Stanford Heart Network (SHN) – Membership Enrollment

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Table of contents

Introduction
Extensive data exist demonstrating generally poor adherence by health care providers and patients to national evidence-based practice guidelines for the comprehensive prevention and outpatient risk factor management of atherothrombotic cardiovascular disease (CVD). To promote various strategies designed to increase effective implementation of these guidelines by health care providers in communities throughout the world, an internet-based project, the Stanford Heart Network (SHN), was launched. SHN links an academic medical center at Stanford University with health care providers conducting CVD risk reduction programs located in hospitals, clinics, physician offices, rehabilitation centers, occupational health centers and community health agencies. The incentives for health care providers in the community to participate in the SHN program are access to tools and materials that assist them in being more effective in CVD risk reduction and systematic data collection for participant and program evaluation.

Background
Over the past two decades, the results of numerous randomized clinical trials have demonstrated that intensive and sustained single or multifactor risk reduction in patients at increased risk of a heart attack or stroke can significantly reduce the occurrence of serious clinical CVD events. Based on these results, national medical organizations in various countries have developed guidelines for appropriate risk factor management and chronic care of high risk patients. Extensive evidence indicates that effective implementation of these guidelines would reduce hospitalizations for CVD, expensive invasive diagnostic and treatment procedures, nonfatal myocardial infarction, and stroke , and CVD death by 25% to 50%. Unfortunately, these guidelines have not been effectively implemented in many medical practice settings. Ineffective implementation of these guidelines has resulted from a lack of integrated systems, lack of funding at all levels for chronic disease prevention services and inadequately trained health care professionals to conduct such programs. In response to this need, scientists and clinicians at Stanford developed and evaluated the Health Education and Risk Reduction Training (HEAR2T) Program.

During the past 25 years research conducted in the Division of Cardiovascular Medicine and the Prevention Research Center at Stanford University School of Medicine has demonstrated the ability to decrease major cardiovascular risk factors, delay the progression of coronary atherosclerosis and reduce clinical CVD events by 47% using a nurse and dietitian-based patient management program over 4 years (Haskell, et al. Circulation 1994, 89:975-990; Quinn, et al. J Am Col Cardiol 1994, 24:900-909; Miller, et al. Circulation 1996, 94:2146-2153). This model was further developed and implemented as demonstration projects in a variety of clinical settings as the Health Education and Risk Reduction Training (HEAR2T) Program (Haskell, et al. Circulation 2001,104:838; Berra, et al. Circulation 2001,104:471). The HEAR2T Program is a physician-directed, RN and RD case-management systems approach that combines lifestyle change with medical management based on national CVD prevention and treatment guidelines. It requires no specialized facilities and can serve patients in a variety of clinical settings and from large geographic areas. Features of the HEAR2T Program include (a) a systematic approach to the identification and management of high risk persons (including women, the elderly, ethnic minorities and persons of low income), (b) case management utilizing specially trained nurses, dietitians and other health care professionals, (c) use of new technologies for assessment, education and tracking, (d) use of existing community resources, and (e) increased involvement of patients in their own care.

Over the past decade, HEAR2T Program demonstration projects were conducted in four unique settings, all of which have resulted in excellent participant retention in the program, significant decreases in CVD risk factors in high-risk persons, and a high level of patient and health care provider satisfaction. These settings included worksites, an independent practice association (IPA), and free clinics for the medically underserved. Also, we have worked closely with two major corporations with multiple facilities in the US that have successfully implemented the HEAR2T

Stanford Heart Network Description and Mission
Well-trained personnel, with access to current information and tools with ongoing communication with medical experts are essential for the successful implementation of effective multifactor CVD risk reduction programs. Feedback from many workshop participants about how Stanford could continue to provide expert assistance to health professionals in the community led to the development of the Stanford Heart Network (SHN). SHN is the first international network of programs involved in an integrative approach to reducing heart attack, stroke and related chronic diseases. SHN provides the HEAR2T Program team at Stanford and collaborating institutions with very unique opportunities to work with a wide range of programs to improve their effectiveness and efficiency. SHN takes advantage of the Internet [stanfordheart.net] to link SHN “members” with resources provided by Stanford University and its collaborators. The SHN facilitates data collection, participant adherence and tracking and supports continued education of health professionals and participants.

