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Partnering for better communities

Partnering for better communities. 15 th Annual Indiana Rural Health Conference June 14, 2012 Gregory N. Larkin, MD, FAAFP State Health Commissioner. Objectives. To understand Indiana’s health risk profile compared to national rankings To learn of important Indiana successes in health

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Partnering for better communities

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  1. Partnering for better communities 15th Annual Indiana Rural Health Conference June 14, 2012 Gregory N. Larkin, MD, FAAFP State Health Commissioner

  2. Objectives • To understand Indiana’s health risk profile compared to national rankings • To learn of important Indiana successes in health • To learn of various new and on-going ISDH programs that incorporate community wide efforts for solutions

  3. Indiana’s National Ranking • 2010 national rankings: • 38th in overall health • 41st in smoking adults • 37th in adult obesity • 36th in diabetes • 41st in cancer deaths • 48th in Public Health Funding/capita

  4. Some Success Stories • Tobacco Reduction Rates • 10 years, 27% to 21% • Increased funding in 2011 • More “clean air work place policies” being adopted or discussed • Obesity “stabilizing” (sort of). • Immunizations – novel approach, good start

  5. INShape • Created by Governor Daniels to motivate, educate and connect Hoosiers for healthier choices • Web-based program that connects credible resources for interested individuals and businesses • 59% of Hoosiers know of “INShape” with interactive communication with 50,000 from all counties and 2,000 Twitter followers and growing Ellen Whitt Asst. Commissioner INShape

  6. Dr. James Howell Asst. Commissioner Dr. Duwve CMO Pam Pontones State Epidemiologist

  7. Outbreak: planes, buses and quarantines • International traveling Hoosier- infected • Misdiagnosed for 2 weeks, family infected • One family member quarantined by legal order • Emergency Intervention by ISDH: • CDC, LHD, Indiana hospitals and providers alerted • Church members screened, vaccination • Bus of children- CHIRP • Entire workforce temporarily shut down, screened and vaccinated • Over 700 people impacted, only 14 cases due to response

  8. Top 5 reported medical errors in Indiana 2006-2010 Terry Whitson Asst. Commissioner

  9. Access and Value of Health Care • Indiana: 39th/50th in physician/capita access • Indiana remains a conservative policy state for “physician extenders” • Physician distribution challenging Having a lower access to either primary care physicians or primary care physician “extenders” reduces delivery of the most cost effective method of community health care: primary care. Primary Care targets prevention and chronic disease management The greatest VALUE for health care dollars is prevention and management

  10. Adult Current Smokers Indiana 2006-2010 Source: Indiana 2006-2010 BRFSS

  11. Three-Level Adult Smoker Status by Age - Indiana 2010 Source: Indiana 2010 BRFSS

  12. Adults Considered Obese*Indiana 2006-2010 *BMI >= 30.0 Source: Indiana 2006-2010 BRFSS

  13. No Data <10% 10%–14% 15%–19% 20%-24% 25-29% Obesity Trends* Among U.S. AdultsBRFSS 2000 (BMI=>30.0 - or a person 5 feet 6 inches tall weighing 186 or more pounds*) *CDC Adult BMI Calculator Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2000.

  14. No Data <10% 10%–14% 15%–19% 20%-24% 25-29% Obesity Trends* Among U.S. AdultsBRFSS 2001 (BMI=>30.0 - or a person 5 feet 6 inches tall weighing 186 or more pounds*) *CDC Adult BMI Calculator Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2001.

  15. No Data <10% 10%–14% 15%–19% 20%-24% 25-29% Obesity Trends* Among U.S. AdultsBRFSS 2002 (BMI=>30.0 - or a person 5 feet 6 inches tall weighing 186 or more pounds*) *CDC Adult BMI Calculator Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2002.

  16. No Data <10% 10%–14% 15%–19% 20%-24% 25-29% Obesity Trends* Among U.S. AdultsBRFSS 2003 (BMI=>30.0 - or a person 5 feet 6 inches tall weighing 186 or more pounds*) *CDC Adult BMI Calculator Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2003.

  17. No Data <10% 10%–14% 15%–19% 20%-24% 25-29% Obesity Trends* Among U.S. AdultsBRFSS 2004 (BMI=>30.0 - or a person 5 feet 6 inches tall weighing 186 or more pounds*) *CDC Adult BMI Calculator Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2004.

  18. 10%–14% 15%–19% 20%-24% 25%-29% 30-34% >=35% Obesity Trends* Among U.S. AdultsBRFSS 2005 (BMI=>30.0 - or a person 5 feet 6 inches tall weighing 186 or more pounds*) *CDC Adult BMI Calculator Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005.

