Integrating Public Health into Clinical Systems - NDSUPrevention In The Primary Care Setting - October 15, 2015

Kristin Erickson, MS, APHN-BC, RNkerickso@co.ottertail.mn.us

The Problem

Factors that influence Health

The Minnesota Solution Statewide Health Improvement Program

PartnerSHIP 4 Health

The Federal Solution CDC 1422 Community Wellness Grant

The Outcomes

Tonight’s Roadmap

The Problem: Chronic illnesses

account for four of the top seven causes of death in MN…

The Problem: The “real” causes of

these deaths are behaviors that are preventable, such as tobacco use/exposure, poor diet, and sedentary living…

Obesity is epidemic in Minnesota.

• Nearly 2/3 of adults are overweight or obese

• Only one out of four adults eats enough fruits and vegetables

• Only slightly more than half of Minnesota adults get at least a moderate level of exercise

Percent of Minnesota Adults Obese

Tobacco continues to be a problem in Minnesota.

• 14.4% of adults smoke, and many others are subjected to secondhand smoke.

• Over a quarter of high school students used tobacco in the past 30 days. www.mnadulttobaccosurvey.org

All contributing to rising health care costs…

What Influences Our Health?

• Socio-Ecological Model: – Individual: knowledge, attitudes,

beliefs

– Interpersonal: family, peers, social networks

– Organizational: employers, schools, etc.

– Community: social norms and standards

– Policy: a law, rule at an employer, college, or multi-unit housing

Where

we’v

e t

raditio

nally

spent

our

effort

s

What Influences Our Health?

• Socio-Ecological Model: – Individual: knowledge, attitudes,

beliefs

– Interpersonal: family, peers, social networks

– Organizational: employers, schools, etc.

– Community: social norms and standards

– Policy: a law, rule at an employer, college, or multi-unit housing

Where

we’v

e t

raditio

nally

spent

our

effort

sW

hat is

most e

ffectiv

e

2009 - present day

https://www.youtube.com/watch?v=SMymFKsix6A

Making the Healthy Choice the Easy Choice

Statewide Health

Improvement Program

(SHIP)

What is Policy Change?

• Policies include laws, ordinances, resolutions, mandates, regulations, or rules (both formal and informal)– Policy change includes the passing of

laws, ordinances, resolutions, mandates, regulations, or rules

– Example: organizational policy that allows the use of flex-time to accommodate physical activity

What is System Change?

• Systems impact all elements of an organization, institution, or system– Systems change impacts all elements

of an organization and often focuses on changing infrastructure within a school, park, worksite or healthcare setting

– Example: Implementation of the WHO 10 Steps to Successful Breastfeeding and becoming a baby-friendly hospital system

What is Environmental

Change?• The environment involves physical

or material elements of the economic, social, or physical environment– Environmental change is a change

made to the physical or material elements

– Example: Incorporating sidewalks, paths, and/or recreation areas into community design

Policy, systems, and environmental changes… supporting healthy individual behaviors…

How it

works

• work with schools to serve more locally grown produce

Rather than just telling kids about good

nutrition

• help employers build opportunities into the day

Rather than just telling people to get more

physical activity

• help college campuses become smoke-free

Rather than just telling students to avoid

second-hand smoke

PartnerSHIP 4 Health

Community and public health partners in Becker, Clay, Otter Tail and Wilkin counties working together to create an environment that supports improved health for all

Funded by the Statewide Health Improvement Program (SHIP) as well as multiple additional funding streams

Multiple funding streams• Statewide Health Improvement Program - SHIP

• SHIP Innovation

• CTG, CDC 1422 Community Wellness Grant

• ClearWay

• UCare

• Otto Bremer Foundation

• BCBS Foundation

• MN GreenCorps

• BCBS Center for Prevention

• NW Regional Sustainable Development

Our Objectives

IncreaseHealthy Eating

Increase Physical Activity

DecreaseTobacco Use

And Exposure

Walking Alongside Our Partners…

• Human Service Organizations

• Schools

• Worksites

• Communities

• Healthcare

• Childcare

Creating a Culture of Health

Environmental Changes

Policy Changes

System Changes

It Takes a Team

• Multi-agency, multi-county, multi-disciplinary staff• The right people doing the right work• Supported by decision-makers• Multiple funding partners

Complete Streets Active Transportation Safe Routes to School

Active School Day:

Active Recess and

Active Classrooms

Comprehensive School Physical Activity Programs:

Bike FleetWorksite Wellness

INCREASING PHYSICAL ACTIVITY FOR ALL

Worksite Wellness: Lactation Room

Farmers MarketsFresh Connect Food Hub

and Farm to School

Human Service Organizations

Community Gardens Healthy Food Pantry Donations

INCREASING HEALTHY FOOD ACCESS FOR ALL

Smoke-Free Multi-Housing Units

Clinical Guideline Implementation

Tobacco-Free Worksites and Secondary Campuses

Counter Marketing and Point of Sale

Increase Access to Tobacco Cessation Services

Smoke-free Childcare and Foster Care

DECREASING TOBACCO USE AND EXPOSURE

Encourage Clinical

Obesity and Tobacco

Guidelines

Encourage Worksite

Wellness to Foster Healthy Role Models

HEALTH CARE STRATEGY #1

ELEVEN PARTNERS Community Health

Service, Inc. (Migrant Health)

Family HealthCare Center (FQHC)

Orthopedic and Sports Physical Therapy, Inc.

