arizona health improvement plan · arizona health care cost containment system 2020 ongoing 3....

Arizona Health Improvement PlanHealthy People, Healthy Communities

2016-2020

2017/2018 Update

This Page Le Inten onally Blank

The purpose of the Arizona Health Improvement Plan (AzHIP) 2016-2020 is to describe how the Arizona Department of Health Services

and community partners work together to improve the health of the population that we serve.

• Based on the State Health Assessment (SHA)• Community driven with participation of public health

system partners and stakeholders to set priorities.• A pre-requisite for accreditation with the Public Health

Accreditation Board (PHAB).

• Community health priorities, objectives, strategies,measures, and time framed targets

• Policy changes needed to accomplish objectives• Organizations responsible for implementation• Measurable health outcomes or indicators• Alignment with national priorities

Elements of the Arizona Health Improvement Plan (AzHIP) include:

The AzHIP 2017/2018 update has been put together to provide our communities, stakeholders, and partners information on progress made to date in each of the Cross-Cutting and Core Health Priority Issues.

The plan is:

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https://www.azdhs.gov/documents/operations/managing-excellence/azhip.pdf

AzHIP Health Priority Issues

• Cancer

• Chronic Lower Respiratory Disease & Asthma

• Diabetes

• Healthcare-Associated Infec ons

• Heart Disease & Stroke

• Maternal & Child Health

• Obesity

• Oral Health

• Substance Abuse*

• Suicide*

• Tobacco

• Uninten onal Injury

Health Priority Issues were defined in March of 2016, except for those defined in May 2017 denoted by (*).

Cross-cu ng issues iden fied during the development of the AzHIP include:

• Access to Care

• Built Environment

• School Health

• Worksite Wellness

AzHIP Cross-Cutting Issues

Addressing each of these issues in collaboration with community partners

has the ability to signifi cantly impact large numbers of Arizonans. Each

issue identifi ed represents areas that were discussed in multiple

workgroups of the AzHIP, and will have impacts on not just one but many of

the health priorities identifi ed in the plan.

Strategy Performance Indicator Progress

AZHIP 2020 Goal Dashboard

AzHIP Health Priority Success Stories 2

https://azdhs.gov/operations/managing-excellence/azhipsuccessstories

https://azdhs.gov/operations/managing-excellence/azhip2020goaldashboard

https://www.azdhs.gov/operations/managing-excellence/index.php#azhip-success-stories

Thank you to all of our partners, stakeholders, community members, Co-chairs, and Steering

Commitee members who con nue to collaborate to help make the AzHIP a success. Through these

partnerships we con nue to build a healthy future for all Arizonans.

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AZHIP CROSS-CUT TING ISSUES

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ACCESS TO CARE

HIGH-IMPACT EVIDENCE-BASED STRATEGIES

Strategy 1: Target outreach efforts to populations who struggle with access to care.

Strategy 2: Expand payment and delivery models to include additional provider types and preventive

services that improve health outcomes.

Strategy 3: Improve the health literacy of consumers.

Strategy 4: Increase incentives and leverage funding streams to address identified workforce

shortages.

Strategy 5: Support the expansion of patient- and family-centered medical homes for comprehensive,

high quality and accessible community health care.

Strategy 6: Support Arizona’s Medicaid program.

Strategy 7: Ensure adequate networks in rural, underserved areas and tribal populations.

Cross-Cutting Issue: Access to Care

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Health Issue

Lead Organizations Completion Timeframe

AI Complete = Completed

1. Provide outreach materials and educate network of partners, providers, and stakeholders.

CoverAZ 2018 Ongoing

2. Identify and utilize existing programs (e.g., KidsCare) for outreach efforts. CoverAZ 2018 Ongoing

1.Provide trainings on targeted outreach to rural and other underserved populations. CoverAZ 2019

2. Provide trainings to community health workers. CoverAZ 2019 3.

Participate in statewide community health worker conference to promote outreach efforts. CoverAZ 2019

1.Address underinsured populations – look at areas where large #s of uninsured reside. CoverAZ 2019

2.Examine pricing structures to better understand a family’s ability to purchase and afford treatment. CoverAZ 2019

3. Improve Consumer literacy. CoverAZ 2019 1. Review and analyze best practices for reimbursement of new provider types. Arizona Association of Health Plans 2019 Ongoing

2. Inventory value‐based purchasing reforms. Arizona Association of Health Plans 2019 Ongoing

1. Host forum with insurers and payers to discuss best practices to improve preventive care screening rates and address cost barriers.

Arizona Alliance for Community Health Centers 2020 Pending Update

2. Promote coverage of evidence‐based self‐management programs. Arizona Department of Health Services 2020 Ongoing

3. Encourage qualified health plans to provide preventive services. Arizona Alliance for Community Health Centers & CoverAz

2020 Pending Update

1. Restore emergency oral health benefits those Medicaid population. Arizona Health Care Cost Containment System 2017 2. Establish comprehensive dental benefit for pregnant women. Arizona Health Care Cost Containment System 2020 Started, Not

Complete

3. Address workforce needs for provision of dental services. Arizona Health Care Cost Containment System 2020 Ongoing

4. Promote the use of dental sliding fee scales in clinics for low income and underinsured.

Arizona Alliance for Community Health Centers 2020 Ongoing

5. Increase the number of sites with sliding fee scales serving low income and underinsured populations.


Access To Ca

re

2

2a.

2b.

2c.

Expand payment and delivery models to include additional provider types and preventive services that improve health outcomes.

Share innovative, best, and promising practices to include and allow reimbursement of alternative providers.

Support health equity for preventive services.

Improve access to dental coverage for low‐income adults and underserved populations.

Evidence‐BasedHigh‐Impact Strategies

Tactics Action Items (AI)

Cross‐Cutting Health Priority Issues

1

1a.

1b.

1c.

Target outreach efforts to populations who struggle with access to care.

Improve awareness of and connection to the Cover AZ Coalition.

Increase the number of community health workers helping with outreach efforts.

Encourage education on insurance in qualified plans with affordable deductibles and copays.

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Health Issue






1. Collaborate with provider networks to utilize health literacy assessment tools, e.g., AHRQ Tool.

Health Literacy Coalition 2020 Ongoing

2. Promote collaboration between health and financial literacy professionals to include knowledge of health insurance opportunities.

CoverAZ 2019 Ongoing

3. Disseminate health literacy assessment tools (e.g., AHRQ Tool) to community organizations.

Health Literacy Coalition 2019 Pending Update

1.Host session on health insurance literacy targeting organizations (e.g. social workers, tribal partners) that are not traditionally involved in outreach efforts. Cover Az 2019

2. Improve understanding of the relationship between screening and diagnostics. Komen AZ 2019 Pending Update

3. Educate individuals on activating and utilizing insurance benefits. CoverAZ & Health Literacy Coalition 2019 Ongoing

4. Promote follow‐up communications from providers reminding individuals to utilize their benefits.

Pending Update 2019 Ongoing

1. Promote integrated inter‐professional team‐based care. University of Arizona Center for Rural Health 2020 Ongoing2. Continue to fund and expand loan repayment programs for healthcare workers. Arizona Alliance for Community Health Centers 2020 Ongoing

3. Conduct an inventory of health related professions to determine needs. University of Arizona Center for Rural Health and Arizona Nurses Association

2020 Pending Update

1. Inventory health workforce shortages. Arizona Nurses Association and Vitalyst 2019 Ongoing

2. Inventory best practices to achieve the greatest impact for the community and workforce.

Vitalyst 2019 Ongoing

3. Improve the ability to utilize all community members to fill the workforce Arizona Medical Association 2019 Ongoing4. Promote and Support Graduate Medical Education funding opportunities. University of Arizona Center for Rural Health 2019 Ongoing

1. Inventory Patient‐ and Family‐Centered Medical Homes. Arizona Alliance for Community Health Centers 2019 Pending Update

2. Distribute successful fiscal models for Patient‐ and Family‐Centered Medical Homes.

Arizona Alliance for Community Health Centers 2019 Pending Update

3. Distribute data on high performance providers and educate on practices implemented to support population health.


1. Understand provider barriers for becoming a Patient‐Centered Medical Home. Arizona Alliance for Community Health Centers 2018 Pending Update

2. Collect and disseminate successful integrated health care models including team‐based care.


3. Improve care coordination services to support integrated health care. Arizona Alliance for Community Health Centers 2018 Ongoing

1. Offer education to providers regarding CLAS Standards and inclusive care. Pending Update 2019 Pending Update

2. Promote resources for providers regarding CLAS Standards. Arizona Department of Health Services 2019 Pending Update

3. Offer education and training related to language access and the impact on healthoutcomes.

Arizona Department of Health Services 2019 Pending Update

4. Promote best practices for providing inclusive care. Pending Update 2019 Pending Update

5. Gather and share data on racial and ethnic disparities to support provider awareness and education efforts.

Arizona Department of Health Services 2019 Ongoing

Enhance integrated inter‐professional workforce development through strategic initiatives.

Better leverage funds to ensure a well‐trained and distributed workforce.

Support the expansion of Patient‐ and Family‐Centered Medical Homes for comprehensive, high quality and accessible community health care.

Review and disseminate best practices of Patient‐and Family‐Centered Medical Homes.

Examine relationships and opportunities for integrated health care.

Educate providers on their responsibility to offer culturally and linguistically appropriate services (CLAS).

Access To Ca

re

4

4a.

4b.

5

5a.

5b.

5c.

Increase incentives and leverage funding streams to address identified workforce shortages.

3

3a.

3b.

Improve the health literacy of consumers.

Improve Provider and Patient Communication.

Educate individuals on understanding their health benefits and participating in preventive health screenings.

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Health Issue






1. Review best practices from other states. Arizona Alliance for Community Health Centers 2020 Ongoing

2. Support data needs to identify and assist in making recommendations for areas ofinnovation.

Arizona Health Care Cost Containment System 2020 Ongoing

3.Convene stakeholders to review best, promising and innovative practices to improve health outcomes. Vitalyst & Arizona Association of Health Plans 2020 Ongoing

1. Include essential community providers as a part of the local network. Arizona Alliance for Community Health Centers 2020 Ongoing

2.Measure and report on metrics for network adequacy, to include: National Health Services Corp, Health Professional Shortage Area Scoring, and State program funding.

Arizona Department of Health Services 2020 3. Improve workforce diversity. Nurses Assocaiation, Vitalyst, & Arizona

Association of Health Plans2020 Ongoing

4. Leverage technology to expand provider networks to rural, underserved, and tribal areas.


1. Improve understanding about network adequacy issues. Vitalyst 2020 2. Review best practices to address surprise billing. AARP 2020 Ongoing

3. Convene insurers, community organizations, and state insurance regulators to discuss community needs.

Vitalyst 2020 Ongoing

Support AHCCCS reforms that continue to improve access to care.

Ensure adequate networks in rural, underserved areas and tribal populations.

Assure provider network adequacy.

Assure insurance network adequacy.

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7a.

7b.

Access To Ca

re

6 Support Arizona’s MedicaidProgram.

6a.

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BUILT ENVIRONMENT

OVERARCHING STRATEGY: ENHANCE THE PHYSICAL AND BUILT ENVIRONMENT OF COMMUNITIES TO IMPROVE OVERALL HEALTH.

HIGH-IMPACT EVIDENCE-BASED TACTICS

TACTIC 1: PROMOTE “HEALTH IN ALL POLICIES” TO INTEGRATE HEALTH CONSIDERATIONS THROUGHOUT PUBLIC POLICY MAKING PROCESSES.

TACTIC 2: SUPPORT AND PROMOTE AFFORDABLE HOUSING DEVELOPMENT AND REHABILITATION OF EXISTING HOUSING TO PROMOTE HEALTHY CHOICES AND LIFESTYLES.

TACTIC 3: ENSURE IMPACTS ON COMMUNITY HEALTH ARE CONSIDERED DURING LAND USE AND TRANSPORTATION PLANNING.

TACTIC 4: PROMOTE, EXPAND, AND CONNECT OPEN SPACE AND RECREATIONAL FACILITIES TO CREATE OPPORTUNITIES TO BE PHYSICALLY ACTIVE.

Cross-Cutting Issue: Built Environment

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Health Issue

Evidence‐BasedHigh‐Impact Strategies Lead Organizations Completion

TimeframeAI Complete = Completed

Cross‐Cutting Health Priority IssuesTactics Action Items (AI)

1. Educate policy makers on Health in All Policies and the merits of using this approach in decision making.

Arizona Alliance for Livable Communities & Arizona Department of Health Services 2018‐2020 Ongoing

2. Monitor and support the integration of HIAP (e.g., Health Impact Assessments) into proposed policies, plans, projects, and programs.

Arizona Alliance for Livable Communities & Arizona Department of Health Services 2017‐2020 Ongoing

3. Launch 2017 as the “Year of Healthy Communities” in partnership with cross sector and local initiatives.

Vitalyst & Arizona Partnership for Healthy Communities 2017

4. Educate partners and the public on opportunities to influence city and county planning processes. Aizona Alliance for Livable Communities 2020 Ongoing

5. Develop briefs highlighting how health intersects with transportation, and housing, and land use; co‐brand with ADOT and Dept. of Housing. Arizona Department of Health Services 2018 Ongoing

1. Encourage more resources for affordable housing development. Arizona Housing Coalition 2020 Ongoing

2.Encourage mixed‐use housing development with easy access to employment, education, recreation, transportation options, shopping, healthy food, and health care.

Arizona Housing Coalition 2020 Ongoing

3. Support design, construction, and rehabilitation of healthy homes that are safe, conserve energy, universally designed, and support active living. Arizona Housing Coalition 2020 Ongoing

4. Promote equal access to housing (e.g. Education and outreach for property owners regarding rental vouchers and fair housing). Arizona Housing Coalition 2020 Ongoing

5. Provide services and permanent housing solutions for homeless individuals and families. Arizona Housing Coalition 2020 Ongoing

1. Promote adoption and implementation of complete transportation policies (e.g., complete streets). Living Streets Alliance & Vitalyst 2017

2.Improve and promote pedestrian and bicycle infrastructure and policies to provide connectivity between neighborhoods (i.e., parks, schools, shopping and employment).

Living Streets Alliance & Southwest Bike Initiative 2020 Ongoing

3. Promote pedestrian and bicycle infrastructure as equals to other modes of transportation. Living Streets Alliance 2020 Ongoing

4. Promote high capacity transit options to reduce reliance on automobiles and improve air quality. Maricopa Association of Governments 2020 Ongoing

5. Incorporate land use and transportation planning that considers the modal choices of the future. Maricopa Association of Governments 2020 Ongoing

1. Promote physical activities by providing wayfinding (e.g., nearby walking trail maps, access to nearby facilities, point of decision prompts, stair challenges,

Local Communities & County Health Departments 2019 Ongoing

2. Promote public and private partnerships that open recreation facilities for public use.


3. Improve access to and condition of parks, trails, and community centers for people of all abilities.


4. Support the creation of safe, accessible parks, open spaces, and community centers in all neighborhoods.


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Promote “Health in All Policies (HIAP)” to integrate health considerations throughout public policy making processes.

Support and promote affordable housing development and rehabilitation of existing housing to promote healthy choices and lifestyles

Ensure impacts on community health are considered during land use and transportation planning.

Promote, expand, and connect open space and recreational facilities to create opportunities to be physically active.

