ncchc updates in correctional health care april 24-27, 2010 nashville, tn

HEALTHY PEOPLE 2020—OVERVIEW AND CORRECTIONAL

CARE INSIGHTSNCCHC

Updates in Correctional Health CareApril 24-27, 2010

Nashville, TN

Susan M. Tiona, M.D.,CCHPKit Carson Correctional

FacilityPO Box 309

Burlington, CO 80807

[email protected]

What is Healthy People?

Healthy People 2020 Vision

A society in which all people

live long, healthy lives.

Healthy People 2020 Mission

Identify nationwide health improvement priorities

Increase public awareness and understanding of the determinants of health, disease, and

disability and the opportunities for progress

Provide measurable objectives and goals that are applicable at the national, state,

and local levelsEngage multiple sectors to take actions to strengthen policies and improve practices

that are driven by the best available evidence and knowledge

Identify critical research, evaluation and data collection needs

Healthy People 2020 Overarching Goals

Attain high quality, longer

lives free of preventable

disease, disability, injury, and premature

death

Achieve health equity,

eliminate disparities, and

improve the health of all

groups

Create social and physical environments that promote good health

for all

Promote quality of life, healthy development and healthy behaviors

across all life stages

Healthy People 2020 Topic Areas

Access to Health Services

Adolescent Health

Arthritis, Osteoporosis, and Chronic Back Conditions

Blood Disorders and Blood Safety

Cancer

Chronic Kidney Disease

Diabetes

Disability and Secondary Conditions

Early and Middle Childhood

Educational and Community-Based Programs


Environmental Health

Family Planning

Food Safety

Genomics

Global Health

Health Communication and Health IT

Healthcare-Associated Infections

Hearing and Other Sensory or Communication Disorders

Heart Disease and Stroke

HIV


Immunization and Infectious Diseases

Injury and Violence Prevention

Maternal, Infant, and Child Health

Medical Product Safety

Mental Health and Mental Disorders

Nutrition and Weight Status

Occupational Safety and Health

Older Adults

Oral Health

Physical Activity and Fitness


Public Health Infrastructure

Quality of Life and Well-being

Respiratory Diseases

Sexually Transmitted Diseases

Social Determinants of Health

Substance Abuse

Tobacco Use

Vision

Sources of Data for Healthy People 2020 Objectives

National Health and Nutrition Examination Survey (NHANES), CDC, NCHS (National Center for Health Statistics); www.cdc.gov/nchs/nhanes.htm

National Health Interview Survey (NHIS), CDC, NCHS; www.cdc.gov/nchs/nhis.htm

National Ambulatory Medical Care Survey (NAMCS), CDC, NCHS; www.cdc.gov/nchs/ahcd.htm

Medical Expenditure Panel Survey (MEPS), AHRQ (Agency for Healthcare Research and Quality); www.meps.ahrq.gov

United States Renal Data System, NIH, NIDDK; (National Institute of Diabetes and Digestive and Kidney Diseases); www.usrds.org

Healthy People 2020 Objectives

Focus on some key objectives with correctional care applications…

Arthritis, Osteoporosis, and Chronic Back Conditions

Reduce the mean level of joint pain among adults with doctor-diagnosed arthritis

Reduce the proportion of adults with doctor-diagnosed arthritis who experience a limitation in activity due to arthritis or joint symptoms

Increase the proportion of adults with doctor-diagnosed arthritis who receive health care provider counseling— For weight reduction among overweight and obese

persons For physical activity or exercise

Arthritis, Osteoporosis and Chronic Back Conditions (cont…) Increase the proportion of adults with

chronic joint symptoms who have seen a health care provider for their symptoms

Increase the proportion of adults with doctor-diagnosed arthritis who have had effective, evidence-based arthritis education as an integral part of the management of their condition

Reduce activity limitation due to chronic back conditions


Increase the proportion of persons with diabetes and chronic kidney disease who receive recommended medical evaluation (serum creatinine, microalbumin, HgA1C, lipids, eye exams)

Increase the proportion of persons with diabetes and CKD who receive recommended medical treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs).

