paul e. jarris, md, mba executive director astho
TRANSCRIPT
Paul E. Jarris, MD, MBAExecutive Director
ASTHO
75
76
77
78
79
80
81
82
America’s Health Rankings – A Call to Action for People & Their CommunitiesUnited Health Foundation, 2007
Determinants of Health and their Contribution to Premature Death, Adapted from McGinnis, et al., 2002
Individual levelClinical settingsDelivered by healthcare providers Screening, Counseling &Treatment
Individual levelClinical settingsDelivered by healthcare providers Screening, Counseling &Treatment
Community, population-based Health system changes Access to/provision of servicesInformational (Group Education, Media) Behavioral, Social Environmental & Policy Change
Community, population-based Health system changes Access to/provision of servicesInformational (Group Education, Media) Behavioral, Social Environmental & Policy Change
Community Guide:Task Force on
Community Preventive Services
Recommendations
Clinical Guide: US Preventive Services
Task Force Recommendations
Managing Population Health: The Role of the Hospital
American Hospital AssociationAssociation for Community Health Improvement
Managing Population Health: The Role of the Hospital. Health Research & Educational Trust, Chicago: April 2012. Accessed at www.hpoe.org
Source: HRET, 2012
Hospital Community Benefit
County Health Rankings Model
Mortality premature death - National Center for Health Statistics 2006-2008
Morbidity poor or fair health - Behavioral Risk Factor Surveillance System 2004-2010
Poor physical health days - Behavioral Risk Factor Surveillance System 2004-2010
Poor mental health days - Behavioral Risk Factor Surveillance System 2004-2010
Low birthweight - National Center for Health Statistics 2002-2008
Education high school graduation - National Center for Education Statistics and state-specific sources 2008-2010
Some college - American Community Survey 2006-2010
Employment - Unemployment Bureau of Labor Statistics 2010
Income children in poverty small area - Income and Poverty Estimates 2010
Family and social support/ inadequate social support - Behavioral Risk Factor Surveillance System 2006-2010
Children in single-parent households - American Community Survey 2006-2010
Air pollution-particulate matter days - U.S. Environmental Protection Agency 2007
Air pollution-ozone days - U.S. Environmental Protection Agency 2007
Access to recreational facilities - Census County Business Patterns 2009
Limited access to healthy foods - U.S. Department of Agriculture 2006
Fast food restaurants - Census County Business Patterns 2009
2 Components: Public Health and Policy Indicators
The rationale for each indicator includes references to related indicators, objectives, or recommendations from Healthy People, the Institute of Medicine (IOM), and The Guide to Community Preventive Services (Community Guide)
http://www.ipha.wildapricot.org/Resources/Documents/Annex_50%20states.pdf
Tobacco Control Nutrition, Physical Activity, and Obesity Food safety Teen Pregnancy Prevention HIV Prevention Health Care Associated Infection Prevention Motor Vehicle Injury Prevention
Indicator 1: Proportion of adults who smoke cigarettes Definition: Adults aged 18 years and older who reported ever smoking at least 100 cigarettes and who currently smoke every day or on some days…Rationale: Healthy People 2020 Objective TU–1: Reduce tobacco use among adults. TU–1.1: Cigarette smoking. Source of data: Behavioral Risk Factor Surveillance System (BRFSS), 2009
Indicator 2: Proportion of high school students who smoke cigarettes Definition: High school students who reported that they had smoked cigarettes on at least 1 day during the 30 days before the survey… Rationale: Healthy People 2020 Objective TU–2: Reduce tobacco use by adolescents. TU–2.2: Cigarettes (past month). Source of data: Youth Risk Behavior Surveillance System (YRBSS), 2009
Indicator 1: Motor vehicle-related death rate Definition: Motor vehicle-related death rate per 100,000 population among all ages. Rationale: Healthy People 2020 Objective IVP–13: Reduce motor vehicle crash-related deaths. IVP–13.1: Deaths per 100,000 population…Source of data: National Highway Transportation Safety Administration, Fatality Analysis Reporting System (http://www-fars.nhtsa.dot.gov/Main/index.aspx), 2009
Indicator 3: Seat belt use Definition: Observed belt use based on probability samples in all 50 states and DC. Rationale: Healthy People 2020 Objective IVP–15: Increase use of safety belts. (Note: HP 2020 objective uses National Occupant Protection Use Survey data.)