Enhance the physical and built environment of communities to

improve overall health

Built Env

ironm

ent

1

2

3

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ARIZONA HEALTH IMPROVEMENT PLAN

HEALTH ISSUE NAME

SCHOOL HEALTH

OVERARCHING STRATEGY: SUPPORT SCHOOLS IN PROMOTING THE HEALTH AND SAFETY OF STUDENTS.


TACTIC 1: PROMOTE IMPLEMENTATION OF LOCAL WELLNESS POLICIES AT THE SCHOOL SITE LEVEL.

TACTIC 2: SUPPORT THE EXPANSION OF PHYSICAL ACTIVITY AND PHYSICAL EDUCATION AT SCHOOL.

TACTIC 3: ENCOURAGE AND PROMOTE RESOURCES AND CURRICULA TO SUPPORT A SUN SAFE ENVIRONMENT.

TACTIC 4: INCREASE PARTICIPATION IN CHILD NUTRITION PROGRAMS THROUGH COLLABORATION OF SCHOOL/COMMUNITY IMPROVEMENT

DESIGN.

TACTIC 5: PROVIDE INFORMATION AND EDUCATION ABOUT THE PREVENTION OF AND RESPONSE TO BULLYING.

TACTIC 6: ENCOURAGE AND PROMOTE RESOURCES AND CURRICULA THAT WILL SUPPORT SUBSTANCE ABUSE PREVENTION.

Cross-Cutting Issue: School Health

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Health Issue






1. Identify and disseminate local wellness policy implementation resources. Action for Healthy Kids & Alliance for Healthy Generations

2018 Ongoing

2. Convene local partners (e.g., Districts, School Nutrition Association of AZ) to unify messaging, maximize resources, and coordinate efforts.

Arizona Department of Health Services & Arizona Department of Education

Pending Update

Planning Phase

3. Assist schools with updating, implementing and evaluating local wellness policies to make them actionable.

Arizona Department of Education & Arizona Department of Health Services

2018 Ongoing

4. Provide technical assistance to school districts and other partners on how to incorporate wellness policies in annual district improvement plans.

Action for Healthy Kids 2018 Ongoing

5. Provide professional development opportunities to districts and partners on policy implementation and USDA regulations.

Arizona Department of Education & Arizona Department of Health Services

2017 1. Convene community, local and state stakeholders to establish a statewide

collaborative.Action for Healthy Kids & Healthy Future AZ 2017 Planning

Phase

2. Document innovative and best practices and benefits of increased Physical Activity. Arizona Department of Education & Healthy Future AZ

2018 Ongoing

3.Provide technical assistance and professional development to Physical Education teachers to increase moderate to vigorous Physical Activity and Physical Education in schools.

Arizona Department of Education & Healthy Future AZ

2018 Ongoing

1. Identify and disseminate Sun Safety resources. Arizona Department of Health Services 2018 2. Encourage the integration of sun protection in school facilities, curricula and

policies.Arizona Department of Health Services 2018 Planning

Phase

3. Promote sun safe physical activity on high UV Index days. Arizona Department of Health Services 2018 Ongoing

1. Encourage District participation in the Child Nutrition Programs . Arizona Department of Education 2018 Ongoing

2.Work with partners to support and encourage participation in school breakfast, summer meal, Child and Adult Care Food Program, and fresh fruits and vegetable programs.

Arizona Department of Education & Arizona Dairy Council 2018

3. Support Arizona Department of Education Health and Nutrition Services efforts to increase participation in child nutrition programs.

Arizona Department of Health Services 2018 PlanningPhase

1. Assess interventions used in response to bullying. Arizona Department of Health Services 2018 2. Leverage current infrastructure for school health advisory councils on social

emotional wellness to include bullying and school safety.Arizona Department of Health Services 2018 Ongoing

3. Provide technical assistance to Districts on examples of policies and procedures to prevent and report bullying for inclusion in local wellness policies.


4. Provide tools, resources, and training to educate staff, students and parents on bullying.


1. Promote the expansion of substance abuse prevention program, e.g., peer‐to‐peer. Governor's Office of Youth, Faith, and Family 2018 Ongoing

2. Provide technical assistance to Districts on examples of policies and procedures to prevent substance abuse in local wellness policies.

Governor's Office of Youth, Faith, and Family & Arizona Department of Health Services

2019 PlanningPhase

3. Provide tools, resources, and training to educate staff, students, and parents on substance abuse.

Arizona Department of Health Services 2018

5 Provide information and education about the prevention of and response to bullying.

6 Encourage and promote resources and curricula that will support substance abuse prevention.

Scho

ol Hea

lth

Support schools in promoting the health and safety of students.

3 Encourage and promote resources and curricula to support a Sun Safety environment.

4Increase participation in Child Nutrition programs

through collaboration of school/community improvement design.

1 Promote implementation of local wellness policies at the school site level.

2 Support the expansion of Physical Activity and Physical Education at school.

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WORKSITE WELLNESSOVERARCHING STRATEGY: ENCOURAGE ALL EMPLOYERS TO PROVIDE EFFECTIVE WORKPLACE WELLNESS

PROGRAMS.


TACTIC 1: INCREASE AWARENESS AND PROMOTION ABOUT THE HEALTH COST BENEFITS AND KEY COMPONENTS OF WORKSITE WELLNESS PROGRAMS AMONG ARIZONA EMPLOYERS.

TACTIC 2: INCREASE USE OF THE CDC WORKSITE SCORECARD AMONG EMPLOYERS WITH A WORKSITE WELLNESS PROGRAM.

TACTIC 3: INCREASE AVAILABILITY OF INFLUENZA VACCINATIONS OFFERED AT ARIZONA WORKSITES.

TACTIC 4: INCREASE USE OF ENVIRONMENTAL AND POLICY APPROACHES AT THE WORKSITE TO PROMOTE OR INCREASE PHYSICAL ACTIVITY, SMOKE FREE WORKSITES, COMPREHENSIVE TOBACCO CESSATION PROGRAMS, REDUCE ENVIRONMENTAL RISK AND ADDRESS WORKSITE STRESSORS.

TACTIC 5: INCREASE AWARENESS AND EDUCATION AMONG EMPLOYERS ABOUT MAKING IT WORK ARIZONA – BREASTFEEDING FRIENDLY WORKSITE TOOLKIT.

TACTIC 6: INCREASE AWARENESS AND PROMOTION OF EARLY HEALTH SCREENING AND DETECTION AT ARIZONA WORKSITES.

Cross-Cutting Issue: Worksite Wellness

13

Health Issue

Evidence‐BasedHigh‐Impact Strategies Lead Organizations Completion


1. Coordinate promotion of Worksite Wellness Programs among Arizona Employers.

Maricopa County Department of Public Health 2017 2.

Provide training and technical assistance (e.g., models, tools, risk assessment) to Arizona employers on how to develop or enhance healthy worksites and understand the benefits for their organization.

Maricopa County Department of Public Health 2017 3. Provide technical assistance on becoming a recognized Healthy Arizona Worksite

Program. Maricopa County Department of Public Health 2017 1. Provide trainings to employers on the CDC Scorecard purpose Maricopa County Department of Public Health 2017 2. Provide technical assistance to employers on completing CDC Scorecard. Maricopa County Department of Public Health 2017

3Increase availability of influenza vaccinations offered at Arizona Worksites.

1. Provide technical assistance, education, and resources to increase influenza vaccination coverage in the Arizona workforce.

Maricopa County Department of Public Health & The Arizona Partnership for Immunization 2018 Ongoing

1. Provide indoor or outdoor walking trail maps, access to facilities, healthy choices prompts, stair challenges, etc.

American Heart Association & Maricopa County Department of Public Health 2020 Ongoing

2. Coordinate and provide onsite employee referral to tobacco cessation programs (e.g., ASHLine).

American Heart Association & Maricopa County Department of Public Health 2020 Ongoing

3.Provide technical assistance to implement and promote compliance with mandatory seatbelt use for drivers and passengers when using or riding in worksite or private vehicles.

Maricopa County Department of Public Health & Arizona Smokers Help Line (ASHLine) 2020 Ongoing

4.

Coordinate and provide technical assistance and resources on how to implement comprehensive tobacco cessation programs that include FDA approved medications, therapies, and counseling, and referral (e.g., ASHLine) and smoke free environments.

Maricopa County Department of Public Health & Arizona Smokers Help Line (ASHLine) 2018 Ongoing

5. Educate employers and employees on applicable safety and health standards for hazards in the work environment. Maricopa County Department of Public Health 2020 Ongoing

1. Promote the ease of implementing the Lactation Accommodation Program in the workplace.

Maricopa County Department of Public Health & Arizona Department of Health Services 2018 Ongoing

2. Provide technical assistance and training on the Lactation Accommodation Program.

Maricopa County Department of Public Health & Arizona Department of Health Services 2018 Ongoing

1. Coordinate and provide resources for employee education on skin cancer risks. American Heart Association & Arizona Department of Health Services 2018 Ongoing

2. Encourage employers to provide access to umbrellas, sun shades, and sun screen at the worksite.

American Heart Association & Arizona Department of Health Services 2019 Ongoing

3. Promote the use of self‐health checks to include weight and blood pressure. Arizona Cancer Coalition & Arizona Department of Health Services 2018 Ongoing

4. Promote the use of on‐site self‐health checks to include mobile mammography, mobile prostate screening and biometric screenings.

Arizona Cancer Coalition Arizona Department of Health Services 2018 Ongoing

5. Provide trainings to employers on how to educate employees on their screening and prevention benefits (e.g., cancer, hypertension, diabetes, vaccines, etc.).

Arizona Cancer Coalition & Arizona Department of Health Services 2020 Ongoing

6Increase awareness and promotion of early health screening and detection at Arizona Worksites.

5Increase awareness and education among employers about Making It Work Arizona – Breastfeeding Friendly Worksite Toolkit.

4

Increase use of environmental and policy approaches at the worksite to promote or increase physical activity, smoke free worksites, comprehensive tobacco cessation programs, reduce environmental risk and address worksite stressors.

Cross‐Cutting Health Priority IssuesTactics Action Items (AI)

Worksite

Wellness

Encourage all employers to provide effective workplace

wellness programs.

1

Increase awareness and promotion about the health cost benefits and key components of Worksite Wellness Programs among Arizona employers.

2Increase use of the CDC Worksite Scorecard among employers with a Worksite Wellness Program.

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AZHIP HEALTH PRIORITY ISSUES

15

CANCER

AzHIP: Cancer

2020 GOAL: REDUCE THE RATE OF CANCER DEATHS BY 5%.

16


STRATEGY 1 : SUSTAIN SUPPORT FOR EXISTING CANCER SCREENING AND TREATMENT PROGRAMS.

Arizona currently receives federal and state funds to provide a free breast and cervical cancer screening, diagnos c, quality improvement and patient navigation program for low-income uninsured, under-insured, and insured women in Arizona. The federal funds require a state 3:1 match. For every $3 provided by the CDC, the state must have $1 in matching funds. The state funds dedicated to the Well Woman HealthCheck Program serve as the required match for this important program. Statewide partners focused on policy help sustain this state funding.

STRATEGY 2: ICREASE ACCESS TO COLORECTAL CANCER SCREENING AND TREATMENT.

Colorectal cancer is the second leading cause of cancer related death in Arizona. Colorectal cancer is preventable and treatable when diagnosed in early stages. Unfortunately, 51% of Arizonans with colorectal cancer are diagnosed at late stage. Screening rates for Arizonans 50 and older are far lower than they should be; it is not unusual for a clinic to have a 30% screening rate.

Most people diagnosed with colorectal cancer who are younger than 50 are diagnosed at late stage. The incidence of young onset colorectal cancer is increasing. In addi on, those under 50 who are symptomatic encounter barriers when requesting diagnostic colonoscopies.

STRATEGY 3: REDUCE EXPOSURE TO RISK FACTORS FOR SKIN CANCER.

Skin cancer risk factors include excessive exposure to sunlight or tanning booths, family history of skin cancer, pale complexion or occupa onal exposures. In Arizona, the focus will be on protecting our skin from the sun. Reducing direct sun exposure or use of tanning beds will help decrease skin cancer incidence. This can be addressed by individuals, schools and businesses. The use of sunscreen and hats during outdoor activities will protect children, adults, and employees.

The Arizona Cancer Registry and Melanoma Task Force has made terrific improvements in the reporting of melanoma cases to the registry. This work has resulted in a much clearer picture of melanoma rates within our state. The Arizona invasive melanoma incidence rate is projected to be higher than the U.S. rate by 2016.

STRATEGY 4: INCREASE THE HPV IMMUNIZATION RATE.

Vaccina on is a public health interven on for reducing the risk of developing HPV-associated cancers. Best prac ce includes the provider making a strong recommenda on for immuniza on and focusing the conversa on on cancer preven on. The HPV immuniza on rate for Arizona is slowly increasing for both adolescent males and females, but there is room for improvement.

STRATEGY 5: INCREASE THE NUMBER OF ARIZONANS RECEIVING BREAST, CERVICAL, LUNG AND COLORECTAL CANCER SCREENING AND

ASSOCIATED DIAGNOSTICS.

The ra onale for screening is simple: if cancer is found before it spreads beyond its original site, survival rates are much higher, and it costs far less to treat. Early detec on is essen al to enhancing quality of life and survival rates. Most health plans cover preven ve screening tests at no cost to the pa ent. However, if the screening test is posi ve and further diagnos c tests are needed, diagnos c tes ng may not be covered and affordable for everyone.

STRATEGY 6: INCREASE THE PROPORTION OF PEOPLE WITH A FAMILY HISTORY OF BREAST, COLORECTAL, AND/OR OVARIAN CANCER WHO RECEIVE GENETIC COUNSELING AND TESTING, WHEN APPROPRIATE.

Understanding one’s family history and ac vely pursuing gene c tes ng are ways to understand inherited health risk factors and poten ally take ac ons to alter them. Addi onally, gene c tes ng is rapidly changing, falling in price and being purchased directly by pa ents. Some providers are being asked to review and decide next steps for gene c test results that they don’t understand. The Arizona Cancer Coalition will con nue to move this work forward.

HEALTH IMPACTIn 2016, Arizona’s cancer mortality rate was 140.7 deaths per 100,000 Arizonans and is the second leading cause of death in Arizona. In 2016, 11,801 Arizonans lost their lives to cancer. We lose 227 Arizonans to cancer each week. In the U.S., men and women each have a 1 in 3 life me risk of developing invasive cancer. In 2016, the American Cancer Society es mates that Arizona will have 354,530 cancer survivors (5.1% of state residents) while the U.S. will have 15.5 million cancer survivors (4.8% of the U.S. popula on).

AzHIP: Cancer

17

Health Issue



Evidence‐Base, Promising, or Best‐Practice

a. Achieve or surpass performance on Core Quality Indicators.

1. Educate Federally Qualified Health Centers and other community clinics on the importance and impact of core quality indicators. Arizona Alliance of Community Health Centers 2018 Ongoing

b.Increase awareness and education on importance of and need for screening and treatment programs.

