. Below is a breakdown of Missouri’s estimated medical costs to treat heart disease, hypertension and stroke based on 2003 Medical Expenditure Panel Survey data.    

Missouri Annual Cost of Hypertension, Heart Disease and Stroke 

Treatment Expenditures (Direct Costs) - Total annual medical cost.      

Hypertension 

$.73 billion

Heart Disease          

$2.14 billion

Stroke                     

$.35 billion

Source: Milken Institute, An Unhealthy America: The Economic Impact of Chronic Disease, October 2007. 

Missouri - Estimated 2007 Medicaid Treatment Costs for Cardiovascular Diseases

Based on Missouri's Medicaid population, economic estimates for 2007 were projected using Medical Expenditure Panel Survey data.  Medicaid spending has grown rapidly in recent years, placing a significant burden on state budgets.  To help states estimate the financial impact of cardiovascular diseases among their Medicaid beneficiaries, the Centers for Disease Control and Prevention (CDC) and RTI International developed the Chronic Disease Cost Calculator. 

 Heart Disease

 $83 million

 Hypertension

 $264 million

 Stroke

 $164 million

 Congestive Heart Failure

 $35.9 million

 

Funded CDC Heart Disease and Stroke Prevention Grantees in Missouri

The Centers for Disease Control and Prevention funds Missouri's Heart Disease and Stroke Prevention program to increase control of high blood pressure and cholesterol; increase awareness of the signs and symptoms of heart attack and stroke and the importance of promptly calling 911; improve emergency response; improve quality of care; and eliminate related health disparities.  These efforts are informed by monitoring heart disease, stroke and related risk factors around the state.

Missouri State Highlights - Heart Disease and Stroke Prevention Program

  • The Missouri Heart Disease and Stroke Prevention (MHDSP) program is collaborating with federally qualified health centers (FQHC) to affect the priority areas of controlling high blood pressure, controlling high cholesterol, improving quality of care, and eliminating health disparities. Currently, 17 of Missouri’s 19 FQHCs are participating in a National Health Disparity Collaborative on diabetes and/or cardiovascular disease to strengthen the process of primary care to improve health outcomes for chronic conditions among the medically underinsured and uninsured.

  • The state medical director for the Emergency Medical System (EMS) at the Department of Health and Human Services (DHHS) has collaborated with MHDSP to incorporate stroke and heart attack into a comprehensive approach to EMS, the “Time Critical Diagnosis System.” This system seeks to develop a statewide coordinated approach to medical transport for ST-Segment Elevation Myocardial Infarction (STEMI), stroke and trauma. An EMS pre-hospital stroke tool has been drafted and approved for distribution based on recommendations from the Statewide Stroke Committee, and collaborations with the American Heart Association, the DHSS EMS unit, the EMS State Advisory Council and the Missouri Hospital Association (MHA). This is an easy and concise tool that allows EMS to quickly assist suspected stroke clients.

WISEWOMAN - The CDC also funds the WISEWOMAN program, which provides low-income, under and uninsured women age 40 to 64 with access to preventive health services by screening for high blood pressure, high cholesterol, and diabetes.  The program also provides lifestyle interventions that are tailored to each woman's heart disease and stroke risk factor screening results and links participants to free and low-cost community-based nutrition, physical activity, and quit smoking resources. 

  • Missouri WISEWOMAN partners with the Show Me Healthy Women program to deliver free heart disease prevention services with its Breast and Cervical Cancer Early Detection program. Heart disease screenings and risk-reducing lifestyle education services began at one St. Joseph community clinic in 2004 and have expanded to over 60 provider locations throughout the state. Partnerships, such as those with the Missouri Tobacco Quitline and Regional Arthritis Centers, help connect WISEWOMAN participants to resources to support heart healthy lifestyles.

