indiana health issues: how chws can help christopher a. maxey, mba primary care office manager...
TRANSCRIPT
Indiana Health Issues: How CHWs
Can Help
Christopher A. Maxey, MBAPrimary Care Office ManagerDivision of Chronic Disease, Primary Care, & Rural Health
Annual CHW/CRS ConferenceMay 13, 2015
Overview
Indiana State Department of Health’s Top Three PrioritiesReduce Indiana’s Infant Mortality RateReduce Indiana’s Obesity RateReduce Indiana’s Smoking Rate
REDUCE INDIANA’S INFANT MORTALITY RATE
Infant Mortality
What is Infant Mortality?When a baby dies after taking their first
breath, but before he or she reaches their first birthday.
Infant Mortality
Three Primary Causes of Infant MortalityPerinatal ComplicationsBirth DefectsSudden Unexpected Infant Death (SUIDs)
Indiana Infant Mortality 594 infants died before their 1st birthday in 2013 Indiana consistently worse than the US and national
goal every year IN 7.1 per 1,000 (2013) / US 5.98 per 1,000
(2012) / Healthy People 2020 Goal 6.0 per 1,000 Indiana has only been below 7 twice in 114 year
recorded history (6.9 in 2008 and 6.7 in 2012) Increase in black infant mortality from 12.3 in 2011 to
15.3 per 1,000 live births in 2013 Decrease in white infant mortality from
6.9 in 2011 to 5.8 per 1,000 live births in 2013
2006 2007 2008 2009 2010 2011 2012 2013
United States 6.7 6.8 6.6 6.4 6.1 6.07 5.98 NaN
Indiana 7.9 7.5 6.9 7.8 7.5 7.7 6.7 7.1
Healthy People 2020 Goal 6 6 6 6 6 6 6 6
0.5
1.5
2.5
3.5
4.5
5.5
6.5
7.5
8.5
Infant Mortality Rates, United States & Indiana, 2006-2013
Rate
per
1,0
00 L
ive B
irth
s
***US 2013 IMR pending
***
Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [Feb. 11, 2015]United States Original Source: Centers for Disease Control and Prevention National Center for Health StatisticsIndiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team
Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [February 11, 2015]
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
7.6 7.48.1 8.0 7.9 7.5
6.97.8
7.5 7.76.7
7.1
6.5 6.4 6.9 6.96.4 6.5
5.5
6.4 6.0
6.9
5.55.8
15.615.9
17.116.9
18.1
15.714.9
16.1
14.7
12.3
14.515.3
Total
White
Rate
per
1,0
00 L
ive
Bir
ths
Indiana Infant Mortality by Race, 2002-2013
2013 Indiana Infant Mortality by Hospital District
Risk Factors of Infant MortalityWhere does Indiana stand?
Indiana has better preterm rates and similar low birthweight rates compared to the national average
Rate of SUIDs typically worse than the national rate Smoking rate among pregnant women substantially
worse than the national rate – Indiana always among the worst 10 states
One-third of Indiana pregnant women do not receive early prenatal care, worse than the US and national goal
Concerning racial disparities for ALL INDICATORS
2006 2007 2008 2009 2010 2011 2012 2013
United States 54.5 56.8 55.4 53.9 51.6 43.3 42.5 NaN
Indiana 61.518500290814
9
44.583644490018
7
49.617158515544
8
71.987553119848
42.9 60.9 56.5 57.8
Healthy People 2020
50 50 50 50 50 50 50 50
5
15
25
35
45
55
65
75
Rate of SIDS for United States & Indiana, 2006-2013
Ra
te p
er
10
0,0
00
liv
e b
irth
s
***
SIDS = Sudden infant death syndrome (R95) Source: Indiana State Department of Health, Maternal & Child Epidemiology Division [February 20, 2015]United States Original: Centers for Disease Control and Prevention National Center for Health StatisticsIndiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team
***US 2013 data pending
SIDS = Sudden infant death syndrome (R95) Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team, 2015
2006 2007 2008 2009 2010 2011 2012 20130
20
40
60
80
100
120
140
61.5
44.6 49.6
72.0
42.9
60.9 56.5 57.8
58.4
42.848.5
64.2
30.1
53.4 51.6 55.1
86.6
58.2 57.2
127.3119.4
111.0119.5
70.0
Indiana
White
BlackR
AT
E P
ER
100
,000
LIV
E B
IRT
HS
YEAR
Rate of SIDS by Race, Indiana, 2006-2013
