This paper presents a community health plan targeting hypertension reduction among male veterans aged 25 to 60 years in Houston, Texas. It profiles Houston's demographic and healthcare landscape, including the Michael E. DeBakey VA Medical Center (MEDVAMC) and its existing hypertension quality-improvement initiative. Drawing on national CDC data and VA patient statistics, the paper outlines a nursing diagnosis, outcomes identification, and a phased intervention plan informed by the Minnesota Intervention Wheel. The plan incorporates public awareness campaigns, identification of untreated hypertensive veterans, and structured follow-up reviews. Evaluation relies on baseline data from 2005 and 2010, with the MEDVAMC's computerized patient records system used to track progress over time.
The paper demonstrates the application of a formal community health planning model (the nursing process combined with the Minnesota Intervention Wheel) to a real, data-supported population. By anchoring each phase — from diagnosis to evaluation — in measurable outcomes and existing baseline data, the author shows how academic frameworks translate into practical public health program design.
The paper opens with a detailed community profile covering Houston's size, demographics, and healthcare infrastructure. It then presents national and local hypertension statistics, followed by a brief clinical diagnosis section. The planning section is the most developed, identifying partnerships, objectives, and a 12-month activity timeline. A short evaluation section describes comparison methods using historic MEDVAMC data, and the conclusion reflects on hypertension as a silent but serious public health threat.
Area size: Houston is the fourth most populous city in the country (after New York, Los Angeles, and Chicago) and the largest city in the southern United States and Texas (Houston facts and figures, 2014). The Houston–Galveston–Brazoria Consolidated Metropolitan Statistical Area (Houston CMSA) is comprised of eight separate counties: Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, and Waller (Houston facts and figures, 2014). The Houston CMSA encompasses 8,778 square miles — an area larger than New Jersey (Houston facts and figures, 2014).
Population size: As of 2010, the City of Houston had a population of 2.1 million. The metro area's population of 5.95 million was the sixth largest among U.S. metropolitan statistical areas and represented a 26% increase since 2000 (Houston facts and figures, 2014).
Demographics: Houston has the youngest population of any major city in the United States, as well as the third-largest Hispanic and Mexican populations in the country (Houston facts and figures, 2014).
Physical and social environment: Houston is 43 feet above sea level and is located at 29 degrees 45 minutes north latitude and 95 degrees 22 minutes west longitude (Houston facts and figures, 2014). The cost of living in Houston is 9% below the national average, and housing costs are 29% lower than the national average (Houston facts and figures, 2014). The city is also well represented in professional sports leagues (Houston facts and figures, 2014).
A Healthy People 2020 objective is to improve health-related quality of life and well-being for all individuals. According to Healthy People 2020, "Health-related quality of life (HRQOL) is a multi-dimensional concept that includes domains related to physical, mental, emotional, and social functioning" (Healthy People 2020 objectives, 2014, para. 2). This objective focuses on individual quality-of-life factors that relate to a sense of well-being and healthy condition (Healthy People 2020 objectives, 2014), making the reduction of hypertension a highly congruent initiative. In this regard, Healthy People 2020 emphasizes that "well-being is a relative state where one maximizes his or her physical, mental, and social functioning in the context of supportive environments to live a full, satisfying, and productive life" (Healthy People 2020 objectives, 2014, para. 4).
The citizens of Houston also enjoy world-class healthcare services. Houston is home to the Texas Medical Center, the largest medical center in the world, with 42 nonprofit and government institutions — including 13 teaching hospitals, two medical schools, four colleges of nursing, a dental college, a college of pharmacy, and a college of optometry — with nearly 5 million patients treated annually (Houston health, 2014).
