Harvey County Council of State Governments


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  • Approximately 50 staff; most based in Topeka. At least one health promotion outreach staff in each of KDHE’s 6 district offices.
  • Chronic Disease Risk Reduction grants awarded to local health departments or their designees on a competitive basis. Currently award grants to counties comprising 70% of the state’s population.
  • Why focus on Chronic Disease and Health promotion? Chronic Disease now accounts for 80% of all health care expenditures; much of it preventable. Injury accounts for 10% of all health care expenditures.
  • HP2010 has 22 focus areas; 467 objectives. SC reviewed Kansas data for all 22 focus areas and listened for recurring themes. Selected cross cutting priorities and then areas for immediate action.
  • Final report will be on web soon. Will send copies through Kathleen and Joel to this group.
  • Will measure our degree of progress towards improving the health of Kansans by monitoring the 10 leading HP2010 indicators
  • Will talk about tobacco and overweight/obesity today, since Harvey group identified these among their indicators.
  • Harvey county population is roughly 1.3% of state population, so move decimal 2 places for estimate of Harvey county costs.
  • Where did it start? In 1990 1-15% obese was the highest any state experienced.
  • By 1995, many moved into the 15-19% range
  • 2003 we see an new category – over 25%
  • HTN 3x more common in obese that normal weight Long term studies indicate that obesity is not only related to CVD, but also predicts it! This is true for men and women. Middle aged woman >23<25 BMI = 50% increased risk of CVD Men >25 <29 BMI = 72% increased risk for CVD
  • African American women highest in obesity; also highest incidence of stroke.
  • Diabetes trend is about 10 years behind obesity trend. If overweight, 500% more likely to have DM; 300% more likely to have HTN; 30% more likely to have arthritis.
  • All ages. National – WIC kids look just like this. No reason to think that Ks kids don’t look just like this national graph. Weight is increasing in every age cohort.
  • 25% of Kansas kids in 6-12 and 9-12 are overweight or risk of overwt. Overwt = BMI>95%tile; at risk of overweight = BMI >85<95 %tile 60% of obese chilren have at least one CVD Risk factor 25% of obese children have 2 or more CVD risk factors If overwt as a child, higher chance of being an overwt adult with all its attendant diseases. Baby boomers: first generation to outlive our children.
  • Tobacco use is #1 preventable cause of death. Stablized, but not dramatically improving despite the knowledge of how to change this picture. Promising trend among adults. Kids smoking rates have stabelized. Spitting tobacco posing a growing threat as result of industry marketing as “safer” alternative. 21% of high school kids smoke 2900 middle school kids use spitting tobacco – boys are especially high 16,200 high school kids use spitting tobacco in Kansas
  • 25% less obesity among kids who were breastfed <half of kids in 9-12 grades have 60+ minutes of PA per day 1 in 3 kids grades 9-12 watch 3+ hours of TV/day 1 in 5 eat five servings of F/V per day – same for adults
  • 1 in 5 kids or adults consume 5 or more F/V per day
  • Preventing makes the most sense and we know how to make that happen 1-866-KanStop Pres of ACS today in Dear Abby: quit at 35 and decrease risk by 90%; quit by 50 and decrease risk by 50% 1 ½ years pre and post ordinace in Pueblo decreased heart attacks by 27%, similar to Helena MT a couple years earlier which measured a 40% reduction in heart attacks after passing CIA. We have an arsenol of best practices – just need to invest.
  • Farmer’s Market July 2006
  • 13 trainings held to date; 312 health care providers attended.
  • Integration Chronic disease self-management program
  • Provider has identified goals for pts. Have they
  • Harvey County Council of State Governments

    1. 1. Harvey County Council of State Governments Kansas Collaborative Meeting November 15, 2006 Paula F. Marmet, MS, RD, Director Office of Health Promotion KS Department of Health & Environment
    2. 2. OHP Mission Through partnership with the people of Kansas, the Office of Health Promotion promotes healthy behaviors, policies and environmental changes that improve quality of life and prevent chronic disease, injury and premature death for all.