1. Coordinate advocacy of partner organizations. American Cancer Society & Komen Foundation 2020 Ongoing

1. Seek competitive grant opportunities for colorectal cancer. Arizona Department of Health Services 2020 Ongoing

2. Mobilize stakeholders to advocate for enhanced, sustainable funding for screening and treatment of colorectal cancer.

American Cancer Society Cancer Action Network 2020 Not Started

1. Educate and inform the public on dangers of overexposure to UV. Arizona Department of Health Services 2020 2. Reduce harms from indoor training. American Cancer Society Cancer Action

Network 2020 1. Encourage the integration of sun protection in school facilities, curricula, and policies. Arizona Department of Health Services &

Local Health Departments 2019 Ongoing

2. Encourage the integration of sun safety into workplace policies and safety trainings. Arizona Department of Health Services & Maricopa County Department of Public Health 2017

1. Encourage adoption of the Advisory Committee on Immunization Practices recommended adolescent vaccines as a standard of care in all clinical practice. The Arizona Partnership for Immunization 2018 Ongoing

2. Support the 2014 Vaccine Study Committee Recommendations. The Arizona Partnership for Immunization 2020 Ongoing

3. Expand outreach to commuity groups to increase knowledge of the recommendations from the Advisory Committee on Immunization Practices. The Arizona Partnership for Immunization 2018 Ongoing

4. Expand outreach to Area Health Education Centers and higher education institutions. Greater Valley Area Health Education Center 2020 Ongoing

1. Analyze Arizona State Immunization Information System data to determine target populations. Arizona Department of Health Services 2016 2. Develop and implement intervention plan for target populations to increase HPV vaccination

rates. Arizona Department of Health Services 2020 Not Started

a. Increase access to diagnostic testing. 1. Address financial barriers to diagnostic testing. Arizona Cancer Society Cancer Action Network 2020 Ongoing

1. Inform and educate Federally Qualified Health Centers on the importance of screening and best practices to increase screening rates. Arizona Alliance of Community Health Centers 2018

2. Inform and educate health plans on the importance of and best practices for increasing screening rates Arizona Department of Health Services 2018 Ongoing

a.Educate providers on appropriate referral guidelines.

1. Utilize risk assessment tools recommended by United States Preventive Services Task Force to aid in identifying and referring patients. Arizona Department of Health Services 2020 Not Started

b. Identify and develop network of genetic counselingresources.

1. Assess existing resource availability to ensure adequate coverage. Arizona Cancer Coalition 2017 Ongoing

Cancer

2020 Goal: Reduce the rate of Cancer deaths by 5%.

3Reduce exposure to risk factors for skin cancer.

The Guide to Community Preventive Services: Increasing Appropriate

Vaccination.

The Guide to Community Preventive Services; Healthy People 2020 Goal:

Cancer.

Healthy People 2020 Goal: Genomics.

The Guide to Community Preventive Services: Cancer Prevention and Control;

Surgeon General’s Call to Action to Prevent Skin Cancer (2014)

American Cancer Society recommendations for colorectal cancer

early detection (2014); National Colorectal Cancer Roundtable (2013).

Arizona Hospital and Healthcare Association: “Economic and Employment Effects of Expanding Medicaid in Arizona”

(2012).

b.

6

Increase the proportion of people with a family history of breast, colorectal, and/or ovarian cancer who receive genetic counseling and testing, when appropriate.

Increase the use of sun protection.b.

a.Support adoption of the Advisory Committee on Immunization Practices recommendations for adolescent vaccines.

Action Items (AI)

Increase access to colorectal cancer screening and treatment.

a.Identify additional funding opportunities and sources for screening and treatment of colorectal cancer.

Evidence‐BasedHigh‐Impact Strategies Tactics

1Sustain support for existing cancer screening and treatment programs.

2

a. Reduce overexposure to UV.

Identify and target populations with lower than average HPV vaccination rates.

Increase the HPV immunization rate.

4

b.

Increase the number of Arizonans receiving breast, cervical, lung and colorectal cancer screening and associated diagnostics.

5Increase screening rates of Federally Qualified Health Centers and health plans.

18

CHRONIC LOWER RESPIRATORY DISEASE & ASTHMA

AzHIP: CLRD & Asthma

2020 GOAL: REDUCE THE CHRONIC LOWER RESPIRATORY DISEASE MORTALITY RATE BY 10%.

19


STRATEGY 1: DEVELOP AND DISSEMINATE A COMPREHENSIVE STATEWIDE INITIATIVE TO ENCOURAGE A VOLUNTARY ADOPTION OF CLEAN AIR POLICIES.

Outdoor air pollu on can trigger an asthma a ack, and the CDC advises individuals with asthma to pay a en on to air quality forecasts and plan outdoor ac vi es when air pollu on levels are low.

STRATEGY 3: INCREASE EARLY INTERVENTION AND PARTICIPATION IN DISEASE MANAGE- MENT PROGRAMS.

There is accumula ng documenta on about the success of evidence-based self-management programs in helping people with the medical and emo onal management demands associated with chronic diseases.

STRATEGY 2: INCREASE THE USE OF HOME- BASED, COMPREHENSIVE INTERVENTIONS WITH AN ENVIRONMENTAL FOCUS FOR INDIVIDU- ALS WITH CHRONIC LOWER RESPIRATORY DISEASE.

Providing educa on on the health and financial benefits of home-based, comprehensive interventions for individuals living with asthma and COPD will significantly impact outcomes.

HEALTH IMPACTChronic Lower Respiratory Disease (CLRD) is an umbrella term used to describe a group of diseases affecting the lungs including chronic bronchitis, emphysema, Chronic Obstructive Pulmonary Disease (COPD), and asthma. It is estimated that 50% of lung disorders go undiagnosed and untreated. CLRD is the 3rd leading cause of death in Arizona, behind cancer and heart disease (2016). In 2016, the age-adjusted mortality rate for CLRD was 45.0 per 100,000 individuals. This translates to 3,788 deaths in 2016 due to CLRD. A 10% reduction in CLRD mortality would result in saving 307 Arizona lives in 2019.

In 2016, 14.6% of Arizona adults were diagnosed with asthma, and 6.8% of Arizona adults were diagnosed with COPD. Data regarding asthma prevalence among children is gathered in multiple ways and is often self-reported by parents. In 2016, 12.4% of parents reported that their child(ren) were diagnosed with asthma by a health care provider.

Factors that contribute to effective management of CLRD include proper diagnosis and access to healthcare. On a local, state, and national level, the impact of CLRD can be lessened through the implementation of clean air policies, increasing resources and support for home-based interventions and disease management programs, and additional education of healthcare professionals.

AzHIP: CLRD & Asthma

20

Health Issue




Action Items (AI)Evidence‐Based

High‐Impact Strategies Tactics

1. Develop campaign for top ten ways for individuals to impact better air quality. American Lung Association 2017 Not Completed

2. Promote the Americal Lung Association State of the Air Report to support better air quality. American Lung Association 2020 Ongoing

1. Review current clean air policies and create recommendations for decision makers. American Lung Association 2017 Not Completed

2.Provide technical assistance and education to property managers, developers, property owners, tenants, and public health advocates to implement clean air policies in multi‐unit housing facilities, educational institutions, and public spaces.

Arizona Smoke Free Living Coalition & Arizona Multi‐Housing Association 2020 Ongoing

1. Identify vulnerable populations for asthma and Chronic Obstructive Pulmonary Disease (COPD).

American Lung Association & Arizona Department of Health Services 2017

2. Review and identify best practices of home‐based interventions for individuals with asthma and Chronic Obstructive Pulmonary Disease (COPD) with an environmental focus. Asthma Coalition & American Lung Association 2017 Not Completed

1. Identify and assess gaps or limited resources for home‐based, comprehensive interventions. American Lung Association & Arizona Department of Health Services 2016

2. Establish return on investment for each identified home‐based comprehensive intervention. American Lung Association & Arizona Department of Health Services 2017 Not Completed

1. Provide localized diagnosis, health status, and air quality information to providers (i.e., scorecard or infographic). Arizona Department of Health Services 2020 Ongoing

2. Prepare Health Brief on Health Disparities among Chronic Lower Respiratory Diseasespopulation. Arizona Department of Health Services 2017

3. Promote training and education opportunities for providers on clinical guidelines for diagnosing Chronic Obstructive Pulmonary Disease (COPD). Arizona Department of Health Services 2017 Ongoing

4. Educate partners on risk factors for developing Chronic Obstructive Pulmonary Disease (COPD). Arizona Department of Health Services 2017 Ongoing

1. Promote the Breathe Easy Arizona Collaborative, “Healthy Living for Healthy Lungs” Campaign. American Lung Association 2016

2. Promote referral and access to self‐management programs or curriculums, e.g., Chronic Disease Self‐Management Program. Arizona Department of Health Services 2016 Ongoing

Chronic L

ower Respiratory Dise

ases

1

2

3Increase early intervention and participation in disease management programs.

The Guide to Community Preventive Services, Asthma Control: home‐based

multi‐trigger, multicomponent interventions.

The Guide to Community Preventive Services, Asthma Control: home‐based

multi‐trigger, multicomponent interventions.

Healthy People 2020: Respiratory Diseases; National Asthma Education and Prevention Program Guidelines (2008); The Impact of Disease Management on Outcomes and Cost of Care (2000); Preventing Chronic

Disease Medscape.

2020 Goal: Reduce the Chronic Lower Respiratory Disease mortality rate by 10%.

b.Improve effective self‐management of Chronic Lower Respiratory Disease for people living with more than one illness.

a.Increase public and health care awareness of risk factors and detection of pulmonary disease.

b.

Develop and disseminate a comprehensive statewide initiative to encourage a voluntary adoption of clean air policies. Educate key stakeholders and decision‐makers on

benefits of adopting clean air policies.

a.Increase public awareness of clean air behaviors inplaces where people live, work, learn, and play.

Increase the use of home‐based, comprehensive interventions with an environmental focus for individuals with Chronic Lower Respiratory Diseases.

a.Promote and develop focused interventions forvulnerable populations.

b.

Provide education about the health and financial benefits of home‐based, comprehensive interventions for individuals with asthma and COPD.

21

DIABETES

AzHIP: Diabetes

2020 GOAL: REDUCE DEATHS ATTRIBUTABLE TO DIABETES BY 10%.

22


STRATEGY 1: INCREASE THE UTILIZATION OF AN INTEGRATED, TEAM-BASED APPROACH TO THE CARE AND TREATMENT OF DIABETES.

Using an integrated care model comprised of a multi-disciplinary team of professionals (physicians, nurses, dietitians, community health workers, pharmacists, behavioral health) working collectively will improve health outcomes for people with diabetes.

STRATEGY 2: PROMOTE THE USE OF ESTABLISHED DIABETES CLINICAL GUIDELINES AND INCREASE PARTICIPATION IN DIABETES

SELF-MANAGEMENT EDUCATION.

To increase awareness of diabetes risk and protective factors amongst the general population, with an emphasis on the at-risk or vulnerable populations disproportionately impacted by diabetes.

STRATEGY 3: INCREASE AWARENESS OF PREVENTION AND THE MANAGEMENT PRACTICES FOR DIABETES AND PREDIABETES.

Approximately 90% of patients with prediabetes are undiagnosed. Prediabetes is a stage in which patients have elevated blood sugar and exhibit risk factors for diabetes, but the blood sugar levels are not high enough to be diagnosed with diabetes. If undiagnosed or not managed correctly, prediabetes may become diabetes, which can lead to secondary complications (i.e., heart disease, blindness, kidney and nerve damage, etc.). Enhancing linkages between clinical- and community-based prevention eff orts increases the availability and use of evidence based and promising practices.

HEALTH IMPACTDiabetes is a metabolic disease diagnosed when a single random plasma glucose measurement is greater than or equal to 200 mg/dl. or an A1C level of 6.5% or greater. One out of three Arizona adults has higher than normal blood sugar levels that are not yet high enough to be diagnosed as diabetes. Complications of diabetes include heart attack, stroke, kidney disease, amputation, and blindness.

In 2016, 2,013 deaths in Arizona were attributable to diabetes, making diabetes the 7th leading cause of disease-related death. Approximately 600,000 Arizonans or 10.8% of the popula on has diabetes. From 2011-2016, diabetes rates increased by 10%. Diabetes was responsible for more than $8.6 billion dollars in healthcare expenses in 2014.

AzHIP: Diabetes

23

Health Issue






1. Increase participation in state‐wide Diabetes Coalition. Arizona Diabetes Coalition 2017 Ongoing

2. Provide education and resources to non‐physician team members through engaging and innovative approaches. Arizona Department of Health Services 2017 Ongoing

1. Create an online repository for established clinical guidelines for different provider types. Arizona Diabetes Coalition 2017 Not Startedd

2. Identify and promote provider educational resources for diabetes self‐management. Arizona Diabetes Coalition 2017 Ongoing

3. Increase awareness of resources related to the American Association of Diabetes Educators 7 Self‐Care Behaviors. Arizona Diabetes Coalition 2017 Ongoing

1. Promote the Community‐Based Referral Network for self‐management programs. Arizona Living Well Institute 2017 Ongoing

2. Increase awareness of reimbursement mechanisms for diabetes self‐management education programs. Arizona Diabetes Coalition 2017 Ongoing

1. Identify innovative partners, strategies, and approaches to reach target audiences. Arizona Department of Health Services 2016 2. Assess and compile resources to align and coordinate efforts. Arizona Department of Health Services 2017 Ongoing

3. Prepare a health brief to address health disparities and to identify the leading secondarycomplications for diabetes in Arizona. Arizona Department of Health Services 2017

4. Collaborate and coordinate with organizations who are implementing awareness campaignsfor consistent messaging. Arizona Department of Health Services 2018 Ongoing

5. Engage stakeholders to promote campaign through organization and member communications. Arizona Department of Health Services 2018 Ongoing

b.Educate community and faith‐based organizations on available resources related to diabetes and prediabetes.

1. Provide technical assistance to community and faith‐based organizations to increase awareness of prediabetes. Arizona Department of Health Services 2017 Ongoing

c. Educate providers and health care workers on prediabetes.

1. Integrate, distribute, and provide technical assistance for the Agents of Change (Chronic Disease Provider) Toolkit . Arizona Department of Health Services 2017

Diab

etes

Project Impact: Diabetes (First national self‐management program conducted by the APhA Foundation in pertnership with the

Bristol‐Myers Squibb Foundation's Together on Diabetes.

3Increase awareness of prevention and management practices for diabetes and prediabetes.

a. Develop an integrated and comprehensive communications plan.

1

Increase the utilization of an integrated, team‐based approach to the care and treatment of diabetes.

a.Increase engagement of non‐physician team members in diabetes self‐management healthcare communities.

2

Promote the use of established diabetes clinical guidelines and increase participation in diabetes self‐management education.

a. Educate providers on established clinical guidelines.

b. Educate on the health and cost benefits of utilizingdiabetes self‐management education programs.

The Guide to Community Preventive Services, Diabetes Prevention and Control:

Self‐Management Education (2014); American Association of Diabetes

Educators.

American Assocaiation of Diabetes EducatorsNational Institute of Diabetes and Digestive and Kidney Diseases, GAME

PLAN for Preventing Type 2 Diabetes (2014); The Guide to Community

Preventive Services ‐ Diabetes Prevention and Contorol: Self‐Management Education.

2020 Goal: Reduce deaths attributable to diabetes by 10%.

24

AzHIP: HAIs

2020 GOAL: REDUCE THE NUMBER OF HEALTHCARE ASSOCIATED INFECTIONS BY 10%.

HEALTHCARE-ASSOCIATED INFECTIONS

25

HEALTH IMPACT

Healthcare-Associated Infec ons (HAIs) are infec ons that occur as a result of microorganisms—such as bacteria and viruses-following a healthcare interven on. As is the case for many other pa ent safety issues, HAIs create addi onal suff ering and come at a high cost for pa ents and their families. Infec ons prolong hospital stays, represent a massive addi onal fi nancial burden for health systems, generate high costs for pa ents and their families, and cause unnecessary deaths. The implementa on of best-prac ces for the reduc on of HAIs will have a signifi cant impact to reduce HAIs in Arizona.


