Heart of a Giant
We are Striving to Build Happy, Safe Strong, Informed Healthy, Equitable Resilient, Inclusive Heart Healthy Communities.
The Boston Public Health Commission recently found that 25% of Boston adult residents–one in four– reported having high blood pressure (hypertension). The percentage of hypertension was higher for the following groups; Black (36%) and Latino (27%) adults, as compared with White adults (20%). The prevalence rates ranged from 34% to 42% in neighborhoods with predominantly Black people.
Multiple studies have proven that in addition to regular doctor visits, a home-based BP control program run by non-physicians can provide efficient, effective, and rapid control (suggesting an innovative paradigm) for hypertension management. In addition, such programs are effective, sustainable, adaptable, and scalable to fit current and emerging national healthcare systems.
In response, Heart of a Giant’s 2HC Program is set up to empower program participants to better manage and facilitate the prevention of high blood pressure through a culturally responsive, community-based, and technology-driven approach that provides comprehensive care tools, community-centered healthcare support, education, and guidance that engage and guide participants towards better health outcomes.
The mission of the HGF is to achieve better health outcomes for heart diseases and related chronic health conditions in our communities and enhance the quality of life through health education, care support, and connection to community resources.
The Healthy Hearts Communities Program (2HC) is an initiative to help individuals and families manage and prevent hypertension. We aim to achieve this through a culturally responsive, community-based, and technology-based approach, provides comprehensive healthcare support, health education, and coaching.
At HGF, we are driven by the African philosophy of Ubuntu, which emphasizes humanity, compassion, and social responsibility. We believe that instilling the philosophy of Ubuntu (“I am because we are”) as a core principle of our organization will significantly help improve our communities’ overall health and well-being.
Our Program incorporates successful and customizable Remote Patient Monitoring (RPM) to monitor Blood pressure and other vital signs through monitoring devices and services to monitor related cardio-metabolic conditions. In addition, we may provide blood glucose monitoring for participants at risk of or living with Diabetes.
We collaborate with local healthcare providers and centers to recruit and support their patients and caregivers. In addition, we provide healthcare providers services to help the following outcomes for the participants.
See below for more information about the delivery methods and expected outcomes for each of the four pillars of the 2HC Program.
Heart of a Giant
Our Community Care Team, composed of health professionals, provides personalized clinical care support to address participants’ health needs and, when applicable, augment their prescribed care plans at home or a familiar place. They will teach participants how to self-monitor BP at home and make available monitoring systems. Participants will receive sets of home blood monitoring devices to develop the habit of monitoring their blood pressure and other vital signs at home. The biometric data will automatically be communicated to the Program Team. If no remote communications links are available, Care Coordinators will contact the participants to collect the data in person or via phone.
The Community Care Team also leverages audiovisual resources and digital health technology to facilitate, promote, and enhance health education and remote care support. In addition to their personalized level of care, participants can access online tools to help educate, coach, and help them track their progress, highlight red flags, and encourage best practices. The team will regularly visit in-person or virtually and contact using other multiple channels to communicate with the participants, including phone or Web messaging. All related communications will be HIPAA-compliant.
Methods of Delivery:
Care Support at Home entails the following:
- Care coordination and referral to hypertension treatment programs or cardiology centers (when applicable)
- Heart health education and vital signs monitoring: blood pressure, BMI, glucose, total lipogram, cholesterol, lifestyle diet and nutrition, activity level…
- Risk-factor evaluation and education
- Personal nutrition evaluation and weight management
- Medication adherence per the physician’s prescription (when applicable)
- Care optimization
- Develop patient advocacy
- Improved patient compliance
- Improved medication adherence
- Improved patient-physician relationships