    3. 3. Office of Health Promotion <ul><li>Cardiovascular Health </li></ul><ul><li>Diabetes </li></ul><ul><li>Arthritis </li></ul><ul><li>Cancer </li></ul><ul><li>Tobacco Use Prevention </li></ul><ul><li>Health Risk Behavior Surveillance (BRFSS) </li></ul><ul><li>Intentional Injury </li></ul><ul><li>Unintentional Injury </li></ul><ul><li>Nutrition </li></ul><ul><li>Physical Activity </li></ul><ul><li>Obesity </li></ul>
    4. 5. H Health Problems in the U.S. Problems in the U.S. Leading Causes of Death* United States, 2000 Actual Causes of Death † United States, 2000 Tobacco Diet / Physical Inactivity Alcohol consumption Microbial agents (e.g., influenza, pneumonia) Motor vehicles Toxic agents (e.g., pollutants, asbestos) Firearms Sexual behavior Illicit drug use Percentage (of all deaths) *Minino AM, Arias E, Kochanek KD, Murphy SL, Smith BL. Deaths: final data for 2000. National Vital Statistics Reports 2002; 50(15):1-20. † Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291 (10): 1238-1246. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Correction: Actual Causes of Death in the United States, 2000. JAMA. 2005;293 (3): 293. 0 5 10 15 20 25 30 35 Percentage (of all deaths) Heart Disease Cancer Stroke Chronic Lower Respiratory Disease Unintentional injuries Diabetes Pneumonia / influenza Alzheimer’s disease Kidney disease
    5. 6. HK2010 Process <ul><li>Steering Committee reviewed the 22 focus areas of Healthy People 2010 </li></ul><ul><li>Identified recurring themes </li></ul><ul><li>Selected cross cutting priorities </li></ul><ul><li>Convened Action Groups </li></ul><ul><li>Selected 5 specific areas for immediate action </li></ul>
    6. 7. Three Cross Cutting Priorities Reducing/Eliminating Health Disparities Early Disease Prevention, Risk Identification and Intervention for Women, Children and Adolescents System Interventions to Address Social Determinants of Health
    7. 8. Healthy Kansans 2010 <ul><li>Goal: To markedly improve the 10 leading health indicators </li></ul><ul><ul><li>Physical Activity </li></ul></ul><ul><ul><li>Overweight & Obesity </li></ul></ul><ul><ul><li>Tobacco Use </li></ul></ul><ul><ul><li>Substance Abuse </li></ul></ul><ul><ul><li>Responsible Sexual Behavior </li></ul></ul><ul><ul><li>Mental Health </li></ul></ul><ul><ul><li>Injury and Violence </li></ul></ul><ul><ul><li>Environmental Quality </li></ul></ul><ul><ul><li>Immunization </li></ul></ul><ul><ul><li>Access to Health Care </li></ul></ul>
    8. 9. Actions for Immediate Action <ul><li>Tobacco Use Prevention </li></ul><ul><li>Disparities Data </li></ul><ul><li>Cultural Competency </li></ul><ul><li>Overweight and Obesity </li></ul><ul><li>Access to quality health care </li></ul>
    9. 10. Costs of Tobacco Use in Kansas <ul><li>Single most preventable cause of death-4,000 deaths per year </li></ul><ul><li>$724 million health care costs $180.4 million Medicaid program </li></ul><ul><li>$547 per household residents’ tax burden </li></ul><ul><li>$811 million smoking caused productivity losses </li></ul><ul><li>550 Ks kids become regular smokers each month </li></ul><ul><li>50,000 kids alive today will die from tobacco related disease </li></ul>
    10. 11. Cost of Obesity in Kansas <ul><li>$657 million in direct medical costs (5.5%) </li></ul><ul><li>$138 million in Medicare Costs (6.4%) </li></ul><ul><li>$143 million in Medicaid expenditures (10.2%) </li></ul><ul><li>By 2020, 1 in every 4 dollars spent on health care will be to treat obesity related disease </li></ul>
    11. 12. Costs of Injury in Kansas <ul><li>$4.06 billion total expenditure (medical and indirect costs) </li></ul><ul><li>$1.43 billion fatal injuries (35%) </li></ul><ul><li>$920 million hospitalized injuries (23%) </li></ul><ul><li>$1.71 billion for non-hospitalized injury (42%) </li></ul><ul><li>Motor vehicle is leading cause of death from injury: Total economic burden in 2000 was almost $1.9 billion ($701 /every adult and child in the state. (NHTSA) </li></ul>
    12. 13. Obesity Trends Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Source: Centers for Disease Control and prevention. No Data <10% 10%–14%
    13. 14. Obesity Trends Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Source: Centers for Disease Control and prevention. No Data <10% 10%–14% 15%–19%
    14. 15. Obesity* Trends Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Source: Centers for Disease Control and prevention.
