PPT for NDSU Class October 2015

1. Integrating Public Health into Clinical Systems - NDSU
Prevention In The Primary Care Setting - October 15, 2015
Kristin Erickson, MS, APHN-BC, RN
kerickso@co.ottertail.mn.us

2.  The Problem
 Factors that influence Health
 The Minnesota Solution
 Statewide Health Improvement Program
 PartnerSHIP 4 Health
 The Federal Solution
 CDC 1422 Community Wellness Grant
 The Outcomes
Tonight’s Roadmap

3. The Problem: Chronic illnesses
account for four of the top seven causes of death in
MN…

4. The Problem: The “real” causes of
these deaths are behaviors that are preventable,
such as tobacco use/exposure, poor diet, and
sedentary living…

5. Obesity is epidemic in Minnesota.
• Nearly 2/3 of adults
are overweight or
obese
• Only one out of four
adults eats enough
fruits and vegetables
• Only slightly more than
half of Minnesota
adults get at least a
moderate level of
exercise
Percent of Minnesota Adults Obese

6. Tobacco continues to be a problem in
Minnesota.
• 14.4% of adults
smoke, and many
others are
subjected to
secondhand smoke.
• Over a quarter of
high school
students used
tobacco in the past
30 days. www.mnadulttobaccosurvey.org

7. All contributing to rising health care costs…

8. What Influences Our Health?
• Socio-Ecological Model:
– Individual: knowledge, attitudes,
beliefs
– Interpersonal: family, peers, social
networks
– Organizational: employers, schools,
etc.
– Community: social norms and
standards
– Policy: a law, rule at an employer,
college, or multi-unit housing
Wherewe’vetraditionallyspentourefforts

9. What Influences Our Health?
• Socio-Ecological Model:
– Individual: knowledge, attitudes,
beliefs
– Interpersonal: family, peers, social
networks
– Organizational: employers, schools,
etc.
– Community: social norms and
standards
– Policy: a law, rule at an employer,
college, or multi-unit housing
Wherewe’vetraditionallyspentourefforts
Whatismosteffective

10.  2009 - present day
 https://www.youtube.com/watch?v=SMymFKsix6A
 Making the Healthy Choice the Easy Choice
Statewide Health
Improvement Program
(SHIP)

11. What is Policy Change?
• Policies include laws, ordinances,
resolutions, mandates,
regulations, or rules (both formal
and informal)
– Policy change includes the passing of
laws, ordinances, resolutions,
mandates, regulations, or rules
– Example: organizational policy that
allows the use of flex-time to
accommodate physical activity

12. What is System Change?
• Systems impact all elements of an
organization, institution, or system
– Systems change impacts all elements
of an organization and often focuses
on changing infrastructure within a
school, park, worksite or healthcare
setting
– Example: Implementation of the WHO
10 Steps to Successful Breastfeeding
and becoming a baby-friendly hospital
system

13. What is Environmental
Change?
• The environment involves physical
or material elements of the
economic, social, or physical
environment
– Environmental change is a change
made to the physical or material
elements
– Example: Incorporating sidewalks,
paths, and/or recreation areas into
community design

14. Policy, systems, and environmental changes…
supporting healthy individual behaviors…
How it
works
• work with schools to serve more
locally grown produce
Rather than just telling
kids about good
nutrition
• help employers build
opportunities into the day
Rather than just telling
people to get more
physical activity
• help college campuses become
smoke-free
Rather than just telling
students to avoid
second-hand smoke

15. PartnerSHIP 4 Health
 Community and public health partners in Becker,
Clay, Otter Tail and Wilkin counties working
together to create an environment that supports
improved health for all
 Funded by the Statewide Health Improvement
Program (SHIP) as well as multiple additional
funding streams

16. Multiple funding streams
• Statewide Health Improvement Program - SHIP
• SHIP Innovation
• CTG, CDC 1422 Community Wellness Grant
• ClearWay
• UCare
• Otto Bremer Foundation
• BCBS Foundation
• MN GreenCorps
• BCBS Center for Prevention
• NW Regional Sustainable Development

17. Our
Objectives
Increase
Healthy
Eating
Increase
Physical
Activity
Decrease
Tobacco Use
And Exposure

18. Walking Alongside Our Partners…
• Human Service Organizations
• Schools
• Worksites
• Communities
• Healthcare
• Childcare
Creating a Culture of Health
Environmental
Changes
Policy Changes
System
Changes

19. It Takes a Team
• Multi-agency, multi-county, multi-disciplinary staff
• The right people doing the right work
• Supported by decision-makers
• Multiple funding partners

20. Complete Streets Active Transportation Safe Routes to School
Active School Day:
Active Recess and
Active Classrooms
Comprehensive School
Physical Activity Programs:
Bike Fleet
Worksite Wellness
INCREASING PHYSICAL ACTIVITY FOR ALL

21. Worksite Wellness:
Lactation Room
Farmers Markets
Fresh Connect Food Hub
and Farm to School
Human Service
Organizations
Community Gardens Healthy Food Pantry
Donations
INCREASING HEALTHY FOOD ACCESS FOR ALL

