Jackie Boucher: Fighting Rural Heart Disease

Jackie Boucher: Fighting Rural Heart Disease

Heart disease hit home for Jackie Boucher, MS, RD, LD, CDE, senior vice president and chief operating officer at the Minneapolis Heart Institute Foundation, when her grandmother Ruth, called her instead of dialing 911 when she was having a heart attack. So with a particular passion for women and heart disease prevention, Boucher was excited to lead the Hearts Beat Back: The Heart of New Ulm Project – a 10-year initiative to reduce myocardial infarctions and coronary heart disease risk factors in the rural community of New Ulm, Minn.

“Before we even wrote the grant to get funding, we reviewed community-wide cardiovascular programs that had already been done and took what we felt worked best,” says Boucher. “We factored in current technology and newer medications for groups with the highest risk factors, and then prioritized and developed interventions for our target population.” Boucher and her team flew to Finland to observe the North Karelia Project, one of the most internationally successful community-wide interventions focused on coronary heart disease. What made this program unique, says Boucher, was that “they were the first project to make changes to the environment, such as working with bakeries to reduce sodium or getting farmer’s to grow berries instead of only having dairy cows, and they made use of social marketing campaigns and reality TV to promote healthier habits and behavior change.”

Over 35 years, the North Karelia Project had significantly reduced heart attacks in its population — the kind of outcomes Boucher was striving for in New Ulm, where rates of overweight and obesity were high above national averages and one of the leading causes of death was heart disease.

“Part of the reason we picked the city of New Ulm was that more than 90 percent of the community receives care at the New Ulm Medical Center, which uses electronic health records (EHRs),” says Boucher. While it takes time to work with information technology teams to add fields so data are entered correctly or to pull data for analysis, using EHRs as a surveillance tool has saved the program a lot of money, allowing for additional measures—such as evaluations from participants in specific components and surveys on behavior change—that demonstrate results early on. “For example, we know fruit and vegetable daily consumption increased by almost one full serving per person,” says Boucher.

In the program’s first 15 months, the average number of heart attacks dropped by 24 percent—and five years after inception, the “Hearts Beat Back” program has met its goals to prevent cardiovascular disease and reduce the incidence of heart attacks. When asked what she is most proud of in inspiring a community to change, Boucher says the success of the program lies in its participants: “Sharing their success stories, taking ownership and seeing changes that result from their work and motivation is what’s inspiring,” adding that involving female community members was critical. “We must engage women,” says Boucher. “Women are the key to intervention.”

What inspired you to undertake this work or project?
Nationally there has been great progress on preventing death from heart attacks, for example, but not as much progress on preventing the heart attack from happening. Developing interventions that can have a population health impact is both challenging and rewarding.

I was lucky to be in the right place at the right time. The overall concept was the idea of Dr. Kevin Graham, a cardiologist at the Minneapolis Heart Institute. He conceptualized it and I helped realize it by hiring talented people (many of whom are registered dietitians) and creating strong community engagement in the project.

How has your work made a difference in your community?
We have strong evidence of impact on both behaviors and clinical measures. From a data perspective we have seen statistically significant improvements in fruit and vegetable intake, exercise and preventive medication use. We have also seen significant reductions in heart attacks, and fewer people with high blood pressure. From a qualitative perspective we have seen broad community engagement and social norm shifts.

Some excellent examples of the pervasive cultural change that has happened since the project started include:

  • The local paper’s recipe columnist now features heart-healthy dishes.
  • Grocery stores are featuring healthier salads in their delis and they are selling well.
  • Restaurant managers, once skeptical about offering healthier options, now serve them to meet demand.
  • The Rotary Club adopted a healthier menu for its luncheon meetings at one of New Ulm’s oldest German restaurants.
  • A belly dancing class proved so popular that it needed a bigger venue — twice!
  • The high school student council is proposing healthier options at concession stands.
  • The Park and Recreation Center memberships are up 81 percent.
  • More than 40 of the area’s largest 100 employers now have active wellness programming — an increase from only five.

What kind of feedback have you received?
The community is very proud of the changes and the national attention their success has generated. Over the past two years we have been invited to meet with the National Health IT Coordinator, had the Surgeon General come to New Ulm to learn about the project, and been featured in magazines, newspapers and on many local news stations.

What do you find most rewarding about your efforts?
The community engagement and commitment to the project has been very rewarding. It is amazing that more than five years into the project, when we have a community steering committee meeting, everyone shows up.

Looking ahead, how would you like to see your project develop or grow?
We have been very lucky to receive core funding from Allina Health, and additional funding (through grants) from UnitedHealth Group, USDA, CDC, etc. Now we need to work on maintaining the momentum built through shared community accountability. We want all of our work to be sustainable in the future, whether it is paid by health care systems, employers, public health, community organizations or philanthropy. That is our next five years to figure out!

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