    15. 16. Obesity Trends Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Source: Centers for Disease Control and prevention.
    16. 17. Age in Years Percent Obesity Prevalence among Kansas Adults by Age Groups, BRFSS 2005 Kansas Behavioral Risk Factor Surveillance System. Obesity is defined as Body Mass Index  30 Kg/m 2 .
    17. 18. Obesity Prevalence among Kansas Adults - Racial Disparities, BRFSS 2005 Percent Racial Groups Kansas Behavioral Risk Factor Surveillance System. Obesity is defined as Body Mass Index  30 Kg/m 2 .
    18. 19. Prevalence and Trend of Diagnosed Diabetes and Obesity among Adults in Kansas, BRFSS 1992-2005 1992-2004 Kansas Behavioral Risk Factor Surveillance System ,Office of Health Promotion, Kansas Department of Health and Environment; 1992-2004 Behavioral Risk Factor Surveillance System, Center for Disease Control and Prevention. Note: Obesity is defined as Body Mass Index (BMI) of 30 or more. BMI = weight (kg)/height (m 2 ) Year Prevalence of diabetes & obesity (%) Obesity & Chronic Diseases Among Kansas Adults:
    19. 20. Source: NHANES - 1963-65 through 1999-02. Trends for Overweight Prevalence among Children & Adolescents – United States, 1963-2000.
    20. 21. Childhood Obesity in Kansas: Kansas Students, Grades 6 – 12, YTS 2002-03 Kansas Students, Grades 9 – 12, YRBS 2005 Source: 2002-03 Kansas Youth Tobacco Survey; 2005 Kansas Youth Risk Behavioral Survey.
    21. 22. Smoking trends in Kansas
    22. 23. <ul><li>Promising Practices for Preventing Obesity: </li></ul><ul><li>Support Healthy Lifestyle </li></ul><ul><li>Breastfeeding </li></ul><ul><li>Adequate physical activity </li></ul><ul><li>Limited screen time </li></ul><ul><li>Achieving optimal level of fruit and vegetable consumption </li></ul><ul><li>Achieving Energy Balance </li></ul><ul><li>Source: Centers for Disease Prevention and Health Promotion </li></ul>
    23. 24. <ul><li>Recommendations – Guide To Community Preventive Services: </li></ul><ul><li>Physical Activity </li></ul><ul><ul><li>- Community wide campaigns. </li></ul></ul><ul><ul><li>- Point of decision prompts. </li></ul></ul><ul><ul><li>- Individually-adapted health behavior change. </li></ul></ul><ul><ul><li>- School-based physical education. </li></ul></ul><ul><ul><li>- Non-family social support. </li></ul></ul><ul><ul><li>- Creation &/or enhanced access to places for physical activity </li></ul></ul><ul><ul><li>combined with informational outreach (policy and </li></ul></ul><ul><ul><li>environmental changes to increase PA). </li></ul></ul><ul><li>Source: The Guide to Community Preventive Services . www.thecommunityguide.org </li></ul>
    24. 25. <ul><li>Nutrition </li></ul><ul><li>Multi-component nutrition interventions to improve knowledge/attitudes and consumption patterns and environments to enhance healthy food choices through: </li></ul><ul><li>- Educational components (such as classroom instruction by </li></ul><ul><li>teachers, integrating nutrition education across curricula, </li></ul><ul><li>peer training) </li></ul><ul><li>- Environmental components (such as school menus,classroom </li></ul><ul><li>snacks & special treats) </li></ul><ul><li>- Other components (such as physical activity, family </li></ul><ul><li>education & involvement, community involvement) </li></ul><ul><li>Source: The Guide to Community Preventive Services . www.thecommunityguide.org </li></ul>