STRATEGY 1: IMPROVE KNOWLEDGE AND IMPLEMENTATION OF INFECTION PREVENTION AND CONTROL.

Implementation of evidence-based infection and prevention control strategies, including infection prevention bundles, has resulted in reductions in HAIs across multiple healthcare facility types.

STRATEGY 2: IMPROVE KNOWLEDGE AND IMPLEMENTATION OF SAFE INJECTION PRACTICES.

Lapses in safe injection practices continue to be reported across all healthcare settings and lead to unnecessary transmission of bacterial, viral and fungal pathogens.

STRATEGY 3: IMPROVE KNOWLEDGE AND IMPLEMENTATION OF APPROPRIATE ANTIMICROBIAL USE AND STEWARDSHIP.

Implementation of antimicrobial stewardship programs – interventions to ensure that every patient getsthe right antimicrobial at the right dose for the right amount of time – has been demonstrated to improve patient outcomes, reduce the development and spread of antibiotic resistant organisms, and decrease healthcare expenditures.

STRATEGY 4: IMPROVE HEALTHCARE WORKER INFLUENZA VACCINATION RATES.Seasonal influenza is a major contributor to morbidity and mortality each year, affecting thousands of people and costing billions of dollars annually across the United States. Influenza vaccination of healthcare workers plays a major role in reducing influenza-related illness and complications among healthcare providers and their patients.

AzHIP: HAIs

26

Health Issue






1. Promote and Support Healthcare‐Associated Infection Collaborative events and trainings. Arizona HAI Advisory Committee & Arizona Department of Health Services 2017

2.Promote participation in long‐term infection prevention and control initiatives and initiate infection prevention and conrol initiatives in ambulatory settings.

Arizona HAI Advisory Committee & Arizona Department of Health Services 2017

1. Distribute and provide technical assistance on the use of evidence based toolkits to facilities. Arizona HAI Advisory Committee & Arizona Department of Health Services 2017

2. Host education events on prevention toolkits. Arizona HAI Advisory Committee & Arizona Department of Health Services 2017

1. Identify, inventory and distribute available resources for health care settings. Arizona Department of Health Services 2017 2. Establish an online library of available resources for health care settings. Arizona Department of Health Services 2017 3. Establish, promote, and strengthen local and state partnerships between health care settings

and public health agencies. Local Health Departments & Arizona Department of Health Services 2020 Ongoing

1. Promote and educate providers on the use of the Injection Safety Toolkit . Arizona HAI Advisory Committee & Arizona Department of Health Services 2017

2. Provide technical assistance on the Injection Safety Toolkit. Arizona HAI Advisory Committee & Arizona Department of Health Services 2017

3. Leverage and promote national injection safety campaigns where appropriate. Arizona HAI Advisory Committee & Arizona Department of Health Services 2017

a.Educate providers on appropriate antimicrobial use and stewardship programs.

1. Educate partners on and promote available antimicrobial resources. Arizona HAI Advisory Committee & Arizona Department of Health Services 2017

1. Provide technical assistance for health care settings implementing antimicrobial use and stewardship programs.

Arizona HAI Advisory Committee & Arizona Department of Health Services 2019 Ongoing

2. Develop an investment business model and supporting resources for the implementation of antimicrobial use best‐practices. Arizona Department of Health Services 2017

1. Distribute and provide technical assistance on the use of the Healthcare Worker Influenza Vaccination Toolkit .


2. Promote awareness of established return on investment projections to encourage the adoption of an annual influenza vaccination requirement by health care settings.


4

2

3

Promote education events on infection prevention and control.

a.

Support implementation of prevention toolkits in healthcare facilities.b.

Promote the use of the Injection Safety Toolkit and similar resources.a.

Improve knowledge and implementation of infection prevention and control.

1

Strengthen partnerships between health care settings and public health agencies.

c.

Improve knowledge and implementation of safe injection practices.

Encourage the use of the Healthcare Worker Influenza Vaccination Toolkit and similar resources.a.

b.

Improve healthcare worker influenza vaccination rates.

Promote and support efforts to implement antimicrobial stewardship programs.

Improve knowledge and implementation of appropriate antimicrobial use and stewardship.

CDC Barriers and Strategies to Improving Influenza Vaccination among Health Care

Personnel (2014)

Hepatitis B outbreak associated with a hematology‐oncology office practice in New Jersey (2009); Injection practices among clinicians in United States health

care settings (2010).

Antibiotic Resistance Threats in the United States (2013); CDC Vital Signs: Making Health Care Safer (2014); Society for Healthcare Epidemiology of America: Antimicrobial Stewardship (2015)

Healthcare‐Associated Infections

2020 Goal: Reduce the number of Healthcare‐Associated Infections by 10%.

CDC Healthcare‐Associated Infections: Guidelines and Recommendations; ADHS Division of Licensing Deficiency Data.

27

AzHIP: Heart Disease & Stroke

HEART DISEASE & STROKE

2020 GOAL: REDUCE DEATHS AND EVENTS RELATED TO HEART DISEASE AND STROKE BY 10%.

28


STRATEGY 1 : INCREASE PUBLIC AWARENESS OF RISK FACTORS, CHAIN OF SURVIVAL, PREVENTION AND TREATMENT MEASURES.

Information about heart attacks and strokes can be elusive, despite efforts to increase widespread public awareness. Informing the public of heart disease and stroke risk factors, warning signs, the need to call 911, and prevention strategies is part of the AzHIP campaign for Arizonans.

STRATEGY 2: INCREASE THE NUMBER OF ARIZONANS WHO ARE TRAINED TO PERFORM HANDS-ONLY CPR.

When bystanders perform hands-only CPR until emergency medical services arrive, the victim’s chances of living more than doubles.

STRATEGY 3: INCREASE THE NUMBER OF QUALITY IMPROVEMENT FOCUSED HEALTH SYSTEMS

PARTICIPATING IN CARDIOVASCULAR SYSTEMS OF

CARE.

Health systems need to ensure they are focused on routinely examining the systems and procedures by which they treat their heart disease patients. Health systems with a focus on quality improvement have better patient outcomes, lower readmission rates and lower overall healthcare cost burden. Just knowing treatment guidelines is not enough. The development, implementation and monitoring of performance-based quality goals in a coordinated effort is the key to improving healthcare performance and patient outcomes.

HEALTH IMPACT

In 2016, heart disease ranked as the#1 leading cause of death in Arizona, accoun ng for 11,4820 deaths. Cerebrovascular disease (stroke) was ranked as the #6 cause of death in Arizona, accoun ng for 2,356 deaths in 2016. In America, someone dies approximately every 40 seconds from diseases of the heart. Together heart disease and stroke are amongst the most widespread and costly health problems facing the nation today, accounting for more than $500 billion in healthcare expenditures and related costs. The cost burden con nues to increase annually. Reducing heart disease in Arizona by 10% by 2020 would result in saving 1,417 lives per year and $6,270,000 health care costs.

AzHIP: Heart Disease & Stroke

29

Health Issue






1. Identify innovative partners, strategies, and approaches to reach target audiences. Arizona Department of Health Services 2017 2. Assess and compile resources to align and coordinate efforts. Arizona Department of Health Services 2017 3. Prepare a health brief to address disparities among target populations. Arizona Department of Health Services 2017 Not Completed

4. Collaborate and coordinate with organizations who are implementing awareness campaignsfor consistent messaging. Arizona Department of Health Services 2017

5. Engage stakeholders to promote campaign through organization and member communications. Arizona Department of Health Services 2017

6. Promote participation in current initiatives including Million Hearts™, to preventcardiovascular disease. Arizona Department of Health Services 2017

1. Engage innovative partners to reach target audiences (e.g., Department of Motor Vehicles, Public Transit, CPR Kiosks and Movie Theaters).

American Heart Association & Arizona Department of Health Services 2020 Ongoing

2. Train Dispatchers to provide telephone CPR and measure performance. Arizona Department of Health Services 2016 1. Collaborate with the American Heart Association's CPR in Schools Initiative . American Heart Association 2016 2. Increase awareness of reimbursement mechanisms for diabetes self‐management education

programs.American Heart Association & Arizona Department of Health Services 2020 Ongoing

3. Explore partnership opportunities with the Arizona Department of Education. Arizona Department of Health Services 2020 Ongoing

1. Ensure that local 911 centers provide guideline based telephone basic life support (CPR and AED instructions). Arizona Department of Health Services 2020 Ongoing

2. Increase the proportion of Emergency Medical Services agencies utilizing current national recommendations for pre‐hospital ECG utilization. Arizona Department of Health Services 2020 Ongoing

1. Increase the number of agencies utilizing pre‐hospital stroke assessment. Arizona Department of Health Services 2020 Ongoing

2. Increase the number of stroke care centers in Arizona. Arizona Stroke Collaborative & Arizona Department of Health Services 2020 Ongoing

1. Implement treatment models to impact cost and critical gaps in rural systems of care. Arizona Stroke Collaborative & Arizona Department of Health Services 2019 Ongoing

2. Enhance and better utilize systems of telemedicine in rural areas. Arizona Stroke Collaborative & Arizona Department of Health Services 2018 Not Started

Increase the number of Arizonans who are trained to perform Hands‐Only CPR.

2

Increase the number of school districts implementing Hands‐Only CPR training. b.

Increase the number of quality of improvement health systems participating in Cardiovascular Systems of Care.

a.Strengthen systems of care and improve outcomes in pre‐hospital, hospital, and post‐hospital settings for patients suffering acute cardiac events.

b.Implement systems of care and improve outcomes in pre‐hospital, hospital and post‐hospital settings for stroke events.

c. Increase access to trained professionals in rural Arizona.

1

Increase public awareness of risk factors, chain of survival prevention and treatment measures.

a.Develop an integrated and comprehensive communications plan.

a.Increase the number of people who perform Hands‐Only CPR.

3

Heart D

isease & Strok

e

2020 Goal: Reduce death and events related to heart disease and stroke by 10%.

American Heart Association; Preventing Chronic Disease Medscape.

American Heart Association: The Ideal STEMI and Cardiac Resuscitation System of

Care; Preventing Chronic Disease Medscape.

30

AzHIP: Maternal & Child Health

MATERNAL & CHILD HEALTH

2020 GOAL: REDUCE MATERNAL AND INFANT MORTALITY BY 5%.

31


HEALTH IMPACT

In 2016, Arizona’s infant mortality rate was 6.1, reaching the Healthy People 2020 goal but s ll refl ec ng signifi cant dispari es. Impac ng infant and maternal mortality requires a life course approach, which is exhibited through the strategies to address the Maternal and Child Health priority. Infant mortality is used as a marker because the outcome can be considered the sum of the experiences of preconcep on health or the health of the woman before pregnancy, pregnancy, birth and the fi rst year of life. As a child is a part of a family, the emo onal and physical health of the family is included.

STRATEGY 1: IMPROVE THE HEALTH OF WOMEN BEFORE AND BETWEEN PREGNANCY(IES).

The health of a woman before she becomes pregnant can make a signifi cant diff erence in the health of her baby, including her behavioral health. The strategies and tac cs for improving the health of women before and between pregnancies include suppor ng the community to coalesce around the importance of wellness for all women of childbearing age including behavioral health. Women are also recommended to space their pregnancies 18 to 59 months apart. In Arizona, the percentage of women prac cing safe spacing has remained rela vely steady from 42% in 2009 to 43% in 2013. Younger mothers (<18) were the least likely to have the desired spacing between pregnancies (16%).

STRATEGY 2: DECREASE THE INCIDENCE OF CHILDHOOD INJURY.

Deaths due to prematurity and unsafe sleep environments were the largest causes of infant mortality in 2016. In 2016, the deaths of 80 of Arizona’s infants were associated with unsafe sleep environments, including co-sleeping (bed sharing with adults and/or other children), sleeping in an adult bed, sleeping on a couch/futon and sleeping on his/her side or stomach. Addi onally, nineteen percent (n=146) of all Arizona child fatali es in 2016 were classifi ed as home-safety related. Arizona’s strategies to decrease childhood injury include suppor ng safe sleep and preven ng injuries around the home.

STRATEGY 3: SUPPORT ADOLESCENTS, INCLUD-ING YOUTH WITH SPECIAL HEALTH CARE NEEDS, TO MAKE HEALTHY DECISIONS AS THEY TRANSITION TO

ADULTHOOD.

According to the Na onal Survey of Children’s Health 2016, 8.4% of Arizona adolescents aged 12-17 were not insured. Additionally, 90.1% had consistent health insurance coverage during the past 12 months. Among those insured, only 68.8% had insurance which met their needs. Youth Risk Behavior Survey (YRBS) data tells us that in 2016, 32% of Arizona high school students were harassed or bullied on school property while 28.5% experienced electronic bullying. YRBS also reports that in 2016, 34.2% of Arizona high school students reported feeling sad or hopeless, 18.6% seriously considered a emp ng suicide, and 9.6% a empted suicide one or more mes. Females were more likely than males to report feeling sad or hopeless and contempla ng and/or a emp ng suicide. Arizona’s adolescents need to feel well and safe, including suppor ng their transi on to adulthood by making healthy decisions concerning their physical health as well as their emo onal health and safety.

STRATEGY 4: STRENGTHEN THE ABILITY OF FAMILIES TO RAISE EMOTIONAL AND PHYSICALLY HEALTHY YOUNG

CHILDREN.

The experiences of the early years can affect the brain architecture of a developing child and subsequently the person they become. Arizona’s strategies will focus on suppor ng the social emo onal development of its infants and young children. Addi onally, efforts will con nue the important work of ensuring all Arizona’s children are fully immunized to ensure their own safety, including the most at risk children. Self-reported data from Arizona schools and childcare facili es showed high immuniza on coverage levels. However, childcare centers’ religious belief exemp on rates increased from 3.5% (2015-16) to 3.9% (2016-17). In kindergarten, personal belief exemp on rates increased from 4.5% (2015-16) to 4.9% (2016-17).

STRATEGY 5: STRENGTHEN PROGRAMS THAT GIVE MOTHERS THE SUPPORT THEY NEED TO BREASTFEED THEIR BABIES.

Breas eeding has been linked to a decreased risk of childhood obesity and may also provide faster weight loss to mothers. Breas eeding supplies the newborn with protec on against disease and a reduc on in the risk of death and may protect against infec ons such as gastroenteri s and diarrheal disease, respiratory illness, and o s media. The protec on of breast milk also extends beyond infancy as breas eeding may prevent celiac disease, diabetes, mul ple sclerosis, sudden infant death syndrome, obesity, diabetes, and childhood cancer. Increasing the ini a on and dura on of breas eeding may provide a low-cost, readily available strategy to help prevent childhood and adolescent illness, including obesity. Breas eeding is also considered a protec ve factor against Sudden Unexpected Infant Death (SUID) and helps to promote mother infant bonding. In Arizona, infants who were ever breas ed decreased from 85% (2013) to 83% and infants who were breas ed at 6 months has decreased from 54.8% (2013) to 52.1% (2014). Arizona’s strategies will focus on suppor ng mothers by providing programs to support the transi on from pregnancy to motherhood.

AzHIP: Maternal & Child Health

32

Health Issue Lead Organizations Completion



Action Items (AI)Evidence‐BasedHigh‐Impact Strategies Tactics

1. Utilize Home Visitors and community based organizations to educate women and their support systems on preconception and interconception health. Strong Families Arizona 2020 Ongoing

2. Promote and support continuing education for providers on preconception and interconception health via online resources. Preconception Health Alliance 2018 Ongoing

3. Align and coordinate efforts of community based organizations to achieve consistent messaging and appropriate referrals.