Suffocation Deaths = Accidental suffocation and strangulation in bed (W75) Source: Indiana State Department of Health, Maternal & Child Epidemiology Division [February 20, 2015]United States Original: Centers for Disease Control and Prevention National Center for Health StatisticsIndiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team
***US 2013 data pending
2006 2007 2008 2009 2010 2011 2012 2013
United States 13.8 15.5 17.3 16.1 15.7 12.1 18.3 NaN
Indiana 23.4888819292202
28.9793689185122
33.8298808060533
31.3494182941271
22.7 22.7 13.2 20.5
2.5
7.5
12.5
17.5
22.5
27.5
32.5
37.5
Rate of Suffocation Deaths for United States & In-diana, 2006-2013
RATE
PER
100
,000
LIV
E BI
RTH
S
***
Suffocation Deaths = Accidental suffocation and strangulation in bed (W75) Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team, 2015
2006 2007 2008 2009 2010 2011 2012 20130
20
40
60
80
100
120
23.5
29.033.8 31.3
22.7 22.7
13.220.5
15.622.0
29.6
22.3
15.7 17.3
7.4
16.4
67.3 67.9
76.2
98.0
59.7 60.6 59.7 60.0
Indiana
White
BlackRA
TE P
ER 1
00,0
00 L
IVE
BIRT
HS
YEAR
Rate of Suffocation Deaths by Race, Indiana, 2006-2013
Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [February 20, 2015]United States Original: Centers for Disease Control and Prevention National Center for Health Statistics Indiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team
2007 2008 2009 2010 2011 2012 2013
Indiana 18.5 18.5 18.2 17.1 16.6 16.5 15.7
United States 10.4 9.7 9.3 9.2 8.9 8.7 8.5
Healthy People 2020 Goal
1.4 1.4 1.4 1.4 1.4 1.4 1.4
2.5
7.5
12.5
17.5
22.5
Percent of Women Who Smoked During Pregnancy, United States & Indiana, 2007-
2013
PE
RC
EN
T
2007 2008 2009 2010 2011 2012 20130.0
4.0
8.0
12.0
16.0
20.0
24.0
28.0
18.5 18.5 18.217.1 16.6 16.5
15.7
19.6 19.9 19.818.4 17.9 18.1 17.4
13.314.3
13.4 13.6 13.3 13.011.8
Percent of Women Who Smoked During Pregnancy by Race, Indiana, 2007-2013
IndianaWhiteBlack
YEAR
PERC
ENT
Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team, 2015
Early Prenatal Care = First TrimesterSource: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [February 20, 2015]United States Original Source: Centers for Disease Control and Prevention National Center for Health StatisticsIndiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team
2007 2008 2009 2010 2011 2012 2013
Indiana 67.5 66.6 66.1 68.5 68.1 68.4 67.4
United States 70.8 71 72.1 73.1 73.7 74.1 74.2
Healthy People 2020 77.9 77.9 77.9 77.9 77.9 77.9 77.9
10.0
30.0
50.0
70.0
90.0
Percent of Women Receiving Early Prenatal Care, United States & Indiana, 2007-2013
PE
RC
EN
T
Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team, 2015
2007 2008 2009 2010 2011 2012 20130.0
20.0
40.0
60.0
80.0
100.0
67.5 66.6 66.1 68.5 68.1 68.4 67.4
69.4 68.9 68.5 70.7 70.3 70.7 69.9
53.4 52.6 53.156.0 56.1 57.4 56.8
Percent of Women Receiving Early Prenatal Care by Race, Indiana, 2007-2013
Indiana
White
Black
YEAR
PERC
ENT
How CHWs Can Help Reduce Indiana’s Infant Mortality Rate Encourage pregnant women to:
Seek early and routine prenatal careTake folic acidStop smokingMaintain a healthy weight
Encourage new moms to:Practice safe sleepBreastfeed
How CHWs Can Help Reduce Indiana’s Infant Mortality Rate Encourage women of childbearing age
(14-44) to:Maintain a healthy weightAvoid alcohol, tobacco, and drugsGet immunizedIf they are thinking of getting pregnant in
the next couple of yearsTake folic acidGet prenatal care
REDUCE INDIANA’S OBESITY RATE
Percentage of Overweight and Obese Adults – Indiana, 1995-2010, 2011-2013*
0
10
20
30
40
50
60
70
80
Overweight
Obese
Pe
rce
nta
ge
64.5% overweight
31.8% obese
*Beginning in 2011, the prevalence estimate was determined using a new, more precise methodology, including the addition of cell phone respondents and new weighting techniques; therefore, the estimates after 2010 should not be compared to earlier prevalence estimates. Source: Indiana Behavioral Risk Factor Surveillance System
Prevalence* of Self-Reported Obesity Among Indiana Adults by County, BRFSS, 2013
*Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011.