    25. 26. <ul><li>Tobacco Use Prevention & Control </li></ul><ul><li>Prevent tobacco use initiation. </li></ul><ul><li>Increase cessation efforts. </li></ul><ul><li>Reduce exposure to secondhand smoke. </li></ul><ul><li>Invest in Proven Practices </li></ul><ul><li>Source: The Guide to Community Preventive Services . www.thecommunityguide.org </li></ul>
    26. 27. Injury Prevention <ul><li>$1 spent on smoke alarms saves $69 </li></ul><ul><li>$1 spent on bike helmets saves $29 </li></ul><ul><li>$1 spent on child safety seats saves $32 </li></ul>
    27. 28. Governor’s Healthy Kansas Agenda <ul><li>Tobacco Use Prevention </li></ul><ul><li>Increase Physical Activity </li></ul><ul><li>Improve Nutrition </li></ul><ul><li>Children in Schools </li></ul><ul><li>Adults in the Workplace </li></ul><ul><li>Seniors where they live </li></ul>
    28. 29. The Capitol Mid-Week Farmers' Market   The Kansas Department of Health and Environment, Office of Health Promotion, and the Kansas Department of Commerce, Agricultural Marketing Division, announce the grand opening of the Capitol Mid-Week Farmers' Market on May 24 th from 9 a.m. to 2 p.m.   Helping to Create a Healthier Worksite      
    29. 30. Farmers' Market June 2006
    30. 31. Farmers' Market June 2006
    31. 35. Smoking Cessation in Pregnancy <ul><li>1-866-KanStop </li></ul><ul><li>4,800 pregnant women smokers in KS </li></ul><ul><li>Neonatal health care costs due to smoking= $3.2 million </li></ul><ul><li>Medicaid = 11% of smoking caused health care costs in Kansas </li></ul><ul><li>Kansas Legislature allocated $250,000 </li></ul>
    32. 36. Provider Training <ul><li>5 A’s approach for tobacco cessation in a clinical setting </li></ul><ul><li>$500 educational stipend to set up system </li></ul><ul><li>$10 incentive for each PG referral to QL </li></ul><ul><li>Provide technical assistance and feedback to providers </li></ul>
    33. 38. Kansas DPCP and HDSP Collaboration Quality of Care Project
    34. 39. Background For Collaboration <ul><li>CDEMS was developed for chronic disease management, not only for diabetes </li></ul><ul><li>DPCP has an established Quality of Care project (3 years and 66 organizations) </li></ul><ul><li>CVH team desired to address CVD quality of care issues </li></ul><ul><li>Tool to be used for identification of gaps in quality of care of chronic diseases </li></ul><ul><li>Anticipate improvement in patient outcomes </li></ul><ul><li>Tool to enhance and/or develop office protocols to improve the quality of care for patients with Diabetes and/or CVD </li></ul>
    35. 40. Diabetes Project Organization Demographics <ul><li>66 funded organizations </li></ul><ul><li>90 sites statewide </li></ul><ul><li>350 participating health professionals </li></ul><ul><li>50% of Kansas’ counties represented </li></ul><ul><li>Diverse organizations participating </li></ul>