  19. 10%–14% 15%–19% 20%-24% 25%-29% 30-34% >=35% Obesity Trends* Among U.S. AdultsBRFSS 2006 (BMI=>30.0 - or a person 5 feet 6 inches tall weighing 186 or more pounds*) *CDC Adult BMI Calculator Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2006.

  20. 10%–14% 15%–19% 20%-24% 25%-29% 30-34% >=35% Obesity Trends* Among U.S. AdultsBRFSS 2007 (BMI=>30.0 - or a person 5 feet 6 inches tall weighing 186 or more pounds*) *CDC Adult BMI Calculator Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2007.

  21. 10%–14% 15%–19% 20%-24% 25%-29% 30-34% >=35% Obesity Trends* Among U.S. AdultsBRFSS 2008 (BMI=>30.0 - or a person 5 feet 6 inches tall weighing 186 or more pounds*) 10%–14% 15%–19% 20%-24% 25%-29% 30-34% >=35% *CDC Adult BMI Calculator Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2008.

  22. 10%–14% 15%–19% 20%-24% 25%-29% 30-34% >=35% Obesity Trends* Among U.S. AdultsBRFSS 2009 (BMI=>30.0 - or a person 5 feet 6 inches tall weighing 186 or more pounds*) 10%–14% 15%–19% 20%-24% 25%-29% 30-34% >=35% *CDC Adult BMI Calculator Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2009.

  23. 10%–14% 15%–19% 20%-24% 25%-29% 30-34% >=35% Obesity Trends* Among U.S. AdultsBRFSS 2010 (BMI=>30.0 - or a person 5 feet 6 inches tall weighing 186 or more pounds*) 10%–14% 15%–19% 20%-24% 25%-29% 30-34% >=35% *CDC Adult BMI Calculator Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2010.

  24. Indiana State Health Improvement Plan (I-SHIP) Vision: Optimal mental, physical, environmental, social, and intellectual well-being for all Hoosiers, leading to a healthy, productive, vibrant and prosperous state.

  25. I-SHIP • Targets: • Decrease Tobacco Usage • Reduce Prevalence of Obesity • Reduce Infant Mortality • Reduce HIV, STDs, and Viral Hepatitis • Assure Food Safety • Reduce Healthcare Associated Infections • Examines health promotion and access to care based on primary, secondary and tertiary prevention. • Everyone has a role!

  26. Committee Representation • Butler University College of Pharmacy and Health Sciences • Council of Community Mental Health • Indiana Dental Association • Association of School Nurses • Primary Health Care Association • Indiana State University College of Nursing, Health and Human Services • LHD (1) • Rural Health Association • I.U. School of Nursing • County Board of Health • LHOs (2) • Vincennes University • ISDH Minority Health • Public Health Association • ISDH Programs (11) • IUPUI Chancellor for Public Health • Indiana Hospital Association • IU Dept. of Applied Health Science

  27. Goals of I-SHIP • Promote improvement of population health and system capacity to perform essential services • Utilize strategic planning as the framework for planning process • Serve as a guiding framework for Community Health Improvement Plans across Indiana • Promote development of a process that is: • Comprehensive and sustainable • Foundation for capacity building at state and local levels • Of benefit to the state as a whole • Grounded in evidence-based data

  28. What is Public Health Accreditation? Kristin Adams Director OPHPM • The measurement of health department performance against a set of nationally recognized, practice-focused and evidenced-based standards. • The issuance of recognition of achievement of accreditation within a specified time frame by a nationally recognized entity. • The continual development, revision, and distribution of public health standards. • The result of many years of deliberate work!

  29. Public Health Accreditation Gap Analysis for Local Health Depts. • Determined what the health department has in place and where to focus future efforts. • Facilitated Assessment • It took approximately 2 hours for most Local Health Departments

  30. Steuben La Porte St. Joseph La Grange Elkhart Lake Porter De Kalb Noble Completed gap analysis Marshall Starke Kosciusko Whitley Allen Jasper Pulaski East Chicago City Fulton Newton Wabash Huntington Miami Wells Adams Cass White Carroll Benton Grant Blackford Jay Howard City of Gary Tippecanoe Warren Clinton Tipton Delaware Madison Randolph Montgomery Hamilton Boone Henry Fountain Wayne Lake Parke Ver- Marion Hancock Hendricks Putnam mil- lion Rush Union Fayette Shelby Johnson Vigo Morgan Clay Franklin Owen Decatur Bartholomew Brown Monroe Dearborn Sullivan Ripley Greene Jennings Jackson Ohio Lawrence Switzerland Jefferson Knox Martin Daviess Washington Scott Orange Clark Pike Dubois Gibson Crawford Floyd Harrison Perry Warrick Posey Vander- Spencer burgh

