Innovations in brain health require attention to data, patient-driven considerations

Key takeaways:

• Maximizing brain health, especially for patients in underserved areas, requires multidisciplinary effort.
• Good brain health strategy requires attention to care throughout the lifespan.

BALTIMORE — The primary drivers of innovations for brain health require attention to both data and patient-driven outcomes, as well as seamless integration of resources inside and outside of a community, according to a presenter.

“We are … becoming a society that is driven by attention, and attention, I think, is like the currency of our brain power,” Karen Orjuela, MD, MSCR, MBA, FAAN, neurohospitalist and vascular neurologist at the University of Chicago, told attendees at the American Neurologic Association annual meeting.

“I encourage you to identify what kind of interventions are high leverage,” she continued. “What are your attention points that can move the needle?”

As social determinants such as education, socioeconomics, family and neighborhood are heavily predictive of neurologic disease, the American Academy of Neurology’s Brain Health Action Plan seeks to join research, education, policy and public engagement as foundational pillars to address the issue, Orjuela said. Drivers of innovation like health equity, prevention, and greater investment in community should act as pillars for future innovation.

The opportunities for innovation in health care are in addressing racial and ethnic disparities in stroke and dementia diagnosis; attention to fluctuation in Medicare and Medicaid for older adults and those unable to afford traditional insurance; efforts to boost preventive medicine and rehabilitation for those most at risk for stroke and an overall strategy to align prevention, equity and improved system design aimed at more stabilization of brain health outcomes.

Orjuela related her experiences as a young neurologist in Colombia 2 decades prior, when the sole method at her disposal to treat stroke was aspirin, in contrast with modern medicine, which has since developed a wealth of imaging, treatment and advancements in the delivery of care.

Most of all, Orjuela continued, is a focus and investment in community. When community leaders and residents have a stake in this innovation, it gives them power and the ability to build sustainable relationships that aim to provide a more sustainable care continuum.

“Sustainability is going to be an important factor of everything we do,” she said. “Everything that we do has an expiration date. Use the time, use your attention and the resources where the benefit is greatest.”

Orjuela discussed her experiences with Live Healthy Chicago, a collaborative initiative that addresses disparities in hypertension rates in communities in Chicago to improve neurological outcomes.

In Chicago, she said, there is a life-expectancy gap of 11.4 years between ZIP codes centered in the city’s Southern and Western sections where the majority of the population live in Black and Hispanic communities, compared with residents of the North side.

In addition, Orjuela cited data that shows a 41% prevalence of hypertension in Black adults and 27 neighborhoods within the aforementioned ZIP codes with excess mortality due to stroke and cardiovascular disease.

The goal of Live Healthy Chicago is to aggregate the score of 10-year atherosclerotic cardiovascular disease risk by 1% in those 27 neighborhoods for middle-aged individuals, she said.

The intervention is triple-tiered, from revising clinical protocols to initiating mobile interdisciplinary health teams and implementing a city-wide awareness campaign featuring core concepts of blood pressure control, lifestyle factors and stressing that food is medicine.

Orjuela said five points are essential to the process by which any innovative strategy can be turned into a viable system for change:

• use of data-driven scaling;
• policy that aligns with the goals of all stakeholders;
• proper integration of funding;
• a solid foundation of community and workforce infrastructure; and
• continuous evaluation of the new health system model

“Neurological disorders remain the most common cause of disability-adjusted life worldwide, so this is our opportunity to be innovative,” Orjuela said. “Keep your health equity focused, and your life course prevention as one of the roadmaps.”

For more information:

Karen Orjuela, MD, MSCR, MBA, FAAN, can be reached at neurology@healio.com.

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