How do we even start…?
“…USPSTF review [sic] concluded that all adults should be screened for obesity and those with obesity should be offered intensive behavioral counseling to promote sustained weight loss.”
How CHWs Can Help Reduce Obesity in Indiana
Use Brief Action Planning with your patients to help them build self confidence and self efficacy to help them lose weight
What is Brief Action Planning?
Brief Action Planning is a highly structured, stepped-care, self-management support technique grounded in the principles and practice of Motivational Interviewing and behavior change theory and research (Gutnick et al 2014)
What is Brief Action Planning?
Brief Action Planning is a structured way of interacting with individuals interested in making a concrete action plan for some aspect of their health.
It is based on the principles and practice of Motivational Interviewing and is supported by evidence from behavioral science and self-management support.
The core skills of Brief Action Planning can be learned by anyone interested in supporting others to make change.
The Spirit of Motivational Interviewing
• The Spirit of Motivational Interviewing underlies Brief Action Planning1. Compassion: Actively promote the other’s
welfare.2. Acceptance: Respect autonomy and the right to
change or not change.3. Partnership: Work in collaboration.4. Evocation: Ideas come from the
person, not the clinician or helper.
“Is there anything you would like to do for your health in the next week or two?”
“How confident (on a scale from 0 to 10) do you feel about carrying out your plan?”
Have an idea?
Not sure?Behavioral Menu
Not at this time
SMART Behavioral PlanSpecificMeasureableAchievableRelevantTimely
Permission to check next time
1) Ask permission to share ideas.2) Share 2-3 ideas.3) Ask if any of these ideas or something else might work.
Elicit a Commitment Statement
Confidence ≥7 Confidence <7,Problem Solving
Follow-up
“Would you like to set a specific time to check back in with me so we can review how things have been going with the plan?”
Follow-up
“How did it go with your plan?”
SuccessPartial success Did not try or no
success
Recognize partial success
“What would you like to do next?”
Reassure that this is common occurrence
Recognize success
REDUCE INDIANA’S SMOKING RATE
Smoking Burden in Indiana
11,100 deaths/annually Nearly 1 in 4 adults smoke (22%-2013) For every death, two new youth start
and 30 are living with a chronic disease
Smoking Burden in Indiana
$2.08 billion in annual health care costs $487 million in Medicaid costs Indiana taxpayers pay $566 per
household to treat tobacco-related disease
For every pack of cigarettes sold in Indiana, it spends $15.90 in health care costs related to tobacco
How CHWs Can Help Reduce Smoking in Indiana
Refer smokers who want to quit in the next 30-60 days to the Indiana Tobacco Quitline
Indiana Tobacco Quitline
The Indiana Tobacco Quitline is a free cessation counseling service that helps Indiana smokers quit tobacco.
This phone-based one-on-one coaching offers tobacco users who have decided to quit help through the process to quit for life.
What is a Quitline?
Telephone-based Cessation Services Offered Toll-free Evidence-based Proactive Coaches
Highly trained in cognitive behavioral therapy 240 hours of training Spanish speaking competency
(170 other languages) Educated up to graduate level Over 50% with 3+ years prior experience
in counseling
The Program
4 prearranged calls w/coach10 prearranged calls for pregnant woman (special program)5 prearranged calls for youthUnlimited Web coaching Unlimited call in privileges and access to coachesFree 2-week NRT starter kit (uninsured, Medicaid,Medicare)Stage-based Support Material
The Program WorksPractices based on 25 yrs of research
helped hundreds of thousands of smokers quit & stay quit
1. Quit at personal pace
2. Conquer urges to smoke
3. Use Pharmacology if necessary
4. Don’t just Quit, become NON-SMOKER
1.Choose own Quit Date, personal Quit Coach help prepare & get ready
2.Learn when & where urges strike & how to cope & manage stress w/o smoking
3.Recommend meds if necessary and teach how to use correctly
4.QUIT for good- support to make this the LAST Quit, help with weight issues
Indiana Tobacco Quitline
Served over
100,000
Hoosiers
since its
launch in 2006
Brief Intervention
ASK Do you use tobacco?
ADVISE Quit tobacco products!
REFER 1-800-QUIT-NOW
Resources
Infant MortalityLabor of Love
http://www.in.gov/laboroflove/index.htm
SmokingQuit Now Indiana
http://www.quitnowindiana.com/
Resources
ObesityBrief Action Planning
http://www.centrecmi.ca/learn/brief-action-planning/
Indiana Healthy Weight Initiative http://www.inhealthyweight.org/
INShape Indiana http://www.inshapeindiana.org/
Questions