Preconception Health Alliance 2018 Ongoing

4. Promote educational materials targeting support systems awareness of preconception and interconception health. Preconception Health Alliance 2018 Ongoing

1. Inventory resources and identify organizations to align and coordinate efforts and messaging. Postpartum Support International, Arizona Chapter 2018 Ongoing

2. Convene interested partners and stakeholders to consider a collective approach. Postpartum Support International, Arizona Chapter 2019

3. Promote educational materials targeting support systems awareness of perinatal mood disorder.

Postpartum Support International, Arizona Chapter 2018 Ongoing

4. Promote and support continuing education for providers on perinatal mood disorder via online resources.

Postpartum Support International, Arizona Chapter 2018 Ongoing

1. Encourage universal adoption of American Academy of Pediatricians 2011 safe sleeprecommendations.

Safe Sleep Task Force & Arizona Department of Health Services 2020 Ongoing

2. Identify and target areas and populations at most risk of sleep related deaths. Arizona Department of Health Services 2016 3. Promote annual training on safe sleep practices for practitioners and community health

organizations. Safe Sleep Task Force 2018 Ongoing

1. Promote the recommendations of the Childhood Fatality Review Committee as appropriate. Arizona Chapter of the American Academy of Pediatrics & State Child Fatality Review Team 2019 Ongoing

2. Encourage all who care for young children to assess injury risk in the child’s environment. Safe Kids Arizona & Strong Families Arizona 2018 Ongoing

1. Educate families about information resources on adolescent development, pregnancyprevention, and STI/STDs that are available to them.

Arizona Family Health Partnership, Teen Outreach Pregnancy Services, & Arizona Department of Health Services

2020 Ongoing

2. Focus on consistent and positive messaging on targeted topics.Arizona Family Health Partnership, Teen Outreach Pregnancy Services, & Arizona Department of Health Services

2020 Ongoing

3. Support and educate about healthy behaviors and decision making to adolescents and teens.Arizona Family Health Partnership, Teen Outreach Pregnancy Services, & Arizona Department of Health Services

2020 Ongoing

1. Educate parents and caregivers about the timing and importance of well visits. Maricopa Community Advisory Board 2020 Ongoing

2. Encourage adoption of teen friendly provider office policies. (to include confidential, private (audio and visual), consent, CLAS, comprehensive). Maricopa Community Advisory Board 2020 Ongoing

3. Educate providers and community health care workers on tactics to support effective communication techniques when addressing difficult subjects with teens. Arizona Department of Health Services 2020 Ongoing

1. Identify and assess current initiatives to effectively reach target populations. Arizona Department of Health Services 2017 2. Promote identified resources on the development of healthy relationships to praents

caregivers, and schools. Arizona Department of Health Services 2019 Ongoing

Support adolescents, including youth with special health care needs, to make healthy decisions as they transition to adulthood.

a. Increase awareness on the importance of preconception and interconception health.

1Improve the health of women before, after, and between pregnancy(ies).

Decrease the incidence of childhood injury.

a. Increase awareness of what constitutes a safe sleepenvironment.

b. Educate the community, parents, and caregivers on potential causes of childhood injury.

b.

Increase awareness of perinatal mood disorder.

2

3

Healthy People 2020: Injury and Violence Prevention; National Center for Education in Maternal and Child Health: Safe Sleep (2014); National Center for Education in Maternal and Child Health: Injury‐Related

Hospitalizations of Children and Adolescents (2014); National Center for Injury Prevention and Control CDC:

Evidence‐Based Effective Strategies for Preventing Injuries (2002)

National Center for Education in Maternal and Child Health: Bullying (2014); Center for Study and Prevention of Violence

Institute of Behavioral Science: We Know What Works (2015); SAMHSA National

Registry of Evidence‐based Programs and Practices (2015)

b.

Increase percentage of teens receiving well visits.

Develop and promote awareness on the development of healthy relationships. c.

a. Support access to proven adolescent development programs, teen pregnancy prevention programs, and STI/STD prevention programs.

Materna

l & Child Hea

lth

2020 Goal: Reduce maternal and infant mortality by 5%.

Healthy People 2020: Maternal, Infant & Child Health.

33





1. Increase parents and caregivers access to resources and opportunities that support the social emotional needs of their children. First Things First 2019 Ongoing

2. Support training on Arizona's Infant and Toddler Guidelines and Program Guidelines for HighQuality Early Education programs serving young children.

First Things First & Arizona Department of Education 2018 Ongoing

3. Promote programs serving young children to align with Arizona's Infant and Toddler Guidelines and Porgram Guidelines for High Quaity Early Education.

First Things First & Arizona Department of Education 2018 Ongoing

4.Integrate professional development opportunities on best practices for supporting the social emotional needs of children for professionals providing parenting education and home visitation programs for parents and caregivers.

First Things First 2017 Ongoing

1. Promote compliance with the required Immunizations for Child Care or School Entry. Arizona Department of Health Services 2019 Ongoing

2. Support providers with tools and resources to allow them to better educate families about the importance of vaccinations. The Arizona Partnership for Immunizations 2018 Ongoing

3. Develop and implement intervention plan for at risk communities. Arizona Department of Health Services 2018 Ongoing

1. Support standardization of guidance and language concerning breastfeeding andbreastfeeding support. Arizona Department of Health Services 2018 Ongoing

2. Support hospitals to move toward Baby Friendly practices. Arizona Department of Health Services 2019 Ongoing

3. Work with providers, health care teams, and community health to support breastfeeding during prenatal visits and pediatric follow‐up visits. Arizona Department of Health Services 2018 Ongoing

1. Promote the Make It Work workplace toolkit. Arizona Department of Health Services 2017 2. Provide support and resources necessary to overcome barriers to progress, i.e., peer

counseling, breastfeeding support groups, breastfeeding aids. Arizona Department of Health Services 2020 Ongoing

3. Strengthen state capacity to build International Board Certified Lactation Consultant infrastructure. Arizona Department of Health Services 2017

Strengthen the ability of families to raise emotionally and physically healthy children.

4

5

Strengthen programs that give mothers the support they need to breastfeed their babies.

Increase the childhood immunization rate.

a. Support and educate parents and caregivers on the social‐emotional needs of their young children.

Support initiation of breastfeeding by developing or expanding breastfeeding education for mothers and their babies.

b.Support mothers to breastfeed for longer periods of time.

National Center for Education in Maternal and Child Health: Breastfeeding (2014); CDC Guide to Strategies to Support

Breastfeeding Mothers and Babies (2013); CDC Division of Nutrition, Physical Activity

and Obesity: Breastfeeding Support (2015); Surgeon General's Call to Action to

Support Breastfeeding (2011)

U.S Department of Health & HumanServices: The 2010 National Vaccine Plan

a.

b.

34

OBESITY

AzHIP:Obesity

2020 GOAL: INCREASE THE PROPORTION OF ADULTS AND CHILDREN WHO ARE AT A HEALTHY WEIGHT BY 5%.

35


HEALTH IMPACT

In 2014, 33.8% of adults in Arizona reported being at a healthy weight. With almost two out of three adults in Arizona either overweight or obese, promo ng healthy ea ng and ac ve living is a top health priority. Being overweight or obese increases the risk of heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death. The World Health Organiza on (WHO) es mates that 44% of the diabetes burden, 23% of the ischemic heart disease burden and between 7% and 41% of certain cancer burdens are a ributable to being overweight and obese. Childhood obesity is a serious concern in Arizona, despite recent declines among pre-school children. The obesity rate among children na onwide has more than tripled since 1970. A healthy weight for adults is defi ned as a Body Mass Index (BMI) of 18.5 to 24.9. Healthy weight for children and adolescents, ages two to twenty, is defi ned as a BMI-for-age between the 5th percen le to less than the 85th percen le on a growth chart.

In order for people to make healthy food choices, healthy food op ons must be available and accessible. Providing healthy foods in exis ng stores, increasing the availability of grocery stores, and suppor ng farm-to-table eff orts (e.g. farmers markets, community gardens) have been shown to increase access to healthy food. Farmers markets support the local economy, increase marke ng opportuni es for farmers and small businesses, provide access to an assortment of local and regionally sourced products, and increase access to healthy, aff ordable food for the community. More farmers markets are accep ng WIC and SNAP as methods of payment as well.

STRATEGY 1: INCREASE AVAILABILITY OF AFFORDABLE HEALTHY FOOD RETAIL.

Screening, diagnosis, educa on and treatment are impera ve components of a comprehensive strategy to address weight. Health care providers and insurers are in a unique posi on to infl uence individuals and engage pa ents in healthy lifestyles. Health care providers are encouraged to provide standardized care for obesity preven on screening, diagnosis and treatment, and advocate for healthy community environments.

STRATEGY 3: ENSURE COVERAGE OF, ACCESS TO, AND INCENTIVES FOR ROUTINE OBESITY PREVENTION, SCREENING, DIAGNOSIS AND INTERVENTION.

Regular physical ac vity has far-reaching health benefi ts, including lower rates of high blood pressure, diabetes, cancer, depression, making it easier to reach a healthy weight. Improving the physical ac vity levels of Arizonans cannot be done solely by focusing on individual behaviors but must be accompanied by eff orts to make it easier to be physically ac ve in the environments in which we live, learn, work, and play.

While there may be a general understanding of the importance of healthy ea ng and being physically ac ve, moving individuals to change behavior can be challenging. We are more likely to adopt a healthy lifestyle when social norms support healthier choices and when individuals, families, and communi es have the tools they need to implement healthy ea ng and ac ve living.

STRATEGY 2: PROVIDE AND SUPPORT OPPORTUNITIES DESIGNED TO INCREASE PHYSICAL ACTIVITY.

STRATEGY 4: EMPOWER ARIZONANS TO ADOPT A HEALTHY LIFESTYLE.

AzHIP:Obesity

36





1. Increase acceptance of governmental nutrition programs at farmer’s markets and relatedentities. Pinnacle Prevention 2018 Ongoing

2. Support innovation (e.g., mobile food markets, food hubs) in low food access areas. Food System Coalitions & Vitalyst 2020 Not Started

3. Promote and support the establishment of school and community gardens. Arizona Department of Education & Arizona Department of Health Services 2019 Ongoing

4. Increase availability of fruits, vegetables and other healthy food options at corner stores andconvenience markets.

Local Health Departments & Arizona Department of Health Services 2018 Ongoing

1. Incentivize healthy food offerings at retailers. Pinnacle Prevention 2020 Not Started2. Influence healthy food placement. Arizona Food Market Association 2020 Ongoing1. Promote and support efforts to achieve 60 minutes of activity per day. Arizona Department of Education & Edunuity 2020 Ongoing

2. Support planning and implementation of an increased amount and types of physical activity in school physical education programs. Arizona Department of Education & Edunuity 2020 Ongoing

1. Promote developmentally appropriate active living education to community residents with special focus on children birth to age 5, through existing child focused programs.

First Things First & Arizona Department of Health Services 2017

2. Develop and support a sustained, targeted physical activity social marketing campaign. Arizona Department of Health Services 2016

1. Educate schools and early care organizations on the benefits of health screenings and best practices for implementation.

Arizona Chapter of the American Academy of Pediatrics & Arizona Department of Education 2020 Ongoing

2. Incorporate FitnessGram (formerly Pres. Phys Fitness Test) back in to schools. Arizona Department of Education & Edunuity 2020 Ongoing

1. Evaluate tobacco‐cessation models for application in obesity prevention and management. Mercy Care Plan & Arizona Department of Health Services 2017 Ongoing

2. Partner with professional organizations on strengthening health care provider obesityeducation.

University of Arizona Western Region Public Health Training Center 2018 Not Started

3. Enhance the connection between providers (e.g., lactation consulstants, registered dieticians, primary care) and health plans to ensure providers have the support to address obesity.

Arizona Academy of Nutrition and Dietetics & Marcy Care Plan 2019 Ongoing

4. Increase provider awareness of breastfeeding support. Arizona Department of Health Services 2017 1. Encourage parents, caregivers, teachers, health care providers and other adults in leadership

roles to model and promote healthy eating and active living. Arizona Department of Health Services 2020 Onging

2. Promote reduction of screen time for families with young children.Arizona Chapter of the American Academy of Pediatrics, First Things First, & Arizona Department of Health Services

2017

3. Support implementation of practices to limit consumption of sugar‐sweetened beverages.Arizona Chapter of the American Academy of Pediatrics & Maricopa County Department of Public Health

2019 Ongoing

1. Identify, inventory, and promote effective tools that individuals can use to support healthy habits. Arizona Department of Health Services 2016

2. Engage community partners (e.g., community health workers, local advocates, faith‐based organizations) to utilize tools to assist community members with adopting a healthy lifestyle.

Local Health Departments & Arizona Department of Health Services 2017

1Increase availability of affordable healthy food retail.

Provide needed tools to implement healthy eating and the incorporation of daily physical activity.

a. Address communities with limited food access.

b. Address affordability, availability, purchasing, and selection of healthy food options.

a. Provide and market effective physical activityprograms in educational institutions

b. Support community programs promoting physical activity.

a.Increase the number of schools and early care organizations incorporating routine health screenings and follow‐up.

b.Promote education for current and future providers on routine obesity prevention, screening, diagnosis and intervention.

a.Model and promote healthy lifestyles across the lifespan to influence healthy eating and active living as the social norm.

b.

2Provide and support opportunities designed to increase physical activity.

3

Ensure coverage of, access to, and incentives for routine obesity prevention, screening, diagnosis and intervention.

4Empower Arizonans to adopt a healthy lifestyle.

Obe

sity

2020 Goal: Increase the proportion of adults and children who are at a healthy weight by 5%.

SNAP‐ED Strategies & Interventions: An Obestiy Prevention Toolkit for States

(2014).

Insitute of Medicine, Accelerating Progress in Obesity Prevention: Solving the Weight

of the Nation (2012)

Insitute of Medicine. Accelerating Progress in Obesity Prevention: Solving the Weight

of the Nation (2012)

The Guide to Community Preventive Services, Obesity Prevention and Control:

Interventions in Community Settings (2014); SNAP‐ED Strategies &

Interventions: An Obestiy Prevention Toolkit for States (2014).

37

ORAL HEALTH

2020 GOAL: IMPROVE THE ORAL HEALTH STATUS OF ARIZONANS BY 5%.

AzHIP: Oral Health

38


HEALTH IMPACT

In 2015, tooth decay remained the number one chronic disease among Arizona children with over half of Arizona’s third grade children (65%) having a history of tooth decay, higher than the na onal average (52%). Good oral health is more than just preserving one’s smile. Aside from causing dental pain, diminished func on, and reduced quality of life, oral disease and related condi ons can aff ect overall physical, developmental, psychological, social, and economic well-being. Poor oral health dispropor onately aff ects low-income individuals, the frail and vulnerable, and the tradi onally underserved. Dispari es exist in Arizona children with American Indian (86%) and Hispanic (69%) children having the highest prevalence of the disease.

Community based preven on programs have far reaching health benefi ts. These programs are a viable way to reach underserved popula ons, to reduce the incidence and prevalence of oral and dental diseases, and to contain and reduce costs associated with the treatment of disease. Preven on programs focus on changing personal oral health behaviors as well as community factors and environmental infl uences. Preven on programs benefi t people of all ages but can be of par cular benefi t for young children and pregnant women.