Veteran citizens of Texas who are eligible by virtue of their service record (no dishonorable discharges) can also obtain healthcare from the Michael E. DeBakey VA Medical Center (MEDVAMC). Currently, the MEDVAMC provides primary healthcare services to nearly 130,000 veterans in the southeast Texas region (About MEDVAMC, 2014). According to the MEDVAMC, "Veterans from around the country are referred to the MEDVAMC for specialized diagnostic care, radiation therapy, surgery, and medical treatment including cardiovascular surgery, gastrointestinal endoscopy, nuclear medicine, ophthalmology, and treatment of spinal cord injury and diseases" (About MEDVAMC, 2014, para. 2). The MEDVAMC includes a number of outpatient resources, including:
A Post-Traumatic Stress Disorder Clinic; Network Polytrauma Center; an award-winning Cardiac and General Surgery Program; Liver Transplant Center; VA Epilepsy and Cancer Centers of Excellence; VA Substance Abuse Disorder Quality Enhancement Research Initiative; Health Services Research and Development Center of Innovation; VA Rehabilitation Research of Excellence focusing on mild to moderate traumatic brain injury; a Kidney Transplant Center; Mental Illness Research, Education and Clinical Center; and one of the VA's six Parkinson's Disease Research, Education, and Clinical Centers (About MEDVAMC, 2014, para. 3).
The MEDVAMC also operates a network of satellite outpatient clinics in Beaumont, Conroe, Galveston, Houston, Katy, Lufkin, Richmond, Tomball, and Texas City, which treat more than 1 million veterans each year (About MEDVAMC, 2014).
At present, approximately one-third of American adults — about 67 million people — suffer from hypertension or high blood pressure (High blood pressure facts, 2014). Fewer than half (47%) of all hypertensive patients have their condition under control (High blood pressure facts, 2014). Another one-third of all American adults suffer from prehypertension, a condition characterized by blood pressure levels higher than normal but still below the hypertension threshold (High blood pressure facts, 2014). The economic costs of hypertension are staggering: nearly $48 billion is spent every year on the condition, a figure that includes the cost of medications, healthcare services, and lost productivity due to absenteeism (High blood pressure facts, 2014).
Current data for male veterans being treated at the Michael E. DeBakey VA Medical Center are presented in Table 1 below.
Table 1: Current aggregate patient data for the Michael E. DeBakey VA Medical Center, Houston
The data indicate that almost two-thirds (62%) of veterans served by the DVAMC live in urban areas, while 36% live in rural regions of the state. The data also indicate that 11% of the veterans served by the Department of Veterans Affairs (VA) in Houston were on active duty during Operation Enduring Freedom or Operation Iraqi Freedom, meaning they are among the youngest veterans currently receiving VA benefits and services. The other health indicators listed show that Houston's health indicators are broadly on par with state averages.
Gulf War veterans from the United States have consistently reported suffering from a broad array of healthcare issues and symptoms; however, rates of hypertension for veterans are comparable between those deployed to combat zones and those who received hazard-free assignments (Schneider, 2009). In response to the need for hypertension interventions for Houston veterans, the MEDVAMC implemented a quality-improvement initiative in September 2006 targeted at helping veterans bring their blood pressure under control (VA has solution for high blood pressure, 2010). The initiative employs intensive appointment scheduling within a brief period, group clinics, and standardized measurement techniques to concentrate VA resources on reducing veteran blood pressure levels (VA has solution for high blood pressure, 2010). As a result of this initiative, more than three-quarters (75%) of veteran patients at the MEDVAMC have succeeded in getting their hypertension under control, compared to just over half (54%) in 2005 (VA has solution for high blood pressure, 2010).
The diagnosis of hypertension is a straightforward process involving a series of blood pressure tests; individuals who consistently test at 140/90 mmHg or higher are regarded as having hypertension (How is high blood pressure diagnosed, 2014). According to McLendon and Shelton (2011), however, "Most symptoms can derive from any number of causes and frequently involve multiple factors. Vague complaints such as weakness, fatigue, or decreased appetite often are the only physical symptoms that patients describe — symptoms that may suggest an underlying problem" (p. 26).
Because there is no cure for hypertension, the ultimate goal for improvement related to this health concern is supporting veterans in bringing their blood pressure back under control in order to avoid the harmful long-term effects of sustained high blood pressure.
Hypertension can be a silent killer because the symptoms of the disease can be deceptive and misleading, causing some individuals to forego medical care, which allows the condition to worsen in the extreme. When timely diagnosed and treated, however, people with hypertension can get their blood pressure back under control and live normal, productive lives. To the uninformed analyst, hypertension may not appear to be a major public health concern, but the research clearly indicates that high blood pressure can result in a number of adverse health conditions, including death.
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