Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Yale University School of Nursing

First Advisor

Mary-Ann Cyr

Abstract

The current use of racial categorization in Atherosclerotic Cardiovascular Disease (ASCVD) risk, limits assessment of confounders beyond cholesterol. The Life’s Essential Eight (LE8) categories of healthy diet, sleep, physical activity, smoking, body mass index, hypertension, total cholesterol, and blood glucose could reduce two million ASCVD events per year. The documentation of Z codes 55 – 65 describe social drivers of health (SDH) like housing, economics, and social systems which complicate care. Development of the ASCVD risk assessment and management protocol (ASCVD-RAMP) assessed ASCVD risk without race modification in patients aged 45 – 75 and improved health equity by pairing SDH with LE8 interventions. Implementation at a Federally Qualified Health Center (FQHC) involved training 9 providers, 3 case managers and 4 registered nurses on changes to clinical practice. ASCVD-RAMP was evaluated with a pre and post implementation survey, a comparison of ASCVD risk calculation and SDH Z code documentation. Following implementation in 164 patients, the ASCVD-RAMP was scaled across the organization. Integration into the EMR and updates to case manager and registered nursing roles ensured sustainability. Removing race from the ASCVD risk calculator resulted in lower risk categorization (p<0.001), improved opinions of calculation (p = 0.013) and LE8 management. ASCVD-RAMP improved perception of management that emphasized patient’s barriers to achieving better health (p=0.002). Utilization of SDH Z codes increased by 533% (p =0.054). Replacing race with SDH results in a change to dynamic variables in assessment of ASCVD risk and improved equity through a holistic patient centered approach to ASCVD prevention management.

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This is an Open Access Thesis.

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