Benson Gretchen, Sidebottom Abbey C, Sillah Arthur, Vock David M, Vacquier Marc C, Miedema Michael D, VanWormer Jeffrey J
Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 100, Minneapolis, MN, United States of America.
Allina Health, 2925 Chicago Avenue, Minneapolis, MN, United States of America.
Prev Med Rep. 2019 Jan 31;13:332-340. doi: 10.1016/j.pmedr.2019.01.018. eCollection 2019 Mar.
Lifestyle significantly influences development of cardiovascular disease (CVD), but limited data exists demonstrating lifestyle improvements in community-based interventions. This study aims to document how lifestyle risk factors changed at the population level in the context of Heart of New Ulm (HONU), a community-based CVD prevention initiative in Minnesota. HONU intervened across worksites, healthcare and the community/environment to reduce CVD risk factors. HONU collected behavioral measures including smoking, physical activity, fruit/vegetable consumption, alcohol use and stress at heart health screenings from 2009 to 2014. All screenings were documented in the electronic health record (EHR). Changes at the community level for the target population (age 40-79) were estimated using weights created from EHR data and modeled using generalized estimating equation models. Screening participants were similar to the larger patient population with regard to age, race, and marital status, but were slightly healthier in regards to BMI, LDL cholesterol, blood pressure, and less likely to smoke. Community-level improvements were significant for physical activity (62.8% to 70.5%, < 0.001) and 5+ daily fruit/vegetable servings (16.9% to 28.1%, < 0.001), with no significant change in smoking, stress, alcohol or BMI. By leveraging local EHR data and integrating it with patient-reported outcomes, improvements in nutrition and physical activity were identified in the HONU population, but limited changes were noted for smoking, alcohol consumption and stress. Systematically documenting behaviors in the EHR will help healthcare systems impact the health of the communities they serve, both at the individual and population level.
生活方式对心血管疾病（CVD）的发展有重大影响，但关于社区干预中生活方式改善的数据有限。本研究旨在记录在明尼苏达州一项基于社区的心血管疾病预防倡议“新乌尔姆之心”（HONU）的背景下，生活方式风险因素在人群层面是如何变化的。HONU在工作场所、医疗保健和社区/环境等方面进行干预，以降低心血管疾病风险因素。HONU在2009年至2014年的心脏健康筛查中收集了包括吸烟、身体活动、水果/蔬菜摄入量、饮酒和压力等行为指标。所有筛查都记录在电子健康记录（EHR）中。使用从EHR数据创建的权重估计目标人群（40 - 79岁）在社区层面的变化，并使用广义估计方程模型进行建模。筛查参与者在年龄、种族和婚姻状况方面与更大的患者群体相似，但在体重指数、低密度脂蛋白胆固醇、血压方面略健康，且吸烟可能性较小。社区层面在身体活动（从62.8%至70.5%，<0.001）和每天食用5份及以上水果/蔬菜（从16.9%至28.1%，<0.001）方面有显著改善，而吸烟、压力、饮酒或体重指数没有显著变化。通过利用当地EHR数据并将其与患者报告的结果相结合，在HONU人群中发现了营养和身体活动方面的改善，但在吸烟、饮酒和压力方面变化有限。在EHR中系统地记录行为将有助于医疗系统在个体和人群层面影响其所服务社区的健康。