    36. 41. Rawlins Cheyenne Decatur Norton Phillips Smith Jewell Republic Washington Marshall Nemaha Brown Doniphan Sherman Thomas Sheridan Graham Rooks Osborne Mitchell Cloud Ottawa Clay Morton Wallace Logan Gove Trego Ellis Russell Lincoln Ellsworth Saline Greeley Wichita Scott Lane Ness Rush Barton Rice McPher- son Hamilton Kearney Finney Stanton Grant Haskell Stevens Seward Gray Meade Clark Ford Hodgeman Comanche Kiowa Edwards Pawnee Stafford Pratt Reno Kingman Harper Barber Harvey Sumner Sedgwick Cowley Butler Chautauqua Mont- gomery Labette Cherokee Elk Wilson Neosho Greenwood Crawford Bourbon Linn Allen Miami Anderson Franklin Wood- son Lyon Coffey Osage Marion Chase Dickinson Morris Geary Waubaunsee Pottawatomie Riley Jackson Shawnee Atchison Leavenworth Douglas Johnson Jefferson Stafford Reno Kansas Diabetes Quality of Care Project Sites
    37. 42. <ul><li>Types of participating organizations: </li></ul><ul><ul><li>Local Health Departments </li></ul></ul><ul><ul><li>Community Health Clinics </li></ul></ul><ul><ul><li>Safety Net Clinics </li></ul></ul><ul><ul><li>American Indian Health Clinic </li></ul></ul><ul><ul><li>Home Health Agencies </li></ul></ul><ul><ul><li>Hospital Affiliated Practices </li></ul></ul><ul><ul><li>Private Practices </li></ul></ul><ul><ul><li>Farmworker Program </li></ul></ul><ul><ul><li>Promotora Program </li></ul></ul>Organization Demographics – cont’d
    38. 44. CDEMS How does it work? Patient Data Entered % of Patients Receiving Vaccinations and Foot Exams Needs Improvement Hard copy inserted into patient’s chart Dr. updates patient’s chart
    39. 45. First Year Outcomes Organizations Checking Yes on the Quarterly Office Self-Assessment Form 42% 60% 42% Holding routine diabetes team meetings 46% 66% 45% Quantifiable goals for quality of care provided to Patients % change 4 th quarter 1st quarter Outcomes Health Care Organization
    40. 46. First Year Outcomes Cont’d…. Organizations Checking Yes on the Quarterly Office Self-Assessment Form 50% 54% 36% Non-physician staff empowered to order overdue labs - 60% 60% All patients scheduled for follow-up 8% 39% 36% Non-physician staff allowed to do foot exam 18% 57% 48% Non-physician staff empowered to administer flu and pneumonia vaccinations 76% 69% 39% Routinely ask patients to remove socks and shoes before exam % change 4 th quarter 1st quarter Outcomes Delivery System Design
    41. 47. First Year Outcomes Cont’d…. Organizations Checking Yes on the Quarterly Office Self-Assessment Form 50% 54% 36% CDEMS used to make decisions about needed care for patients % change 4 th quarter 1st quarter Outcomes Decision Support 200% 54% 18% Patients routinely know their targets for blood pressure, finger stick blood sugar, and HbA1 64% 69% 42% Provide resources for patients to allow them to be full partners in their care % change 4 th quarter 1st quarter Outcomes Self-management Support
    42. 48. First Year Outcomes Cont’d…. Organizations Checking Yes on the Quarterly Office Self-Assessment Form 66% 75% 45% Use CDEMS to record patients with eye exams, foot exams, HbA1c, flu and pneumonia vaccinations 55% 42% 27% Use CDEMS as a reminder system to prompt when a patient is due for labs or visit % change 4 th quarter 1st quarter Outcomes Clinical Information Systems 30% 51% 39% Develop partnerships in the community for referral % change 4 th quarter 1st quarter Outcomes Community Resources