STRATEGY 1: EXPAND ACCESS TO CHILDHOOD ORAL DISEASE PREVENTION PROGRAMS.

Screening, diagnosis, educa on and treatment are important components of a comprehensive strategy to address oral health across the lifespan. Health care providers, insurers and stakeholders are in a unique posi on to infl uence individuals and engage pa ents in healthy behaviors. Health care providers are encouraged to provide linkages to the oral health care system and promote u liza on of the oral health care benefi t.

STRATEGY 2: INCREASE UTILIZATION OF THE ORAL HEALTH CARE SYSTEM.

Studies conducted by CDC con nue to demonstrate the benefi ts of community water fl uorida on. Widespread use of community water fl uorida on prevents cavi es and saves money, both for families and the health care system. For larger communi es of more than 20,000 people where it costs about 50 cents per person to fl uoridate the water, every $1 invested in this preven ve measure yields approximately $38 savings in dental treatment costs.

The rela onship between oral health and total health underscores the need for oral health care to be integrated into healthcare systems. Enhancing interprofessional development and increasing oral health literacy is an integral part of total health.

STRATEGY 3: INTEGRATE ORAL HEALTH INTO WHOLE PERSON HEALTH.

STRATEGY 4: EXPAND AND MAINTAIN COMMUNITY WATER FLUORIDATION SYSTEMS.

AzHIP: Oral Health

39





1. Provide education for familiesthrough home visiting to develop good oral health habits. Strong Families Arizona & Arizona Department of Health Services 2018 Ongoing

2. Promote the Empower oral health standards in childcare facilities. Arizona Department of Health Services 2017 1. Educate on the value of school‐based sealant, fluoride varnish, and fluoride mouth rinse

programs. First Things First & Arizona Department of Health Services 2018 Ongoing

2. Increase the number of school based sealant and fluoride varnish programs. Arizona Department of Health Services 2019 Ongoing

3. Promote utilization of school based sealants and fluoride varnish programs throughinnovative engagement strategies. Arizona Department of Health Services 2019 Ongoing

a. Support the Oral Health Coalitions’ advocacy efforts.

1. Promote the Oral Health Coalitions’ activities.Arizona Alliance for Community Health Centers & Arizona American Indian Oral Health Initiative

2018 Ongoing

1. Educate parents and caregivers on accessing and utilizing the pediatric dental benefit.Strong Families Arizona, Arizona Academy of Pediatric Dentistry, & Arizona Health Care Cost Containment System

2018 Ongoing

2. Assist adults in finding the oral health care they need. Strong Families Arizona 2018 Ongoing

3. Educate providers on the benefits of integrating oral health screenings in to the primary care setting. Arizona Health Care Cost Containment System 2018 Ongoing

4. Support the Arizona Health Care Cost Containment System efforts to increase awareness ofhow to utilize the pediatric dental benefit.


1. Promote resources for provider education (e.g., Smiles for Life Curriculum ).Arizona Dental Association, Arizona Academy of Pediatric Dentistry & Arizona Department of Health Services

2018 Ongoing

2. Promote the integration of oral health knowledge in to curricula for multiple provider types. A.T. Still University 2018 Ongoing3. Build infrastructure for training health centers (e.g., GVAHEC). A.T. Still University 2018 Ongoing

4. Work with state professional health organizations to promote inter‐professionalcollaboration.

Arizona Dental Association & Arizona Academy of Pediatric Dentistry

2018 Ongoing

1. Provide anticipatory guidance to adults, parents, and caregivers in health and social services settings.

Arizona Academy of Pediatric Dentistry & Arizona Department of Health Services 2019 Ongoing

2. Enhance the network of individuals (e.g., CHWs, navigators, paraprofessionals, faith‐basedorgs) engaging community organizations to provide oral health education. Arizona Department of Health Services 2019 Ongoing

3. Increase the understanding of good oral health and its positive impact on an individual'soverall health and well‐being. A.T. Still University 2019 Ongoing

1. Work with local government to inform and educate on the merits of community water fluoridation.

Oral Health Coalition & Arizona Dental Association 2020 Ongoing

2. Leverage national resources or organizations for community water fluoridation promotion. Arizona Academy of Pediatric Dentistry & Arizona Department of Health Services 2020 Ongoing

3. Address systems need for the public to access community water fluoridation data (i.e., WFRS Database).


1. Ensure appropriate staff are trained on the Center for Disease Control's Community Water Fluoridation Training and share the training with stakeholders and partners.

Arizona Academy of Pediatric Dentistry & Arizona Department of Health Services 2020 Ongoing

2. Provide technical assistance on community water fluoridation to local public health departments, water system personnel, policymakers, health providers, and the public.

Arizona Dental Association, Arizona Academy of Pediatric Dentistry, & Arizona Department of Health Services

2020 Ongoing

a. Address the need for community water fluoridation to the public and policy makers.

b.

b.Increase access to and utilization of school‐based, including early care and education, prevention programs.

b. Increase awareness on how to access the oralhealth care system.

a. Enhance Inter‐professional collaboration.

1Expand access to childhood oral disease prevention programs.

a. Increase access to early childhood oral disease prevention programs.

4Expand and maintain community water fluoridation systems.

Educate stakeholders and provide technical assistance on community water fluoridation.

2Increase utilization of the oral health care system.

3Integrate oral health into whole person health.

b. Improve oral health literacy to encourage personal and family self‐care.

The Guide to Community Preventive Services, Preventing Dental Caries:

Community‐Based Initiatives to Promote the Use of Dental Sealants & School‐Based Dental Sealant Delivery Programs; ASTDD Best Practice Approach Reports: School‐based Dental Sealant Praograms (2015) & Use of Fluoride: School‐based Fluoride Mouthrinse and Supplement Programs

(2011).

Centers for Medicare and Medicaid Services, Improving Access to and

Utilization of Oral Health Services for Children in Medicaid and CHIP Programs (2011); ASTDD Best Practice Approach

Reports: Developing Workforce Capacity in State Oral Health Programs (2015); Keep Kids Smiling: Promoting Oral Health

Through the Medicaid Benefit for Children and Adolescents (2013).

ASTDD Best Practice Approach Reports: Emergency Department Referral Programs

for Non‐traumatic Dental Conditions (2015), Perinatal Oral health (2012) &

State oral Health Coalitions and Collaborative Partnerships (2011); ASTDD First Dental Visit by Age One (2012); Oral

Health Risk Assessment Timing and Establishment of the Dental Home (2003).

The Guide to Community Preventive Services ‐ Preventing Dental Caries:

Community Water Fluoridation; ASTDD Best Practice Approach Reports: Use of Fluoride: Community Water Fluoridation

(2011).

Oral H

ealth

2020 Goal: Improve the oral health status of Arizonans by 5%.

40

TOBACCO*

2020 GOAL: REDUCE THE PERCENT OF YOUTH AND ADULTS THAT SMOKE CIGARETTES BY 25%

AzHIP: Tobacco

*The AzHIP acknowledges the traditional and sacred use of tobacco among American Indian people living in Arizona. All instances wheretobacco is mentioned in this report are in reference to commercial tobacco use.

41


STRATEGY 1: PROMOTE THE UTILIZATION OF CESSATION SERVICES AMONG HEALTH PLANS, EMPLOYERS, AND HEALTH SYSTEMS.

Educating health plans, employers, and health systems on the economic advantages of promoting the utilization of evidence based tobacco cessation services among employees and staff has been recommended as a best practice as part of a comprehensive tobacco control program. In addition, utilization of the Healthy Arizona Worksites Program (HAWP) and Arizona Smoker’s Helpline (ASHLine) as vehicles to educate health plans, employers, and health systems will help to ensure stakeholders receive informed information and access to a proven evidence-based quitline.

Among health plans, it is noted that an estimated 300,000 members of the Arizona Health Care Cost Containment System (AHCCCS) smoke, and focusing priorities on this population will potentially reduce tobacco prevalence to under 10%, thus rendering Arizona as an even stronger leader among states in achieving tobacco-related health outcomes.

STRATEGY 2: UTILIZE COMMUNITY OUTREACH, EDUCATION, AND ADVOCACY TO PREVENT YOUTH TOBACCO USE.

According to the CDC, 90% of smokers begin smoking before the age of 18. Sustained reductions in tobacco use and related morbid conditions require robust strategies aimed at preventing tobacco use among youth. Witnessing recent reductions in tobacco use among youth warrants a continued effort to using targeted community interventions with special emphases on high risk youth and engaging them via peer-based approaches to prevent commercial tobacco use. Research findings and best practice reports, along with successes in the use of youth coalitions have demonstrated that youth are most effective at educating their peers on a myriad of public health issues, including tobacco use. Students Taking A New Direction (STAND) is Arizona’s statewide anti-tobacco youth coalition and consists of more than 300 members and more than 30 coalitions. Members take part in efforts at the school level, city level, county, and at the state level to educate their peers as well as to promote policies that protect their communities. By developing, implementing, and assessing a combined approach to reaching youth a continued reduction in youth tobacco prevalence can be achieved.

STRATEGY 3: DEVELOP AND IMPLEMENT A STATEWIDE PROGRAM TO ASSIST DECISION MAKERS AND ADVOCATES TO PROMOTE SMOKE

FREE POLICIES.

Conducting community outreach to multi-unit housing complexes to promote public awareness of the health and economic benefits of smoke free environments has been recommended as a community-level intervention best practice to lower tobacco prevalence and related negative health outcomes associated with second-hand smoke. The continuation and ramping up of the statewide smoke free policy program ensures that Arizona continues to improve the health and wellness of residents in general and those who may reside in multi-unit housing complexes, with particular attention to the fact that lower income populations are disproportionately represented in multi-housing environments.

STRATEGY 4: PROMOTE THE USE OF CESSATION TREATMENTS AMONG ADULT AND YOUTH SMOKERS.

Research has shown that it can take a number of attempts at quitting tobacco before someone quits successfully. Encouraging individuals to utilize available evidence based resources for cessation by promoting awareness of treatment options and the economic benefits of quitting tobacco supports a multi-dimensional, evidence-based approach to quitting tobacco. Approaches include utilizing quitline/coaching services, training healthcare providers to utilize evidence-based interventions, and utilizing nicotine replacement therapies, such as the nicotine patch, gum or lozenges or Chantix/Zyban, etc.).

HEALTH IMPACTIn 2016, 14.7% of adults smoked cigarettes in Arizona, and there were more than 100,000 high school youth smoking. Adult and youth smoking rates are defined as smoking at least one cigarette in the past 30 days as collected annually by the Behavioral Risk Factor Surveillance System and biannually by the Youth Risk Behavior Survey. Tobacco use contributes to many poor health outcomes, including cancer, heart disease, stroke, asthma, low birth weight, and sudden unexplained infant death syndrome (SIDS). Tobacco is the leading cause of preventable death in Arizona, with over 7,000 tobacco-attributed deaths occurring each year. The life expectancy of a smoker is reduced by 10-30 years compared to a non-smoker. A 25% reduction in smoking in Arizona would result in almost 200,000 fewer smokers throughout the state.

AzHIP: Tobacco

42





1. Identify and distribute targeted return on investment information for cessation services. ASHLine & Arizona Department of Health Services

2018 Ongoing

2. Promote a Screening, Brief Intervention, & Referral to Treatment (SBIRT) model among healthsystems.

ASHLine & Arizona Department of Health Services 2016

3. Implement training and promote utilization of proven cessation services. ASHLine & Local Health Departments 2016 1. Identify and distribute targeted return on investment information for employers. ASHLine & Arizona Department of Health

Services 2018 Ongoing

2. Assess gaps in health and wellness policies among employers. Maricopa County Department of Public Health & Arizona Department of Health Services 2018 Ongoing

3. Develop a menu of proven tobacco cessation programs to promote cessations services inArizona.

ASHLine 2017 Ongoing

1. Establish and enhance current youth coalition activities through youth‐to‐youth education, outreach, and policy.

Pima Prevention Partnership, Students Taking a New Direction, & Local Health Departments 2020 Ongoing

2. Engage youth to participate in enforcement programs. Attorney General's Office & Arizona Department of Health Services 2020 Ongoing

3. Implement retailer diversion and education programs. Attorney General's Office & Arizona Department of Health Services 2020 Ongoing

4. Educate School Health Advisory Committees on providing youth tobacco prevention resources. Local Health Departments 2020 Ongoing

1. Build and expand on established youth‐based presentations to elementary schools. Pima Prevention Partnership, Students Taking a New Direction, & Local Health Departments 2016

2. Train youth on referral process for cessation services. Local Health Departments 2020 Ongoing

1. Collect data from multi‐unit housing complexes to support the need for policy change. American Lung Association 2017 2. Train landlords and property managers on the benefits of smoke free policies. Arizona Multi‐Housing Association, American

Lung Association, & Local Health Departments2016

3. Convene stakeholders to identify community needs. American Lung Association & Local Health Departments 2016

4. Assist with the development and implementation of plans to include technical assistance, resources and activities for creating smoke free environments.

American Lung Association & Local Health Departments 2020 Ongoing

1. Increase awareness of the health risks and economic impact of poor air quality.Arizona SmokeFree Living, Local Health Departments, & Arizona Department of Health Services

2018 Ongoing

2. Provide education to assist with the adoption of smoke free rules and policies in outdoor environments. Arizona SmokeFree Living 2018 Ongoing

1. Increase implementation of referral systems in healthcare organizations. ASHLine & Local Health Departments 2016 2. Increase individual awareness and utilization of benefit options, including behavioral

interventions and pharmacotherapies.ASHLine & Arizona Department of Health Services 2016

3. Promote tobacco cessation services and best practices through community‐based events. ASHLine & Local Health Departments 2018 Ongoing

4. Partner with organizations that serve high‐risk populations. ASHLine, Local Health Departments, & Arizona Department of Health Services 2016

1. Educate individuals about treatment options and the health and economic benefits of quitting tobacco. Arizona Department of Health Services 2018 Ongoing

2. Leverage national campaigns to support efforts when appropriate. Arizona Department of Health Services 2018 Ongoing

a.Prevent tobacco use among youth using targeted community interventions with special emphasis on high‐risk populations.

a.

CDC Best Practices for Comprehensive Tobacco Control Programs (2014); The

Guide to Community Preventive Services, Reducing Tobacco Use and Secondhand Smoke Exposure (2014); Public Health

Service Clinical Practice Guidelines (2008); U.S. Preventive Services Task Force, Final Update Summary: Tobacco Use in Children

and Adolescents: Primary Care Interventions (2015).

b.

Engage youth in peer‐based approaches to prevent commercial tobacco use.

Develop and implement a statewide program to assist decision makers and advocates to promote smoke free policies.

a.

Conduct community outreach to multi‐unit housing (e.g., property managers, developers, owners, & residents) complexes to foster the creation of smoke free indoor environments.

Educate employers on the benefits of adopting effective cessation plans.

2Utilize community outreach, education, and advocacy to prevent youth tobacco use.

CDC Best Practices for Comprehensive Tobacco Control Programs (2014); CDC Key

Outcome Indicators for Evaluating Comprehensive Tobacco Control Programs

(2005); National Prevention Council, National Prevention Strategy: Tobacco‐

Free Living (2014).b.

National Prevention Council, National Prevention Strategy: Tobacco‐Free Living

(2014); The Guide to Community Preventive Services, Reducing Tobacco Use and Secondhand Smoke Exposure: Smoke‐

Free Policies (2014).Promote public awareness of the health and economic benefits of smoke free outdoor environments.