Lake Region Healthcare, Essentia Health, Sanford Health, and Perham Health Clinics

Local Public Health Departments

HEALTH CARE STRATEGY

Five Partners

• Essentia Health St. Mary’s in Detroit Lakes

• Lake Region Healthcare in Fergus Falls

• Perham Health in Perham

• St. Francis in Breckenridge

• Essentia Health and Sanford Health in Fargo-Moorhead

Participate with Local Hospitals in their

Community Health Needs Assessment and Strategic

Planning Process

Health Care Strategy #2

• Minnesota bent the curve and outperformed nearby states• Significant health care savings linked to 60,000 more Minnesotans at a healthy weight

U.S. and Regional Obesity Rates

Data source: CDC Behavioral Risk Factor Surveillance System

http://www.health.state.mn.us/news/pressrel/2015/ship042015.html

Initial Results:Minnesota Alone Trims Obesity Rates Among Upper Midwest States

2015

A NEW CDC GRANT

OPPORTUNITY

“Community Wellness Grant” (CWG)

FUNDING TO PREVENT OBESITY, DIABETES, AND HEART DISEASE AND STROKE

The Minnesota Department of Health (MDH) received new Centers for Disease Control & Prevention (CDC) funding to support local communities to improve health.

PartnerSHIP 4 Health is one of FOUR selected communities to receive funding targeted for cross-cutting, creative approaches that can positively impact the health of residents, especially those with the greatest health needs.

The key components and strategies of this grant enhance communities’ current efforts through the Statewide Health Improvement Program (SHIP), The Minnesota Accountable Health Model or SIM, and Health Care Homes.

Four Components - Fifteen Strategies – 11/15 related to healthcare

Improve the Quality of Health Systems, Care Systems, and Care Delivery for People w/Hypertension and Pre-Diabetes Disparities

2.1 Increase electronic health records (EHR) adoption and the use of health information

technology (HIT) to improve performance (e.g., implement advanced Meaningful

Use data strategies to identify patient populations who experience CVD-related

disparities)

2.2 Increase the institutionalization and monitoring of aggregated/standardized quality

measures at the provider level (e.g., use dashboard measures to monitor

healthcare disparities and implement activities to eliminate healthcare disparities)

2.3 Increase engagement of non-physician team members (i.e., nurses, pharmacists,

nutritionists, physical therapists and patient navigators/community health workers)

in hypertension management in community health care systems

2.4 Increase use of self-measured blood pressure monitoring tied with clinical support

2.5 Implement systems to facilitate identification of patients with undiagnosed

hypertension and people with prediabetes

Link Clinical and Community Resources to Support Heart Disease, Stroke and Type 2 Diabetes Prevention

2.6 Increase engagement of CHWs (such as Community Paramedics) to

promote linkages between health systems and community

resources for adults with high blood pressure and adults with

prediabetes or at high risk for type 2 diabetes

2.7 Increase engagement of community pharmacists in the provision of

medication-self management for adults with high blood pressure

2.8 Implement systems to facilitate bi-directional referral between

community resources and health systems, including lifestyle change

programs (e.g., EHRs, 800 numbers, 211 referral systems, etc.)

• Washington, D.C., September 21, 2015 – At 27.6 percent, Minnesota now has the 36th highest adult obesity rate in the nation, according to The State of Obesity: Better Policies for a Healthier America, a report from the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).

• Across the country, rates increased in five states (Kansas, Minnesota, New Mexico, Ohio and Utah) and remained stable in the rest.

• Minnesota’s increase in 2014 comes despite investments in the very areas advocated by the Trust organization and the Robert Wood Johnson Foundation, which co-released Monday’s report.

• Minnesota’s Statewide Health Improvement Program, or SHIP, has spent nearly $100 million since 2009 on projects to get people to eat better, exercise more and smoke less.

http://healthyamericans.org/reports/stateofobesity2015/release.php?stateid=MNhttp://healthyamericans.org/reports/stateofobesity2015/http://stateofobesity.org/http://www.startribune.com/minnesota-one-of-five-states-with-more-obese-adults-in-2014/328583361/

Current Outcomes: September 2015 DataObesity Rates Remain High

Questions?