Chronic Kidney Disease (cont…)

Improve cardiovascular care in persons with chronic kidney disease Reduce the percentage of persons with CKD

who have elevated blood pressure (Target <130/80)

Reduce the percentage of persons with CKD who have elevated lipid levels

Increase the percentage of persons with CKD who know that they have impaired renal function

Diabetes

Increase the proportion of persons with diagnosed diabetes who receive formal diabetes education

Increase the proportion of adults with diabetes whose condition has been diagnosed

Increase the proportion of persons with diabetes who obtain an annual urinary microalbumin measurement

Increase the proportion of adults with diabetes who have a HgA1C measurement at least twice year

Diabetes (cont…)

Increase the proportion of adults with diabetes who have an annual dilated eye exam, at least an annual foot exam, and at least an annual dental exam

Improve glycemic control among the population with diagnosed diabetes Reduce the proportion with A1C value >9% Increase the proportion with A1C value <7%

Increase the proportion of diabetics whose blood pressure is under control (Target < 130/80)

Diabetes (cont…)

Improve lipid control among diabetics Increase the proportion of people with

IFG, “pre-diabetes,” or multiple diabetes risk factors that are engaged in diabetes prevention behaviors Increase the proportion of the high-risk,

overweight population reporting a physically active lifestyle

Increase the proportion of the high-risk, overweight population who report intentionally losing weight in the previous year

Health Communication and Health IT

Increase the proportion of persons who report that their health care providers have satisfactory communication skills Increase the proportion of persons who report that their

health care provider always listens carefully to them Increase the proportion of persons who report that their

health care provider always explains things so that they can understand them

Increase the proportion of persons who report that their health care provider always shows respect for what they have to say

Increase the proportion of persons who report that their health care provider always spends enough time with them


Increase the proportion of adults with high blood pressure whose blood pressure is under control

Increase the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high

Reduced the mean total blood cholesterol levels among adults

Reduce the proportion of adults with high total blood cholesterol levels

Increase the proportion of adults who have had their blood cholesterol checked within the preceding 5 years

Heart Disease and Stroke (cont…)

Increase the proportion of adults with pre-hypertension who meet the recommended guidelines for: Body mass index Saturated fat consumption Sodium intake Physical activity Moderate alcohol consumption


Increase the proportion of adults with hypertension who meet the recommended guidelines for: Body mass index Saturated fat consumption Sodium intake Physical activity Moderate alcohol consumption

Increase the proportion of persons with coronary artery disease who have their LDL cholesterol level at or below recommended levels


Increase the proportion of adults with elevated LDL cholesterol who have been advised by a health care provider to: Eat fewer foods high in saturated fat or high in cholesterol Control weight or lose weight Increase physical activity or exercise Take recommended medication

Increase the proportion of adults with elevated LDL cholesterol who meet the recommended guidelines for: Healthy weight Cholesterol-lowering diet Physical activity

Nutrition and Weight Status

Increase the proportion of adults who are at a healthy weight

Reduce the proportion of adults who are obese Reduce iron deficiency among females aged

12 to 49 years Reduce iron deficiency among pregnant

females Reduce consumption of saturated fat and

sodium in the population aged 2 and older Increase the consumption of calcium in the

population aged 2 and older

Nutrition and Weight Status (cont…)

Increase the proportion of physician office visits that include counseling or education related to nutrition or weight

Increase the proportion of primary care physicians who regularly measure the body mass index of their patients

Reduce consumption of calories from solid fats and added sugars in the population aged 2 years and older

Older Adults

Reduce the proportion of adults who have moderate to severe functional limitations

Increase the proportion of older adults with one or more chronic health problems who report confidence in managing their conditions

Increase the proportion of older adults with reduced physical or cognitive function who engage in light, moderate, or vigorous leisure-time physical activities