Promote the utilization of cessation services among health plans, employers, and health systems.

a.Educate stakeholders on the economic advantages of promoting the utilization of effective cessation services.

3

1

4Promote the use of cessation treatments among adult and youth smokers.

The Guide to Community Preventive Services, Reducing Tobacco Use and

Secondhand Smoke Exposure (2014); CDC Key Outcome Indicators for Evaluating

Comprehensive Tobacco Control Programs (2005); Public Health Service Clinical

Practice Guidelines (2008); U.S. Preventive Services Task Force (2015)

b.Promote public awareness of the treatment options and the health and economic benefits of quitting tobacco.

Encourage individuals to utilize available evidence‐based resources for cessation.

b.

Toba

cco

2020 Goal: Reduce the percent of youth and adults that smoke cigarettes by 25%.

43

UNINTENTIONAL INJURY

2020 GOAL: REDUCE THE UNINTENTIONAL INJURY DEATH RATE BY 5%.

AzHIP: Unintentional Injury

44

HEALTH IMPACTIn 2014, Arizona’s uninten onal injury death rate was 42.6 per 100,000 residents. Uninten onal Injury deaths are defi ned as deaths occurring as a result of: transporta on injuries, falls, drowning, poisonings, fi re/burns, fi rearm-related injuries, and recrea on-related injuries. While these topics do not cover all mechanisms of uninten onal injuries, the topics addressed account for the largest burden of injury-related events. Uninten onal injuries can be prevented by strengthening and implemen ng community-based preven on policies and programs and focusing eff orts among groups at highest risk for injuries, including youth and older adults.


Arizona has strong community partnerships established with various agencies around the state. We will con nue to collaborate and support eff ec ve traffi c safety policies and programs to prevent motor vehicle-related injuries and deaths. Some of partners include Arizona Department of Transporta on, Arizona Department of Highway Safety, Arizona Game and Fish, Indian Health Services, County Health Departments as well as some tribal communi es.

STRATEGY 1: IMPLEMENT AND STRENGTHEN POLICIES AND PROGRAMS TO ENHANCE TRANSPORTATION SAFETY.

STRATEGY 2: PROMOTE, STRENGTHEN, AND IMPLEMENT POLICIES AND PROGRAMS TO PREVENT FALLS, ESPECIALLY AMONG OLDER ADULTS.

Fall-related injuries are a serious public health problem, especially among older adults age 65+. Enhancing linkages between clinical- and community-based preven on efforts increases the availability and use of these programs. Properly designed and maintained playgrounds, home safety devices (e.g. stair gates) and use of protec ve gear when playing ac ve sports can help prevent children from sustaining injuries related to falls.

AzHIP: Unintentional Injury

45





2. Educate high‐risk populations on the use of proper restraints in motor vehicles. Arizona Department Of Transportation & Arizona Game & Fish 2018 Ongoing

2. Facilitate targeted safety outreach to off‐road vehicle users. Arizona Game and Fish 2019 Ongoing

2. Develop targeted training for first responders and Arizona Hospitals on the Centers for Disease Control field triage criteria to screen for injury resulting from fall incidents. Arizona Department of Health Services 2020 Ongoing

1. Collaborate with and support the efforts of the Arizona State Falls Coalition on developing education. Arizona Department of Health Services 2020 Ongoing

2. Implement education and individual interventions (e.g., Tai Chi) to prevent falls. Arizona Department of Health Services 2020 Promote healthy living practices that are evidence‐based to reduce falls.

1. Implement the Strategic Highway Safety Plan. Arizona Department Of Transportation 2018Implement and strengthen policies and programs to enhance transportation safety.

Increase advocacy regarding appropriate occupant protection.

Educate providers on the need for "fall" screenings.

1. Communicate the costs of injuries that could have been prevented by use of motor vehicle restraints. Arizona Department of Health Services 2018

1. Promote the implementation of Stopping Elderly Accidents, Deaths and Injuries (STEADI) by all health care providers to screen for the risk of falls. Arizona Department of Health Services 2018

Healthy People 2020: Injury and Violence Prevention; The Guide to Community

Preventive Services, Motor Vehicle‐Related Injury Prevention (2013)

CDC Stopping Elderly Accidents, Deaths and Injuries (STEADI) (2015); CDC Home and Recreational Safety (2011); National

Council on Aging, Falls Free®: 2015 National Falls Prevention Action Plan;

Ongoing

Ongoing

Ongoing

1Increase the use of proper motor vehicle restraints.

2

Promote, strengthen, and implement policies and programs to prevent falls, especially among older adults.

a.

b.

a.

b.Unintentiona

l Injury 2020 Goal: Reduce the Unintentional Injury Death Rate by 5%.

46

SUBSTANCE ABUSE

Updated April 2018

In 2014, Arizona had the 15th highest drug overdose death rate in the country. Reducing substance abuse is not only a health priority in the Arizona Health Improvement Plan, but has been a high priority of Governor Doug Ducey. Governor Ducey, through the Governor’s Office of Youth, Faith and Family (GOYFF), convened the Arizona Substance Abuse Task Force in Spring 2016. The Governor’s Office of Youth, Faith, and Family (GOYFF) and the Arizona Health Care Cost Containment System (AHCCCS) co-chaired the Task Force. Twenty-nine individuals were appointed to serve as task force members, and several addi onal people with special exper se were invited to par cipate in work groups. In October, the Task Force concluded its work and submi ed a formal report making 104 recommenda ons to Governor Ducey. The report contains recommenda ons for Arizona regarding preven on and early interven on programs, access to treatment, medica on-assisted treatment, and neonatal abs nence syndrome.

The Arizona Health Improvement Plan (AzHIP) incorporates the Arizona Substance Abuse Recommenda ons as the set of strategic ac ons for the substance abuse sec on of the AzHIP. The Governor’s Office of Youth, Faith, and Families serves as the lead partner in overseeing implementa on of the Substance Abuse Task Force recommenda ons, with ac ons being implemented by mul ple community and state partners.

Adding further focus to this important work, Governor Doug Ducey made reducing opioid deaths the top health priority, challenging his cabinet agencies to reduce the state’s opioid deaths by 25% no later than 2018 and by 50% by 2021.

Goal Council 3 was convened with several agencies, led by the Arizona Department of Health Services, AHCCCS, and the GOYFF, to work collabora vely with other stakeholders to combine and expand our mutual efforts to address the epidemic. On June 5, 2017, Governor Doug Ducey declared a statewide public health emergency to address the growing number of opioid deaths in Arizona. The requirements under the emergency declara on included:

• Providing consulta on to the Governor on iden fying and recommending necessary elements for an EnhancedSurveillance Advisory.

• Ini a ng emergency rule making with the Arizona A orney General’s Office to develop rules for opioidprescribing and treatment within health care ins tu ons.

• Developing guidelines to educate healthcare providers on responsible prescribing prac ces.• Developing and providing training to local law enforcement agencies on proper protocols for carrying, handling,

and administering naloxone in overdose situa ons; and• Providing a report on findings and recommenda ons, including addi onal needs and response ac vi es, and

preliminary recommenda ons that require legisla ve ac on to the Governor by September 5, 2017.

A summary of ac vi es related to the emergency declara on follows.

AzHIP: Substance Abuse

47

SUBSTANCE ABUSE

Enhanced Surveillance/Repor ng of Opioid-Related Data• Governor Ducey issued an execu ve order on June 15, 2017 to increase the repor ng of opioid-related data, allowing

state health officials to have informa on within 24-hours of specific events. This was a first step toward understandingthe current burden in Arizona and build recommenda ons to be er target preven on and interven on. The specifichealth condi ons in the enhanced surveillance included suspected opioid overdoses, suspected opioid deaths,naloxone doses administered in response to either condi on, naloxone doses dispensed, and neonatal abs nencesyndrome.

• This Execu ve Order was revised and renewed on August 10, 2017, under the Governor’s Execu ve Order 2017-05Enhanced Surveillance Advisory.

• On October 9, 2017, emergency rules went into effect to con nue opioid-related repor ng on an on-going basis. Themeline for repor ng was extended from 24 hours to 5 business days.

• Opioid repor ng rules were finalized in April 2018.Emergency rulemaking for opioid prescribing and treatment within health care ins tu ons

• Emergency rules for licensed health care ins tu ons went into eff ect on June 28, 2017. These rules focus on health andsafety; provide regulatory consistency for all health care ins tu ons; establish, document, and implement policies andprocedures for prescribing, ordering, or administering opioids as part of treatment; include specifi c processes relatedto opioids in a health care ins tu on’s quality management program, and no fy the Department of a death of a pa entfrom an opioid overdose.

• ADHS conducted regular rulemaking and gathered input on how the rules could be improved through several stakehold-er workgroup mee ngs and surveys in September and October.

• Health care ins tu ons rules were fi nalized in March 2018.

Developing guidelines to educate healthcare providers on responsible prescribing prac ces• ADHS u lized the Arizona Prescrip on Drug Ini a ve Health Care Advisory Team, which has been in place since 2015, to

review and update the Arizona Opioid Prescribing Guidelines published in 2014.• The Rx Ini a ve Health Care Advisory Team, made up of professional health care associa ons, prac cing clinicians, and

subject ma er experts, met nine mes since June 2017 to review and update the guidelines.• The content of the guidelines was fi nalized in December 2017, and the fi nal document is posted at www.azhealth.gov/

opioidprescribing/• The Guidelines are a voluntary, consensus document that promotes pa ent safety and best prac ces if prescribing opi-

oids for acute and chronic pain.Current updates refl ect:

• Incorpora on of the most recent evidence, na onal guidelines (including the VA/DoD Clinical Prac ce Guideline forOpioid Therapy for Chronic Pain, 2017 and CDC Guideline for Prescribing Opioids for Chronic Pain, 2016), best prac cesfrom other states, and Arizona data.

• A shi in pain care that avoids unnecessary exposure to opioids in order to reduce the risk of adverse outcomes.Previous guidelines focused on the “safe prescribing” of opioid therapy, while these guidelines aim to preventini a ng unnecessary opioid therapy while addressing pa ents’ pain from a whole-person perspec ve.

• Emphasis on non-s gma zing language. Health care providers can counter s gma by using accurate, nonjudgmentallanguage. These guidelines employ person-first language (“Pa ents with substance use disorder” instead of “addicts”),nonjudgmental terminology (“nega ve urine drug test” instead of “dirty”) and suppor ve terms (“recovery” instead of“no cure”).

• Increased focus on preven on, recogni on, and treatment of opioid use disorder in pa ents receiving long-term opioidtherapy for chronic pain, given the high risk of developing opioid use disorder in this popula on.

• Integra on into clinical workflow (opera onaliza on). A key element of success of guideline implementa on is howseamlessly it can be incorporated into a clinician’s normal ac vi es. This revised version includes specificopera onaliza on ac ons under each guideline.


48

Developing and providing training to local law enforcement agencies on proper protocols for carrying, handling, and administering naloxone in overdose situa ons

• ADHS has free naloxone kits available for law enforcement agencies and first responders who are unable to bill fornaloxone. Agencies can request naloxone by comple ng the request form on the ADHS website.

• ADHS provided 6,317 naloxone kits for 63 law enforcement agencies between June 2017 and May 2018.• Over 1200 first responders have received training since June 2017.• ADHS received a SAMHSA grant to help support training of first responders in naloxone administra on and conduc ng

screening, brief interven on, and referral to treatment. AzPOST and the University of Arizona are partnering withADHS to implement grant ac vi es.

• 85% of people experiencing non-fatal overdoses received naloxone pre-hospital.

Providing a report on fi ndings and recommenda ons, including addi onal needs and response ac vi es, and preliminary recommenda ons that require legisla ve ac on to the Governor by September 5, 2017

• ADHS submi ed the Opioid Ac on Plan to Governor Ducey on September 5, 2017. The Opioid Ac on Plan includes 12major recommenda ons with over 50 ac ons slo ed for comple on by June 30, 2018.

In January 2018, Governor Doug Ducey called a special session of the Arizona Legislature to cra comprehensive opioid legisla on. The session began January 22 and concluded on January 25 with the unanimous passage of SB 2001. Gov-ernor Ducey signed the landmark legisla on on January 26, which included a $10 million appropria on for opioid use disorder treatment for the uninsured and underinsured. Most of the provisions of the law went into eff ect April 26, 2018.

For more informa on on Arizona’s opioid emergency response, visit www.azhealth.gov/opioid

SUBSTANCE ABUSE


49

SUICIDE

Information provided by AHCCCS: An End to Suicide in Arizona 2018 State Plan

EXECUTIVE SUMMARY

According to officials at the World Health Organiza on (WHO), more than 800,000 people die by suicide each year globally; many more make an a empt. Suicide remains the second leading cause of death among 15-29 year olds worldwide; a suicide happens once every 20 seconds. It is es mated for every completed suicide, there are 20 others who have a empted.

In Arizona, the latest data shows 1320 Arizonans died by suicide in 2015.

In 2016, there were 1310 deaths. Maricopa County had the highest rate of suicide with 683 deaths. Statewide, there were 292 suicides by women, and 1018 by men. The youngest suicide was age 9; the oldest suicide was age 96. The majority of suicides were completed with a gun.

Suicide is not just a behavioral health concern. Suicide may be linked to depression and other mental illnesses, but the majority of those who have a behavioral health illness do not commit suicide. Suicide touches every family and community in Arizona, regardless of diagnoses, zip codes, ethnici es, or faith. Suicide is the second leading cause of “years of poten al life lost” in our state for American Indians. Also of grave concern are suicides among our increasing popula ons of re rees and veterans.

In 2017, AHCCCS staff hosted quarterly Four Corner calls among suicide preven on professionals, organized suicide preven on month events and social media posts, worked with Medicaid health plans on suicide preven on plans for their members,collaborated with groups statewide with the Be Connected movement to prevent military suicides, promoted the Zero Suicide best prac ce framework at public events, and partnered with community organiza ons to discuss suicides in their neighborhoods and how we could work be er together to prevent future deaths.

The 2018 state plan is a guideline for ac vi es to prevent suicide in Arizona. This plan has been created with guidance using the framework from the Substance Abuse and Mental Health Administra on (SAMHSA) and the Na onal Ac on Alliance’s plan for Zero Suicide.

HISTORY

The 2018 End to Suicide in Arizona State Plan follows the changes incorporated in the recommenda ons from the 2012 Na onal Strategy for Suicide Preven on: Goals and Objec ves for Ac on, a joint report from the U.S. Surgeon General and the Na onal Ac on Alliance for Suicide Preven on: h p://www.surgeongeneral.gov/library/reports/na onal-strategy-suicidepreven on/full_report-rev.pdf

Also of note, on July 1, 2016, all behavioral health services in the state of Arizona were transferred from the Arizona Department of Health Services (ADHS) to the Arizona Health Care Cost Containment System (AHCCCS), the state Medicaid Agency. Suicide preven on is now managed by AHCCCS staff, in partnership with Arizona Department of Health Services.

2018 PLAN

The 2018 End to Suicide in Arizona State Plan provides recommenda ons including strategic direc ons, objec ves and strategies specific to our state. The four strategic direc ons are the same as those given in the Na onal Strategy with the goals, objec ves, and strategies closely following the na onal plan. The statewide strategies iden fied in the plan are those that can be directly supported by the Arizona Suicide Preven on Coali on and AHCCCS.