State Laws and Policies

Public Awareness of Heart Disease and Stroke

SR2741 (2006) - The members of the Missouri Senate hereby designate the month of May, 2006, as Stroke Awareness Month in Missouri and urge all the citizens of our state to familiarize themselves with the warning signs, symptoms, and risk factors associated with stroke so that we might begin to reduce the devastating effects that a stroke makes on our population.

SCR3 (2005) - The establishment of Congenital Heart Defect Awareness Day will provide the opportunity to share experience and information with the public and the media in order to raise public awareness about congenital heart defects: The members of the Senate, Ninety-third General Assembly, First Regular Session, the House of Representatives concurring therein, hereby recognize February 14th, as Congenital Heart Defect Awareness Day in Missouri.

RSMo 301.3145 (2004) - Any supporter of the American Heart Association of appropriate age as prescribed by law may receive special license plates in show of support and awareness. The American Heart Association hereby authorizes the use of its official emblem red dress icon to be affixed on multiyear personalized license plates. Any contribution to the American Heart Association, except reasonable administrative costs, shall be used solely for the purposes of the American Heart Association.

Prevention of Risk Factors (Nutrition, Physical Activity, Tobacco)

Tobacco Control

Missouri's state employee tobacco cessation program meets two of the three CDC guidelines that include:

1) Coverage for at least four counseling sessions of at least 30 minutes; YES
2) Access to smoking cessation agents, including prescriptions and nicotine replacement; NO 
3) Counseling and medication coverage for at least two quit attempts annually; YES 

  • Missouri also has a cigarette excise tax and quit line.  The cigarette excise tax in Missouri is $.17.

  • Missouri's state Medicaid tobacco cessation program covers over-the-counter and prescription products, therapy, counseling and social support. A statewide public program is also available; coverage may vary from other programs. 

Increase Early Detection and Treatment of Heart Disease and Stroke 

 

No policy listed at this time

 

State Employee Health and Wellness

  • Missouri law generally provides that public and private employers may provide health insurance at a reduced premium rate and reduced deductible level for employees who do not smoke or use tobacco products.

  • Missouri has incentive rates for employees, saving up to $25 per month, who take the personal health analysis and participate in Lifestyle Ladder or Smart Steps® to be eligible for the incentive rate.

Improve Quality of Care and Access to Care

MO H 1898 (2010, enacted, Chapter No. 191) - Establishes the Women's Heart Health Program within the Department of Health and Senior Services to provide heart disease risk screening to uninsured and underinsured women.

RSMo 196.1109 (2003) - All moneys that are appropriated by the General Assembly from the life sciences research trust fund shall be appropriated to the Life Sciences Research Board to increase the capacity for quality of life sciences research at public and private not-for-profit institutions in the state of Missouri and to thereby: (1) Improve the quantity and quality of life sciences research at public and private not-for-profit institutions, including but not limited to basic research (including the discovery of new knowledge), translational research (including translating knowledge into a usable form), and clinical research (including the literal application of a therapy or intervention to determine its efficacy), including but not limited to health research in human development and aging, cancer, endocrine, cardiovascular, neurological, pulmonary, and infectious disease, and plant sciences, including but not limited to nutrition and food safety; and (2) Enhance technology transfer and technology commercialization derived from research at public and private not-for-profit institutions within the centers for excellence.

Address and Eliminate Disparities


No policy listed at this time

Emergency Medical Services (EMS) and Automated External Defibrillators (AED)

RSMo 190.200/HB1790 (2008) - 1. The Department of Health and Senior Services in cooperation with local and regional EMS systems and agencies may provide public and professional information and education programs related to emergency medical services systems including trauma, STEMI, and stroke systems and emergency medical care and treatment. 2. The department shall, for STEMI care and stroke care respectively: (1) Compile and assess peer-reviewed and evidence-based clinical research and guidelines that provide or support recommended treatment standards; (2) Assess the capacity of the emergency medical services system and hospitals to deliver recommended treatments in a timely fashion; (3) Use the research, guidelines, and assessment to promulgate rules establishing protocols for transporting STEMI patients to a STEMI center or stroke patients to a stroke center. (4) Define regions within the state for purposes of coordinating the delivery of STEMI care and stroke care, respectively; (5) Promote the development of regional or community-based plans for transporting STEMI or stroke patients via ground or air ambulance to STEMI centers or stroke centers, respectively, in accordance with section 190.243; and (6) Establish procedures for the submission of community-based or regional plans for department approval.

