reply to student:

Hello, Secretary Denis Richard McDonough.

I am Irene Robinson, the current emergency department nurse manager at Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia (CMC VAMC). We previously met this year on Saturday, May 27th, when you toured the emergency department. I am an Air Force veteran who has also been in nursing for 29 years and has held a nursing leadership role for the past twelve years. I am pursuing my Doctor of Nursing degree. I am writing this proposal to discuss cardiovascular disease and why I advocate for creating a mobile application (app) to promote health among African American men. A mobile app can encourage medication adherence and lifestyle modifications such as smoking cessation, increased exercise, and healthy eating while providing educational resources (Al-Arkee et al., 2021).  Hypertension-related cardiovascular disease is a silent killer among African American men over 18. I hope to receive congressional support for cardiovascular disease management for this patient population.   

Situation

Cardiovascular disease is the leading cause of death globally and continues to be the silent killer among African American men diagnosed with hypertension (American Heart Association, 2023). Stroke is the leading cause of death and disability, disproportionately affecting African American male veterans, including Philadelphia and the VA Jackson Health Care Veterans Affairs at G.V. (Sonny) Montgomery VA Medical Center in Jackson, Mississippi. At the CMC VAMC, of the 16,997 veteran patients, 92.1% are male, and 48.1% are African American. Among the veteran patients at the Philadelphia medical center, 60.56% are African American male veterans with blood pressures over 140/90. The national benchmark for blood pressure is less than 140/90 for African American patients is 71%. Heart disease kills about 20 percent more African Americans in Mississippi than other ethnic groups (Jackson Heart Study – Mississippi State Department of Health, 2022). Veterans Affairs Medical centers should focus on reducing this health disparity and improving heart health for all Mississippians and veterans, primarily African American veterans. According to the Mississippi State Department of Health, 2021, black Mississippians experienced more hypertension than white Mississippians (Blacks- 48.9%, Whites- 42.6%), with a 14.8% prevalence higher among blacks than whites (Purnell, 2018).

The identified policy that will positively impact this health disparity is H.R. 4182 Men’s Awareness and Improvement Act. This bill was introduced on June 15, 2023, to promote men’s health awareness. Nine out of ten deaths are men due to the lack of health care awareness and knowledge. The enactment of this bill will support implementing and creating a mobile app that could help throughout all Veterans Affairs Medical Centers. It will be the driving force for the preventative care practice change that will improve the overall health of our Nation’s male veterans. 

Background

Applying bill H.R. 4182 to promote health among African American male veterans will reduce exacerbation of hypertension-related cardiovascular disease. H.R. 4182 found that educating men, their families, and health care providers about the importance of early detection of health issues that can impact men, such as cardiovascular disease, can result in reducing rates of mortality of conditions affecting males, as well as improve the health and its overall economic well-being. Creating a mobile app designed for simplicity, scalability, and sustainability will provide education on preventive measures to decrease cardiovascular disease and promote health (Ahmed et al., 2020). I am advocating and asking that immediate action be implemented by creating an easy-to-use mobile app for patients diagnosed with hypertension. The effectiveness of the practice change will promote and educate patients about lifestyle modifications. The mobile app will offer diet, exercise, smoking cessation, and medication adherence education to prevent further exacerbation of cardiovascular disease that is known to shorten the life span and lead to death (Al-Arkee et al., 2021). As part of the process, the mobile app will offer a multidisciplinary approach on all education platforms and the offering of familiarity and comfort for patients and their support systems to communicate with their VA healthcare team easily. Promoting health among this patient population will reduce healthcare costs, as evidenced by decreased emergency room visits, reduced hospitalization, and adherence to preventative health care.

Assessment

In Philadelphia, Pennsylvania, the death rate for African American men with cardiovascular disease was 433.6 from 2017 to 2020 (Healthy People 2020).  In 2021, 344 men died from hypertension in Mississippi (Purnell, 2018).  African American men are among the highest patient population diagnosed with hypertension, which can lead to cardiovascular-associated deaths, with the most co-morbidities being modifiable and or preventative. Measuring the intervention’s success will result from meeting the measurable blood pressure goal below 140/90. The blood pressure goal is relevant to all Veteran Affairs Medical Centers because blood pressures greater than 140/90 indicate a high-risk patient quality measure.

Recommendation/Request

As a Doctor of Nursing Practice student, I request that a mobile app be created, implemented, and supported on your behalf for all Veterans Affairs Medical Centers. An easy-to-use and easily accessible mobile app will engage and empower patients and their families when planning care. Implementing this practice change will result in health maintenance, improved quality of life, education, better utilization of healthcare, and healthcare resources that will promote health. 

Thank you, Secretary McDonough for your time and attention on this crucial topic that our veterans could greatly benefit from. I am available for any further questions or research you deem essential.

Respectfully,

Irene Robinson MSN, RN

CMC VAMC Emergency Department Nurse Manager