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Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
Art Kaufman #PriesterHealth 2013
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Art Kaufman #PriesterHealth 2013

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    • 1. Addressing SocialDeterminants inNew Mexico:Partnership between CooperativeExtension and Health ExtensionPriester National Health Extension ConferenceCorvallis, OR Apr 16-17, 2013Arthur Kaufman, MD Sonja Koukel , PhD Juliana Anastasoff, MSProf Fam & Comm Med Comm & Env Health Spec Health Ext Officer, North NMVice Chanc, Comm Health Coop Extension Service Office for Comm HealthUniv of New Mexico NM State Univ Univ of New Mexicoakaufman@salud.unm.edu sdkoukel@nmsu.edu janastasoff@salud.unm.edu
    • 2. “The University of New Mexico Health SciencesCenter will work with community partners tohelp New Mexico make more progress in healthand health equity than any other state by 2020.”
    • 3. Comments from a Sampling ofCommunity Health Leaders Important to overcome image:• “University of ABQ”• “UNM only present while grant funds last” UNM needs to:• Commit to long term partnerships• Build upon local wisdom, leaders, organizations, programs• Create single UNM telephone number to help communitiesand providers navigate the UNM Health System• Have full-time presence in all communities like NMSU
    • 4. Determinants of HealthContribution to Mortality• Lifestyle 43%• Biology/Genetics 27%• Environment 19%• Health Services 11%% Nat’l Health Budget1%7%2%91%Marc Lalonde (1974)4
    • 5. Growing Need for New, IntegratedModels of Care “Status One” – top 5 % of care users consume 50%of resources Social determinants of disease in high user subset• 70% underlying cause of high ER use “behavioral”• 70% of “behavioral” is alcohol and substance abuse Intense case management requires collaboration(medical, behavioral, social, community outreach)
    • 6. Quality Care is Not Enoughex. Diabetes in Native Americans• Recommended Preventive Services:- Native Americans have best rates• Deaths from Diabetes:- Native Americans have highest ratesNew Mexico Dept of Health 2010 Report on EthnicDisparities in Health6
    • 7. The Social Health of the Fifty States:Where is New Mexico?Source: Institute for Public HealthThis combines in asingle measure eachstates’ performance on16 social indicatorsrepresenting differentstages of life (ex. Childpoverty, teen drug use,unemployment, suicideamong elderly, foodstamp coverage)7
    • 8. Tips for Staying Health• Don’t be poor• Don’t have poor parents• Own a car• Don’t work in a stressful, low paid manualjob• Don’t be unemployed• Don’t live in damp, low quality housing8
    • 9. Education and Health• High correlation of educational attainment andhealth• 56% of New Mexicans had some college education(we rank 36th in nation)• If 24% more (80%) had some college, we wouldavert 677 deaths/yearSource: Robert Wood JohnsonFoundation Commission to Build aHealthier America9
    • 10. “Food Deserts” in New MexicoAreas with Limited Access to Affordable and Nutritious Food10
    • 11. Establish Health Extension Rural Offices• Place full-time agents in rural communitiesacross the state• Link community health priorities with UNMresources• Monitor effectiveness of university programsin addressing community health needsKaufman, A, et al: Health Extension in New Mexico: An Academic Health Center and theSocial Determinants of Disease. The Annals of Family Medicine, Jan. 2010, vol. 8 No. 1.
    • 12. HEROs Roles• HERO Regional Coordinators, Agents HSClinked, community-based• They decentralize AHC resources & expertisein all mission areas• They facilitate community-campusengagement, partnerships• They educate, advocate so AHC priorities,activities better align with community’s
    • 13. McKinley County – CrownpointYouth/Pipeline Development into Health Professions• “Grow our own”• “Health Summit” – Eastern NavajoMid-Schoolers• Future mentoring14
    • 14. Urban Example of CoopExt/Health Ext Collaboration• Primary Care Community Health Centerswithout resources for patient education• Diabetes, Obesity, Hypertension leadingchronic diseases in primary care• Health Ext. Coordinator recruited Coop Ext.Agent to teach nutrition classes withinprimary care clinic15
    • 15. Rural Example of CoopExt/Health Ext Collaboration• NM HS grad rate one of lowest in country,espec Hispanic, Native Amer communitiesHealth sector among biggest employers• Ethnic diversity of health workforce notkeeping pace with diversity of nation• UNM’s pipeline programs working withNMSU’s 4-H program to recruit kids16
    • 16. Growing Need for New,Integrated Models of Care• “Status One” – top 5% of care usersconsume 50% of resources• Social determinants of disease- 70% of cause of high ER users behavioral- 70% of “behavioral” alcohol, subst abuse• Intense case management requires collab(med, behav, social, outreach, Coop Ext)17
    • 17. Health Extension, Cooperative Extension andCHWs Working Together on Social DeterminantsCooperative Extensiongives nutrition classes inprimary care clinicsFood Co-opEconomic developmentollashoneyeggs chickensplantsHousing renovationUrban Gardening
    • 18. Community Health Workers(“Promotoras”): Sustainable Funding viaMedicaid Managed Care Organizations Managed Medicaid MCO profits reduced by high ER use Can’t locate high user group for their case managers Dept Fam & Comm Med received MCO contract to hire, trainCHWs – assigned “panel” of high users to “manage” in field Results:– 62% reduction in cost to MCOs– Program extended to 2 other MCOs– Program expanded to 5 other regions of state– Pilot: FM resident/CHW teams co-manage panel, teach each other
    • 19. 20Charlie Alfero, Hidalgo Medical Services, Lordsburg, New Mexico
    • 20. How We’re Changing Research:2007 Top Health Priorities from 31 Countyand 6 Tribal Councils(compared with UNM HSC research priorities) County Health Councils’Priorities (in order)– Substance Abuse– Teen Pregnancy– Obesity– Access to Care– Violence– Diabetes UNM HSC Research Priorities(“Signature Programs”)– Cancer– Cardiovascular andMetabolic Diseases– Brain and Behavior– Infectious Disease andImmunity
    • 21. Regional HERO Agents/CoordinatorsBecoming Regional Academic HubsLocation of HEROsExpansion of HEROs toAcademic Hubs
    • 22. Health Measures for Lea County: Red Flags
    • 23. 24Example of Determinant and OutcomeTracking in State
    • 24. Challenges to Collaboration betweenCoop Ext-Health Ext Collaboration• History: Parallel, non-communicatingsystems (Coop Ext and Medical System)• Competition: Land grant vs Flag ship Univsfor funding, recognition• Confusion: “Extension” is a Coop Ext“brand”-- funders, govt could be confused• “Show me:” Does cooperation really helpcommunities? Is it really a win-win?25
    • 25. Emerging Coop Extension-Health Extension CollaborationModels• New Mex State U- U of New Mexico• Oregon State- OHSU• Univ of Kentucky (Land Grant/Flag Ship)• Univ of Kansas- Kansas State• Others26
    • 26. Health Extension and theAffordable Care ActSection 5405 “Primary Care Extension Prog”• National program• Health Ext agents help transform prim care• Measures of success: community health aswell as primary care transformation• Authorized, not appropriated27
    • 27. National Dissemination of HealthExtension• AHRQ IMPaCT grant: 4 states funded, eachlinked with 3-4 others (18 states pilotingHealth Extension• Commonwealth grant – on-line toolkit-natldissem. www.healthextensiontoolkit.org• Natl Invitational Conferences (NM, SC) onAHCs and the Social Determinants28

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