RSMo 190.092 (2004) - 1. A person or entity who acquires an automated external defibrillator shall ensure that: (1) Expected defibrillator users receive training by the American Red Cross or American Heart Association in cardiopulmonary resuscitation and the use of automated external defibrillators, or an equivalent nationally recognized course in defibrillator use and cardiopulmonary resuscitation; (2) The defibrillator is maintained and tested according to the manufacturer's operational guidelines; (3) Any person who renders emergency care or treatment on a person in cardiac arrest by using an automated external defibrillator activates the emergency medical services system as soon as possible; and (4) Any person or entity that owns an automated external defibrillator that is for use outside of a health care facility shall have a physician review and approve the clinical protocol for the use of the defibrillator, review and advise regarding the training and skill maintenance of the intended users of the defibrillator and assure proper review of all situations when the defibrillator is used to render emergency care. 2. Any person or entity who acquires an automated external defibrillator shall notify the emergency communications district or the ambulance dispatch center of the primary provider of emergency medical services where the automated external defibrillator is to be located. 3. Any person who has had appropriate training, including a course in cardiopulmonary resuscitation, has demonstrated a proficiency in the use of an automated external defibrillator, and who gratuitously and in good faith renders emergency care when medically appropriate by use of or provision of an automated external defibrillator, without objection of the injured victim or victims thereof, shall not be held liable for any civil damages as a result of such care or treatment, where the person acts as an ordinarily reasonable, prudent person would have acted under the same or similar circumstances.

Stroke Systems of Care

MO SCR 12 (2011, adopted) - Requests the MO HealthNet Division to assess chronic disease management of stroke prevention in atrial fibrillation patients, with the intent of identifying opportunities to improve quality of care and reduce the financial and clinical burden of AFib-related strokes on public assistance programs, including Medicare and Medicaid. A report of findings and recommendations will be given to the General Assembly by December 31, 2011. 

RSMo 190.241/HB1790 (2008) - The department [of health and senior services] shall designate a hospital as a STEMI or stroke center when such hospital, upon proper application and site review, has been found by the department to meet the applicable level of STEMI or stroke center criteria for designation in accordance with rules adopted by the department as prescribed by section 190.185. In developing STEMI center and stroke center designation criteria, the department shall use, as it deems practicable, appropriate peer-reviewed or evidence-based research on such topics including, but not limited to, the most recent guidelines of the American College of Cardiology and American Heart Association for STEMI centers, or the Joint Commission's Primary Stroke Center Certification program criteria for stroke centers, or Primary and Comprehensive Stroke Center Recommendations as published by the American Stroke Association. The department of health and senior services shall, not less than once every five years, conduct an on-site review of every trauma, STEMI, and stroke center through appropriate department personnel or a qualified contractor.

RSMo 190.245 (2008) - The department shall require hospitals, as defined by chapter 197, RSMo, designated as trauma, STEMI, or stroke centers to provide for a peer review system, approved by the department, for trauma, STEMI, and stroke cases, respective to their designations, under section 537.035, RSMo. For purposes of sections 190.241 to 190.245, the Department of Health and Senior Services shall have the same powers and authority of a health care licensing board pursuant to subsection 6 of section 537.035, RSMo. Failure of a hospital to provide all medical records necessary for the department to implement provisions of sections 190.241 to 190.245 shall result in the revocation of the hospital's designation as a trauma, STEMI, or stroke center. Any medical records obtained by the department or peer review committees shall be used only for purposes of implementing the provisions of sections 190.241 to 190.245 and the names of hospitals, physicians and patients shall not be released by the department or members of review committees.

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