  31. Today’s LHD Immunization Challenges • Historically, LHDs have evolved as a primary provider of immunizations • Access, cost • Private providers quit immunizing: reimbursement, cost, schedule complexity • Most funding for LHDs immunizations is solely intended for the “uninsured” (no insurance) or “under insured” (insurance that DOES NOT cover vaccines) • CDC auditing usage to assure appropriateness • ISDH in compliance to restrict inappropriate usage

  32. Immunization Administration Problem and Solution • In most rural counties either local providers “restart” immunizing or LHD develop capabilities to immunize the “insured” • LHDs do not have the funding for private stock nor the administrative billing capabilities • ISDH to offer LHDs near seamless capabilities to immunize both insured and uninsured • VAXCARE (39% of Indiana’s LHD now use): • Provides private stock at no cost to LHD, fully provides billing needs, gives LHD for vaccine administration fees

  33. CHIRP UPDATE • ISDH was awarded $1 M to develop bidirectional CHIRP data flow between 5 Indiana HIOs and major EMRs • Thousands of Indiana physicians and all major hospital systems currently connected to a HIO • Once completed, CHIRP data will be readily and immediately available for provider and patient review • MyVaxIndiana- first in the nation!

  34. Indiana Tobacco Reduction Efforts • Indiana Tobacco Prevention and Cessation (ITPC) • Independent agency created 10 years ago to administer grants to county and statewide anti-tobacco coalitions • Nationally recognized processes • Every county has a different coalition profile • Reduction impact paralleled national reduction trends, but Indiana remains 46/50th

  35. July, 2011- Stronger Partners • Indiana State Department of Health becomes lead agency for anti-tobacco efforts • ITPC defunded and merged into ISDH • Eliminates redundancy of administrative support • Leverages existing ISDH health promotion/programs with those of ITPC • Chronic Disease • Respiratory Disease • Cancer • Non redundant elements of ITPC remains fully intact • ITPC executive director now Assistant Commissioner • Separate ISDH commission, Tobacco Prevention/Cessation, established

  36. Resources for Indiana Tobacco Wars • All 2011 ITPC Grant awards to remain fully intact (2 years) • Additionally, INCREASED funding • Elimination of redundant administration • Dissemination of significant “reserve” ITPC monies • Estimated $2M MORE funding in 2011, 2012, 2013 • Solicit more community/state grants for tobacco cessation • Seek INNOVATION

  37. July 1, 2011 • Indiana becomes a “Clean Air” State • Exposure to “second hand” smoke NOT allowed in most public places • ATC is the enforcing agency • ISDH will provide educational and cessation support

  38. Indiana and Statewide Trauma Care System Art Logsdon Trauma/Injury Prevention What is a statewide trauma care system? Why should Indiana develop one? History of Indiana’s path towards development Logical next steps

  39. Statewide Trauma Systems Captain Leo Larkin, MD, 1952 WWII Surgeon Purple Heart, Wake Island, Pacific warfront “Commish” Larkin, MD, age 3 years • Field doctors in WWII learned: • Importance of close coordination • Importance of rapid stabilization and transport of severe trauma injured soldiers • Importance of “intense (trauma) care” centers • Thousands of lives saved vs. WWI care practices • Vietnam medical lessons: • “Golden Hour” from injury to care crucial! • Field and hospital coordination and integration is vital • Airlift medical services introduced Evolution of “Trauma Care”

  40. Domestic Applications of Lessons Learned Trauma injuries, battlefield or highway, require rapid evaluation by skilled personnel and immediately transported to a qualified care center Trauma care centers are unique in capabilities and are NOT the typical community “emergency room” When trauma patients are transported, ground or air, to trauma centers, the preventable death rates DROP by 15-30% and significant reduction of chronic disabilities and overall community care costs.