This plan was submi ed to the Arizona Coali on for Suicide Preven on and other community partners for comment and fi nal review. As such, this plan is presented in collabora on with the Coali on, on behalf of the ci zens of Arizona.

Together, our mission is to improve the health and wellbeing of all Arizonans by elimina ng suicide.

AzHIP: Suicide

50

SUICIDE

Information provided by AHCCCS: An End to Suicide in Arizona 2018 State Plan

KEY COMPONENTS

Suicide preven on should be community-based; the eff ort to reduce s gma associated with suicide, and/or asking for help to address mental illness needs to be communal. Key mental health and suicide preven on terms used in this document follow defi ni ons in the Na onal Strategy for Suicide Preven on:h p://www.surgeongeneral.gov/library/reports/na onal-strategy-suicidepreven on/full_report-rev.pdf

STRATEGIC DIRECTIONS

1. Healthy individuals and communi es2. Ready access to preven on resources for clinicians and communi es3. Treatment and support services available to clinicians, communi es, survivors4. Con nued evalua on and monitoring of preven on programming

A 2018 calendar is included in the index with a preliminary list of ac vi es related to the following goals, objec ves, and immediate points of ac on. As the year progresses, updates will be available on the AHCCCS blog.

2018 GOALS

1.Reduce the number of suicides in Arizona to zero through coordinated preven on ac vi es2. Develop broad-base support for the Zero Suicide model3. Reduce s gma related to suicide4. Promote responsible media repor ng of suicide5. Promote eff orts to reduce access to lethal means of suicide among those with iden fi ed

suicide risk6. Provide training to schools, community, clinical, and behavioral health service providers on the

preven on of suicide and related behaviors7. Promote suicide preven on as a core component of health care services8. Promote suicide preven on best prac ces among Arizona’s largest health care providers for

pa ents and staff 9. Provide care and support to individuals aff ected by suicide deaths or suicide a empts and

implement community best prac ce-based postven on strategies to help prevent furthersuicides

10. Increase the meliness and usefulness of na onal, state, tribal, and local surveillance systemsrelevant to suicide preven on and improve the ability to collect, analyze, and use this informa onfor ac on

11. Improve meliness of data collec on and analysis regarding suicide deaths12. Evaluate the impact and eff ec veness of suicide preven on interven ons and systems, and

synthesize and disseminate fi ndings13. Coordinate statewide calendar of suicide preven on ac vi es, fostering a collabora ve

community of support

For more informa on on the , visit An End to Suicide in Arizona 2018 Plan visit: h ps://azahcccs.gov/AHC-CCS/Downloads/Plans/2018AZSuicidePreven onPlan.pdf

AzHIP: Suicide

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STRATEGY PERFORMANCE INDICATOR PROGRESS

52

StrategyKey Performance Indicator

Data Source Baseline Baseline Year

2016 2020 Target

Reduce the rate of Cancer deaths by 5%. Vital Stats144.0 per

100,0002015 TBD

129.5per

100,000

1Sustain support for existing cancer screening and treatment programs.

Number of unique cases managed from abnormal breast or cervical cancer screening results through final diagnosis.

CaST & ADHS WWHP 116 2015 139 TBD

Colorectal cancer screening rate. AZ Health Plans:Health Net* & Mercy Care**

35.6% 201533%*and 47%*

80.0%

Number of health plans partnering with the Arizona Cancer Coalition to use evidence‐based strategies to increase the number of covered individuals being screened.

Health Net & Mercy Care 2 2015 2 6

Number of providers reporting melanoma cases.AZ Cancer

Registry, ADHS*164 2013 231

(2014)200

AZ Cancer Registry, ADHS*

1,165 2012 1396 (2014)

TBD

AZ Cancer Registry, ADHS+

1,398 2012 1686 (2014)

TBD

4 Increase the HPV immunization rate.

Number of males+ and females* (ages 13 to 21) completing the HPV vaccination three‐dose series.

ASIIS 31% 2015 44%*

27%+ 80%

Breast cancer screening rate. BRFSS 58.7% 2012 65.5%, 80%

Cervical cancer screening rate. BRFSS 80.5% 2012 78.6% 93.0%

BRFSS* 35.6% 2012 69.1% 70.0%

BRFSS+ 63.0% 2012 69.1% 85.0%

6

Increase the proportion of people with a family history of breast, colorectal, and/or ovarian cancer who receive genetic counseling and testing, when appropriate.

Percent of men and women completing family history and receiving genetic counseling and/or testing.

Under Development TBD 2017 Data not available

at this time. TBD

3 Reduce exposure to risk factors for skin cancer.

Number of melanoma cases (in situ * and invasive+).

Colorectal cancer screening rate (including: sigmoidoscpy and colonoscopy+, and FOBT*).

Evidence‐Based High‐Impact Strategies

Cancer

2020 Goal

5

Increase the number of Arizonans receiving breast, cervical, lung and colorectal cancer screening and associated diagnostics.

Increase access to colorectal cancer screening and treatment.2

Cancer Performance Indicator Progress - 2017/2018 Update

53



2016 2020 TargetEvidence‐Based High‐Impact

Strategies

Reduce the Chronic Lower Respiratory Disease mortality rate by 10%.

ADHS Vital Records

44.5per

100,0002013 45.1

(2015)

38.7per

100,000

1

Develop and disseminate a comprehensive statewide initiative to encourage a voluntary adoption of clean air policies.

Number of Healthy @ Home Arizona Home Safety and Family Wellness Assessments conducted in Health Start participant homes.

ADHS Health Start Program

346 2014 1603 497

2

Increase the use of home‐based, comprehensive interventions with an environmental focus for individuals with Chronic Lower Respiratory Diseases.

Number of individuals who have attended the Smoke Free Living trainings to increase their knowledge of home‐based multi‐trigger, multicomponent interventions with an environmental focus for persons with asthmas from at‐risk communities.

American Lung Association 54 2014 140 600

3Increase early intervention and participation in disease management programs.

Number of participants in chronic disease self‐management programs.

AZLWI 1,726 2015 1,106 2,000Chronic L

ower Respiratory

Diseases

2020 Goal

CLRD & Asthma Performance Indicator Progress - 2017/2018 Update

54




Strategies

Reduce deaths attributable to diabetes by 10%. Vital Records23.4per

100,0002014 25.7

(2015)

18.7per

100,000

1

Increase the utilization of an integrated, team‐based approach to the care and treatment of diabetes.

Percent of teams utilizing an integrated, team‐based approach to the care and treatment of diabetes.

HRSA UDS 19% 2015 26.9% 25.0%

2

Promote the use of established diabetes clinical guidelines and increase participation in diabetes self‐management education.

Number of participants attending Diabetes Self‐Management Education accredited or recognized programs.

AADE and ADA DSME 14,149 2012 13,660 18,000

3

Increase awareness of prevention and management practices for diabetes and prediabetes.

Pre‐diabetes* and diabetes+ prevalence rate. BRFSS 7.8% 20132.0%*

and10.8%+

5.0%

2020 Goal

Diab

etes

Diabetes Performance Indicator Progress - 2017/2018 Update

55




Strategies

Reduce the number of Healthcare‐Associated Infections by 10%.

HAI Program

CLABSI: 0.84 CAUTI: 0.87 MRSA: 1.029 CDIFF: 0.981

SSICOLO: 1.019 SSIHYST: 0.96

2015





1Improve knowledge and implementation of infection prevention and control.

Number of participants in HAI collaborative events, trainings and initiatives.

HAI Program 400 2015 NA 500

2Improve knowledge and implementation of safe injection practices.

Number of unsafe injection practice occurrences reported. HAI Program 0 2016 0 0

3

Improve knowledge and implementation of appropriate antimicrobial use and stewardship.

Percent of healthcare facilities implementing antimicrobial stewardship programs or activities.

HAI Program ACH: 60% LTC: 71%

2016 ACH: 75%LTC:71%

ACH & LTC: 80%

4Improve healthcare worker influenza vaccination rates.

Proportion of facilities with ≥91% of healthcare workers receiveing the flu vaccine. HAI Program 37.0% 2015

ACH: 58%Hemodialysis:

50%65.0%He

althcare‐Associated Infections

2020 Goal

HAIs Performance Indicator Progress - 2017/2018 Update

56




Strategies

HDD*143.0per

100,0002013 141.3

128.7 per

100,000

HDD+28.2per

100,0002013 31.1

25.4 per

100,000

1

Increase public awareness of risk factors and prevention measures for cardiovascular disease and the warning signs for heart attack and stroke.

Number of participation in evidence‐based and promising practices among health departments, health systems and community organizations.

HRSA UDS/Contractor

Report77% 2013 92.20% 97.80%

2

Increase the number of Arizonans who are trained to perform compression‐only CPR.

Number of dispatchers trained to provide telephone CPR. ADHS BEMSTS 55 2014 65 75

3

Increase the number of health systems participating in Cardiovascular Systems of Care.

Number health systems reporting that they are utilizing or implementing Cardiovascular Systems of Care.

AZLWI 1,842 2014 TBD 2,000

Heart D

isease & Strok

e

2020 GoalReduce death and events related to heart

disease* and stroke+ by 10%.

Heart Disease & Stroke Performance Indicator Progress - 2017/2018 Update

57




Strategies

Vital Stats* 7 2013 <6(2015)

<6

Vital Stats+ 447 2013 473 (2015)

420

1Improve the health of women before, after, and between pregnancy(ies).

Percent of women with a past year preventive medical visit. BRFSS 56.8% 2014 61.8% 64.4%

2Decrease the incidence of childhood injury.

Reduce the rate of hospitalizations for non‐fatal injury in children and adolescents.

HDD 200.8 2014 160.8 188.2

Percent of adolescents, ages 12‐17, who are bullied or who bully others.

NSCH 18.8% 2011‐12 18.8% 17.8%

Rate of teen births. Vital Stats29.9 per 100,000

2013 23.7 22.3

Percent of adolescents with a preventive medical visit in the past year.

NSCH 75.8% 2011‐12 75% 76.0%

Percent of children in Arizona Kindergartens that have 2 doses of MMR.

AZ IDR 94.2%2015‐16 school year

NA 95.0%

Percent of children receiving a developmental screening using a parent‐completed tool.

NSCH 21.8% 2011‐12 27.1% 26.0%

Percent of infants who are ever breastfed. Breastfeeding Report Cards (NIS) 83.2% 2013 Not Available 81.9%

Percent of infants who are breastfed exclusively through 6 months.

Breastfeeding Report Cards (NIS) 23.8% 2013 Not Available 25.5%

2020 Goal

4

Strengthen the ability of families to raise emotionally and physically healthy young children.

Materna

l & Child Hea

lth

3

Support adolescents, including youth with special health care needs, to make healthy decisions as they transition to adulthood.

5

Strengthen programs that give mothers the support they need to breastfeed their babies.

Reduce maternal* and infant+ mortality by 5%.

Maternal & Child Health Performance Indicator Progress - 2017/2018 Update

58




Strategies

BRFSS 35.8% 2013 32.6%(2015)

37.6%

YRBS 72.7% 2013 74.4%(2015)

76.3%

1Increase availability of affordable healthy food retail.

Percent of farmers markets that accept SNAP and WIC. Farmers Market Database 25.3% 2015 51% 60.0%

Percent of adults who reported meeting the aerobic physical activity guidelines (150+ min per week moderate physical activity).

BRFSS 52.9% 2013 54.5% (2015)

57.0%

Percentage of youth who reported physical activity of at least 60 minutes per day for the last 7 days.

YRBS 21.7% 2013 26.0% (2015)

27.0%

Percent of children (2‐4 years) who are overweight or obese. WIC 23.9% 2014 24.4% 20.0%

Percentage of children ages 3 to 17 who had an outpatient visit with a primary care practitioner (PCP) or obstetrical/ gynecological (OB/GYN) practitioner and who had evidence of BMI percentile documentation during the measurement year.

AHCCCS TBD 2016 TBD TBD

Percent of adults who are overweight or obese. BRFSS 61.8% 2013 65.3% (2015)

58.0%

4 Empower Arizonans to adopt a healthy lifestyle.

Percentage of Arizona adults eating vegetables at least three times and fruits at least twice daily.

BRFSS 11.3% 2013 11.1%(2015)

18.0%

2020 Goal Increase the proportion of adults and children who are at a healthy weight by 5%.

Obe

sity 2

Provide and support opportunities designed to increase physical activity.

3

Ensure coverage of, access to, and incentives for routine obesity prevention, screening, diagnosis and intervention.

Obesity Performance Indicator Progress - 2017/2018 Update

59




Strategies

BRFSS 43.6% 2014 42.7% 41.5%

Percent of high‐need elementary schools that have a school‐ based or school‐linked sealant program.

ADHS 28.8% 2015 35.0% 40.0%

Number of preschool children that have received fluoride varnish.

FTF 51,506 2015 41,805 60,000

2 Increase the utilization of the oral health care system.

Percent of children (ages 1 to 20 years), enrolled in Medicaid for ≥ 90 days, who received preventive dental services.

CMS 416 EPSDT 50% 2013 39% 60%

Proportion of local health departments and Federally Qualified Health Centers (FQHCs) that have an oral health program.

AACHCADHS 55.0% 2017 NA TBD

Number of unique individuals completing pregnancy and infant oral health training for home visitors.

ADHS 47 2016 47 TBD

4Expand and maintain community water fluoridation systems.

Percent of the population who receive optimally fluoridated drinking water.

CDC WFRS 57.8% 2012 60%

83.3% 83.0%2011/1275.2%NSHC

Oral H

ealth

1 Expand access to oral disease prevention programs.

Integrate oral health into whole‐person health.3

2020 Goal Improve the oral health status of Arizonans by 5%.

Oral Health Performance Indicator Progress - 2017/2018 Update

60




Strategies

YRBSS*14.1per

100,0002013 10

7.6per

100,000

BRFSS+15.4per

100,0002014 14.7

11.5per

100,000

1

Promote the utilization of cessation services among health plans, employers, and health systems.

Number of health plans, employers, and health systems receiving training on tobacco cessation services.

ASHLine 1,030 2016 1,030 1500

2

Utilize community outreach, education, and advocacy at the community level to prevent youth tobacco use.

Number of local policies and initiatives developed by youth coalitions.

Pima Prevention Partnership 30 2015 60 80

3

Develop and implement a statewide program to assist decision makers and advocates to promote smoke free policies.

Number of multi‐unit housing properties that have smoke‐free housing options.

Arizona SmokeFree Living 100 2015 180 500

4Promote the use of cessation treatments among adult and youth smokers.

Number of individuals utilizing the ASHLine for cessation services.

ASHLine 16,503 2015 28,312 25,000

Toba

cco

Reduce the percent of youth* and adults+ that smoke cigarettes by 25%.

2020 Goal

Tobacco Performance Indicator Progress - 2017/2018 Update

61




Strategies

Reduce the Unintentional Injury Death Rate by 5%.

ADHS Vital Stats

43.3 per

100,0002014 53.7

41.0 per

100,000

1 Increase the use of proper motor vehicle restraints.

Percent of Arizonans using safety belts. FARS 87% 2014 88% 92%

2Implement interventions to prevent or minimize the impact of falls.

Fall‐related death rate among all Arizonans. ADHS Vital Stats

11.8 per

100,0002014

13.7per

100,000

11.1per

100,000

Unintentiona

l Injury

2020 Goal

Unintentional Injury Performance Indicator Progress - 2017/2018 Update

62

Arizona Health Improvement Plan 2017/2018 Update

63

arizona health improvement plan · arizona health care cost containment system 2020 ongoing 3....

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