Benefits and Services To SHN Members
The SHN links, primarily via the Internet, researchers/clinicians/educators at Stanford University with clinicians/educators in community-based practice groups (members). Each member has its own customized URL on the SHN server where participants can enroll in CVD risk reduction programs. While on-line, participants enter demographic and health data, complete a CVD risk assessment questionnaire, receive assessment results, access targeted education and program materials based on their results, and link to risk reduction services provided by each member and other URLs. Health professionals at member sites can review individual or group data and communicate with participants. Site managers designated at each member site can customize selected components of their web site, assigned health professionals secure access to information on their participants and produce reports from their data. Network managers at Stanford have access to data from all member sites.

HealthCalc.Net, a Division of Health Fitness Corporation provides technical support to SHN, including software development and hosting of the SHN web site. State-of-the-science security/privacy features are used for all protected health information (PHI) included on the site. Management of protected health information on the site meets the Health Insurance Portability and Accountability Act (HIPAA) requirements.

Core services provided to SHN members include the following:

  • A customized web site on the SHN server with 24/7 maintenance for the year
  • Training of the “site manager” via the telephone and internet
  • Instruction and assistance on how to customize and operate the site
  • Support for the electronic transfer of participant information to the SHN/member site
  • Review of SHN use by health professionals designated by the site manager via the telephone and internet
  • Application for secure downloading of participant data to member’s computer

Member Eligibility and Responsibilities
Members of SHN are organizations that have as a goal reducing the risk of heart attack and stroke in their membership and includes hospitals, clinics, physician offices, employers, health clubs, community health agencies or other entities providing health education and medically supervised health services.

Members must agree to review and adhere to the SHN Terms of Use and Privacy Policy

  • Members must appoint a site manager who will be responsible for the local oversight of the member web site, including member-unique information posted on the site, designation of eligible participants who can have access to the site and the assignment of health professionals to their site.
  • Members must agree to use the SHN website for only the intended uses and not provide access to unauthorized persons (see Terms of Use and Privacy Policy for additional details).
  • Members must agree to pay the annual fee within 30 days of signing SHN membership form and receiving an invoice from Stanford University

Fees and Payment Schedules
The following annual fee schedule has been established to cover the costs of the services provided by Stanford University and its contractor HealthCalc.net.*

1st Year Succeeding Years
Basic Services - level 1 $5,000 $2,500
  • Set-up & maintain website 24/7
  • Provide training of site manager
  • Electronic upload to web site of basic information on ≤ 20,000 participants/year
  • Provide ≤ 3 sub accounts on site
  • Provide basic training for site use to ≤ 3 health professionals (phone and internet)
  • Basic technical support
Advanced Services – level 2 $7,500 $4,000
  • Set-up & maintain website 24/7
  • Provide training of site manager
  • Electronic upload to web site of basic information on ≤ 50,000 participants
  • Provide ≤ 20 sub accounts on site
  • Provide basic training for site use to ≤ 12 health professionals (phone and internet)
  • Basic technical support
Advanced Services – level 3 $15,000 $7,500
  • Set-up & maintain website 24/7
  • Provide training of site manager
  • Electronic upload to web site of basic information on ≤ 100,000 participants/year
  • Provide ≤ 80 sub accounts on site
  • Provide basic training on site use to ≤ 30 health professionals (phone and internet)
  • Provide health professional education and quality control – one 60-minute conference call/ month with SHN staff
  • Provide annual report on results of all subjects taking the on-line cardiovascular risk assessment
  • Basic technical support

Fees should be paid by check from the member organization to:

    Stanford University

Payments should sent to:

    William L. Haskell, Ph.D.
    Stanford Prevention Research Center
    Stanford University School of Medicine
    Hoover Pavilion, Room N229
    211 Quarry Road, Stanford, CA 94305-5705
    Phone: 650 - 725-5012
    Fax: 650-723-7018
    e-mail: whaskell@stanford.edu

* Additional Fees
Additional fees will be charged for specific services agreed to in advance, including custom programming for the web site, training of staff at the member site or at Stanford University and quality control and educational services during the year (usually by telephone or at member site). Special arrangements can be made for additional services involved in the implementation of the HEAR2T Program at a member site.
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