  41. Components of a Statewide Trauma Care System • Consistent, expert initial injury evaluation • Determines who should be immediately referred to a Trauma Care system • Consistent transportation protocols • National expert guidelines determines when and how a patient is transported to a trauma care center vs. “ER” • Certification of trauma care centers • Assures each trauma care center is staffed and equipped appropriately • Performance improvement systems • Dynamic data registries to assess system improvement and outcomes • Education and policy development of injury prevention

  42. Indiana’s Administrative Journey • 2004- ISDH Trauma System Advisory Task Force - ~ 50 members • 2006- IC 16-19-3-28 (Public Law 155)- ISDH as the lead agency for statewide trauma system, with rule-making authority • 2008, December- ACS trauma system consultation • 2010, Gov. Daniels by Executive Order creates the Indiana State Trauma Care Committee, ISDH State Health Commissioner, Chair

  43. Indiana Today • Indiana State Department of Health • Trauma care system development (IC 16-19-3-28, PL 155) • Rule authority for TCC designation and system development • Hospital, long term care and ambulatory clinic regulation • Director of Trauma Care and Injury Prevention • Indiana Department of Homeland Security • Emergency Medical Services (ambulances) • Emergency Medical Commission governance • 41 states combine EMS and Trauma Care in 1 state agency, most often the state public health department • 80% of motor vehicle accident deaths occur in rural Indiana where 25% of the population lives.

  44. Indiana Trauma Centers (I/II) La Grange Elkhart Steuben La Porte St. Joseph Lake Porter De Kalb Noble Marshall Kosciusko Starke 9 trauma centers 1 South Bend 2 Fort Wayne 4 Indianapolis 2 Evansville Allen Whitley Jasper Pulaski Fulton Newton Wabash Huntington Miami Wells Adams Cass White Benton Carroll Grant Tippecanoe Howard Jay Blackford Warren Clinton Tipton Madison Delaware Randolph Montgomery Hamilton Boone Henry Fountain Wayne Parke Ver- Marion Hancock Hendricks Putnam mil- lion Rush Union Fayette Shelby Johnson Clay Vigo (Ohio has 38 trauma centers) Morgan Franklin Owen Decatur Bartholomew Brown Monroe Dearborn Sullivan Ripley Greene Jennings Jackson Ohio Lawrence Switzerland Jefferson Knox Martin Daviess Washington Scott Orange Clark Pike Dubois Gibson Crawford Floyd Harrison Perry Warrick Posey Vander- Spencer burgh

  45. Indiana’s Ability to Respond for “Golden Hour” of Critical Care 1 La Grange Elkhart Steuben La Porte St. Joseph Lake Porter De Kalb Noble Marshall Kosciusko Starke 2 Allen Whitley Jasper Pulaski Fulton Newton Wabash Huntington Miami Wells Adams Cass White Benton Carroll Ground transportation (46% of Hoosiers) Grant Tippecanoe Howard Jay Blackford Warren Clinton Tipton Delaware Madison Randolph Montgomery Hamilton Boone Henry Fountain Wayne Helicopter (91% Hoosiers) (50% Availability) Parke 4 Ver- Marion Hancock Hendricks Putnam mil- lion Rush Union Fayette Shelby Johnson Clay Vigo Morgan Franklin Owen Decatur Bartholomew Brown Monroe Dearborn Sullivan Ripley Greene Jennings Jackson Ohio Lawrence Switzerland Jefferson Knox Martin Daviess Washington Scott Orange Clark Pike Dubois Gibson Crawford Floyd Harrison Perry Warrick 2 Posey Spencer

  46. Proposed Trauma Triage and Transportation Rule

  47. “Birth” of Indiana’s Statewide Trauma Care System: May 18, 2012

  48. Logical Next Steps? • Integrate KEY trauma care system components • ISDH: Trauma care system ownership, injury/illness data bases (registries), health care facility regulation • IDHS: Emergency care transportation (EMS) • Better State integration of Emergency Care Components (require legislative actions) • National expert evaluation of Indiana, American College of Surgeons (ACS), recommended in 2008 that EMS and trauma care should be in the same state agency for improved integration and coordination of trauma patient care. ISDH develops a Trauma Care and Injury Prevention division • Redefine the EMS governance commission and Trauma Care Committee to include all components of state emergency care (e.g. now primarily ambulance representation vs. adding more hospital and trauma care center representation)

  49. Coming to a Region Near You! • Statewide “Trauma Care and Injury Prevention” Listening Tour • Meeting in each district • Key stakeholders invited • Discuss challenges and successes for preventing injuries and improved outcomes from trauma

  50. June Listening Tour Locations • District 10 • Evansville – Monday, June 4 • Evansville Vanderburgh Central Library • 200 SE Martin Luther King Jr. Blvd. • District 7 • Terre Haute – Wednesday, June 20 • Landsbaum Center for Health Education • 1433 N. 6½ Street • District 1 • Portage – Thursday, June 28 • Oakwood Grand Hall • Woodland Park

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