Public Health Indicators: Indicator 3: Proportion of low income children 2- < 5 years of age who are obese Definition: Obesity is defined as a body mass index (weight (kg)/height (m)2) ≥ the 95th percentile for age and sex based on the 2000 CDC Growth Charts…Rationale: Healthy People 2020 Objective NWS–10: Reduce the proportion of children and adolescents who are considered obese…
Policy Indicators: Indicator 1: Sale of less nutritious foods and beverages in secondary schools Definition: Can students purchase each of the following snack foods or beverages from vending machines or at the school store, canteen, or snack bar –candy; salty snacks that are not low in fat, such as regular potato chips; cookies, cakes, pastries… Rationale: Healthy People 2020 Objective NWS–2: Increase the proportion of schools that offer nutritious foods and beverages outside of school meals.
Public Health Data
Clinical Data
Measurement
Accountability
Accountable Care Organizations Patient Centered Medical Homes Community Health Assessments Community Health Improvement Plans
◦ IRS 990 Requirements for Tax Exempt Hospitals◦ PHAB Requirements for Health Agencies
Public Health Agencies/Governments
From the Population/Community Health Subcommittee:
Promote healthy living and well-being through community interventions that result in improvement of social, economic, and environmental factors.
Promote healthy living and well-being through interventions that result in adoption of the most important healthy lifestyle behaviors across the lifespan.
Promote healthy living and well-being through receipt of effective clinical preventive services across the lifespan in clinical and community settings.
• Health outcomes- Health outcomes of individuals, including health/functional
status, mortality, and quality of life; - Measures that assess the health of a total population or a
subset of a population (sub-population), including disparities across the population.
- Measures that cover the lifespan, including those that focus on children, adolescents, and the elderly.
• Determinants of health- Adoption of healthy lifestyle behaviors;
• Population-level measures in the following priority areas are encouraged:
− Overweight/obesity; − Physical activity;− Tobacco use (e.g., screening, smoking cessation); and− Nutrition
- Receipt of health promotion and education services; - Modifiable social, economic, and environmental determinants of
health with demonstrable relationship to population health outcomes.
#0421: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up (endorsed)
Percentage of patients aged 18 years and older with a calculated BMI documented in the medical record AND if the most recent BMI is outside the parameters, a follow up plan is documented. Parameters: age 65 and older BMI > or = 30 or < 22; age 18-64 BMI > or = 25 or< 18.5. Provider Level
#1999: Late HIV Diagnosis (new) Percentage of persons 13 years and older diagnosed with Stage 3 HIV infection (AIDS) within 3 months of a diagnosis of HIV infection. Population Level
Diabetes0272: Diabetes Short-Term Complications Admission Rate 0274: Diabetes Long-Term Complications Admission Rate 0638: Uncontrolled Diabetes Admission Rate
PotentialPrevalence of Diabetes in the communityPrevalence of Obesity in the community
Children0717: Number of School Days Children Miss Due to Illness0728 : Asthma Admission Rate (pediatric)1334 : Children Who Received Preventive Dental Care1346 : Children Who Are Exposed To Secondhand Smoke Inside Home1348 : Children Age 6-17 Years who Engage in Weekly Physical Activity
Percent of 19 to 35 month olds who have received full schedule of age appropriate immunizations against Measles, Mumps, Rubella, Polio, Diphtheria, Tetanus, Pertussis, Haemophilus Influenza, Hepatitis B.
The rate of birth (per 1,000) for teenagers aged 15 through 17 years.
The rate of deaths to children aged 14 years and younger caused by motor vehicle crashes per 100,000 children.
The percent of mothers who breastfeed their infants at 6 months of age.
Public Health Data
Clinical Data
Measurement
Accountability
Paul Jarris, MD, MBAExecutive Director
Association of State and Territorial Health Officials
www.astho.org