Physical Activity and Fitness

Reduce the proportion of adults who engage in no leisure-time physical activity

Increase the proportion of physician office visits for chronic health diseases or conditions that include counseling or education related to exercise

Physical Activity and Fitness (cont…)

Increase the proportion of adults that meet current Federal physical activity guidelines for aerobic physical activity and for muscle strength training Increase the proportion of adults who engage

in aerobic physical activity of at least moderate intensity for at least 150 minutes/week or 75 minutes/week of vigorous intensity, or an equivalent combination

Increase the proportion of adults who perform muscle-strengthening activities on 2 or more days of the week

Respiratory Diseases

Reduce hospitalizations for asthma Reduce hospital emergency department

visits for asthma Reduce activity limitations among

persons with current asthma Reduce the proportion of adults whose

activity is limited due to chronic lung and breathing problems

Respiratory Diseases (cont…)

Increase the proportion of persons with current asthma who receive appropriate asthma care according to National Asthma Education and Prevention Program (NAEPP) guidelines. Persons with current asthma who receive written asthma

management plans from their health care provider Persons with current asthma with prescribed inhalers who

receive instruction on their use Persons with current asthma who receive education about

appropriate response to an asthma episode, including recognizing early signs and symptoms or monitoring peak flow results

Increase the proportion of persons with current asthma who do not use more than one canister of short-acting inhaled beta agonist per month

Correctional Care Insights for Healthy People 2020

Healthy Inmates 2020

?

??

How do we make it work?

Healthy Inmates 2020 Vision

A correctional system in which all inmates have the opportunity

for healthy living

Healthy Inmates 2020 Mission

Identify health improvement priorities for correctional health care

Increase awareness and understanding of the determinants of health, disease, and disability

and the opportunities for progress

Provide measurable health objectives and goals that are applicable across a wide

range of correctional settingsEngage correctional health professionals to

take action to strengthen policies and improve practices that are driven by the best

available evidence and knowledge

Identify critical research, evaluation and data collection needs for correctional

health care

Healthy Inmates 2020 Long Term Goals

Eliminate preventable

disease, disability, injury, and premature

death

Achieve health equity, remove disparities, and improve health status across

all ethnic groups

Cultivate correctional

environments that promote good health

for all

Promote healthy

behaviors for all

incarcerated individuals

Healthy Inmates 2020Focus Areas 1-5


Arthritis, Joint Pain, and Chronic Back Conditions


Diabetes

Health Communication

Healthy Inmates 2020Focus Areas 6-10


Nutrition, Weight Status and Exercise

Older Adults

Respiratory Disease

Special Groups: Adolescent and Women’s Health


Increase the proportion of inmates who report having little or no problem accessing routine health care services

Increase the proportion of inmates who report having little or no problem accessing specialty health care services

Increase the proportion of inmates who report overall satisfaction with their health care

Arthritis, Joint Pain, and Chronic Back Conditions

Reduce the mean level of joint pain among adult inmates with

doctor-diagnosed arthritis

Reduce the proportion of adult inmates with arthritis

who experience a limitation in activity due

to arthritis or joint

symptoms

Increase the proportion of adult inmates with arthritis who receive health care provider counseling—• For weight

reduction among overweight and obese persons

• For physical activity or exercise

Reduce activity

limitation of adult

inmates due to chronic

back conditions


Improve cardiovascular care in inmates with chronic kidney disease

Diabetes

Improve glycemic control among the incarcerated population with diagnosed diabetes

Reduce the proportion of inmates with diabetes whose A1C value is >9%

Increase the proportion of inmates with IFG, “pre-diabetes,” or multiple diabetes risk factors that are engaged in diabetes prevention behaviors

Report having a physically active lifestyle

Diabetes

Increase the proportion of inmates with diabetes who are being treated according to the “Standards of Medical Care in Diabetes—

2010” ADA guidelines

Receive formal

diabetes education

Annual urinary micro-

albumin

HgA1C checked at least twice a

year

Annual dilated

eye exam, foot

exam, and

dental exam

Blood pressure less than

130/80

LDL at or below target

guidelines (100 w/o CAD; 70 w/ CAD)