22. Smoke-Free Multi-Housing
Units
Clinical Guideline
Implementation
Tobacco-Free Worksites and
Secondary Campuses
Counter Marketing and
Point of Sale
Increase Access to Tobacco
Cessation Services
Smoke-free Childcare and
Foster Care
DECREASING TOBACCO USE AND EXPOSURE

23. Encourage
Clinical
Obesity and
Tobacco
Guidelines
Encourage
Worksite
Wellness to
Foster Healthy
Role Models
HEALTH CARE STRATEGY #1
ELEVEN PARTNERS
 Community Health
Service, Inc. (Migrant
Health)
 Family HealthCare
Center (FQHC)
 Orthopedic and Sports
Physical Therapy, Inc.
 Lake Region Healthcare,
Essentia Health,
Sanford Health, and
Perham Health Clinics
 Local Public Health
Departments

24. HEALTH CARE STRATEGY
Five Partners
• Essentia Health St.
Mary’s in Detroit Lakes
• Lake Region Healthcare
in Fergus Falls
• Perham Health in
Perham
• St. Francis in
Breckenridge
• Essentia Health and
Sanford Health in
Fargo-Moorhead
Participate with Local
Hospitals in their
Community Health Needs
Assessment and Strategic
Planning Process
Health Care Strategy #2

25. • Minnesota bent the curve and outperformed nearby states
• Significant health care savings linked to 60,000 more Minnesotans at a healthy weight
U.S. and Regional Obesity Rates
Data source: CDC Behavioral Risk Factor Surveillance System
http://www.health.state.mn.us/news/pressrel/2015/ship042015.html
Initial Results:
Minnesota Alone Trims Obesity Rates Among Upper Midwest States

26. 2015
A NEW CDC GRANT
OPPORTUNITY
“Community Wellness Grant”
(CWG)

27. FUNDING TO PREVENT OBESITY, DIABETES,
AND HEART DISEASE AND STROKE
 The Minnesota Department of Health (MDH) received new Centers for
Disease Control & Prevention (CDC) funding to support local communities to
improve health.
 PartnerSHIP 4 Health is one of FOUR selected communities to receive funding
targeted for cross-cutting, creative approaches that can positively impact the
health of residents, especially those with the greatest health needs.
 The key components and strategies of this grant enhance communities’
current efforts through the Statewide Health Improvement Program (SHIP),
The Minnesota Accountable Health Model or SIM, and Health Care Homes.
 Four Components - Fifteen Strategies – 11/15 related to healthcare

28. Improve the Quality of Health Systems, Care Systems, and Care
Delivery for People w/Hypertension and Pre-Diabetes Disparities
2.1 Increase electronic health records (EHR) adoption and the use of health information
technology (HIT) to improve performance (e.g., implement advanced Meaningful
Use data strategies to identify patient populations who experience CVD-related
disparities)
2.2 Increase the institutionalization and monitoring of aggregated/standardized quality
measures at the provider level (e.g., use dashboard measures to monitor
healthcare disparities and implement activities to eliminate healthcare disparities)
2.3 Increase engagement of non-physician team members (i.e., nurses, pharmacists,
nutritionists, physical therapists and patient navigators/community health workers)
in hypertension management in community health care systems
2.4 Increase use of self-measured blood pressure monitoring tied with clinical support
2.5 Implement systems to facilitate identification of patients with undiagnosed
hypertension and people with prediabetes

29. Link Clinical and Community Resources to Support
Heart Disease, Stroke and Type 2 Diabetes Prevention
2.6 Increase engagement of CHWs (such as Community Paramedics) to
promote linkages between health systems and community
resources for adults with high blood pressure and adults with
prediabetes or at high risk for type 2 diabetes
2.7 Increase engagement of community pharmacists in the provision of
medication-self management for adults with high blood pressure
2.8 Implement systems to facilitate bi-directional referral between
community resources and health systems, including lifestyle change
programs (e.g., EHRs, 800 numbers, 211 referral systems, etc.)

30. • Washington, D.C., September 21, 2015 – At 27.6 percent, Minnesota now has the
36th highest adult obesity rate in the nation, according to The State of Obesity:
Better Policies for a Healthier America, a report from the Trust for America’s Health
(TFAH) and the Robert Wood Johnson Foundation (RWJF).
• Across the country, rates increased in five states (Kansas, Minnesota, New Mexico,
Ohio and Utah) and remained stable in the rest.
• Minnesota’s increase in 2014 comes despite investments in the very areas advocated
by the Trust organization and the Robert Wood Johnson Foundation, which co-
released Monday’s report.
• Minnesota’s Statewide Health Improvement Program, or SHIP, has spent nearly $100
million since 2009 on projects to get people to eat better, exercise more and smoke
less.
http://healthyamericans.org/reports/stateofobesity2015/release.php?stateid=MN
http://healthyamericans.org/reports/stateofobesity2015/
http://stateofobesity.org/
http://www.startribune.com/minnesota-one-of-five-states-with-more-obese-adults-in-2014/328583361/
Current Outcomes: September 2015 Data
Obesity Rates Remain High

31. Questions?