Health Communication

Increase the proportion of inmates who report that their health care providers have satisfactory communication skills

Their health care provider

listens carefully to them


explains things so that they can

understand them

Their health care provider shows respect for what they have to say


spends enough time with them


Reduced the mean total cholesterol levels among inmates

Reduce the proportion of inmates with high total cholesterol levels


Increase the proportion of inmates with pre-hypertension who meet the recommended guidelines for:

Body mass index

Increase the proportion of inmates with hypertension who meet the recommended guidelines for:

Body mass index


Increase the proportion of inmates with elevated LDL cholesterol who have been advised by a health care provider to:

• Eat fewer foods high in saturated fat or high in cholesterol• Control weight or lose weight• Increase physical activity or exercise• Take recommended medication

Increase the proportion of inmates with elevated LDL cholesterol who meet the recommended guidelines for:

• Healthy weight• Cholesterol-lowering diet• Physical activity

Increase the proportion of persons with coronary artery disease who have their LDL cholesterol level at or below recommended levels

Nutrition, Weight and Exercise

Reduce consumption of saturated fat and

sodium

Increase the consumption of calcium

Reduce consumption of calories from solid fats

and added sugars


Increase the proportion of providers who regularly measure the body mass index of their patients

Increase the proportion of inmates who are at a healthy weight


Increase the proportion of inmates that meet current Federal physical activity guidelines for aerobic physical activity and for muscle

strength training

Increase the proportion of inmates who engage in aerobic physical

activity of at least moderate intensity for at least 150

minutes/week or 75 minutes/week of vigorous intensity, or an

equivalent combination

Increase the proportion of inmates who perform muscle-

strengthening activities on 2 or more days of the week

Older inmates

Reduce the proportion of older inmates who have moderate to severe functional limitations

Increase the proportion of older inmates with one or more chronic health problems who report confidence in managing their conditions

Increase the proportion of older inmates with reduced physical or cognitive function who engage in light, moderate, or vigorous leisure-time physical activities

Respiratory Disease

Increase the proportion of inmates with current asthma who receive appropriate asthma care according to National Asthma Education and Prevention Program (NAEPP) guidelines.

Receive written asthma management plans from their health care providerReceive instruction on use of prescribed inhalers Receive education about appropriate response to an asthma episode, including recognizing early signs and symptoms or monitoring peak flow resultsDo not use more than one canister of short-acting inhaled beta agonist per month

Special Groups: Adolescents and Women

???

Process for Implementing Healthy Inmates 2020

PHASE 1: Choose the focus areas and

objectives that will define the Healthy Inmates project.

PHASE 2: Develop data collection tools

that will unify the information

gathering process

PHASE 3: Collect data from as many correctional

practices as possible in order to identify trends and baselines for each

objective

PHASE 4: Encourage correctional practices to implement one or

more project objectives

PHASE 5: Periodically repeat the information

and data gathering process to evaluate the progress being made

Data Collection Tools

Inmate Pain Survey (Available at www.care4cons.com) Arthritis, Joint Pain, and Chronic Back Conditions

Inmate General Health Survey(Available at www.care4cons.com) Access to Health Services Health Communication

Older Inmates Health Survey(Under Development) Older Inmates

Healthcare Delivery Audits(Under Development) Chronic Kidney Disease Diabetes Heart Disease and Stroke Nutrition, Weight and Exercise Respiratory Disease

Clinical Guidelines

Asthma NIH Guidelines ATP III Cholesterol Guidelines Diabetes Care Standards

Diabetes Care in Corrections JNC 7 (Hypertension) Guidelines Obesity Guidelines (1998) Physical Activity Guidelines USRDS Report

(All links available at www.care4cons.com)

Getting Involved to Make Healthy Inmates 2020 Work

Share your tools,

audits, strategies, implemen

tation ideas, etc.

Collect (and share)

your data

Adopt one or more Healthy Inmates

2020 objectives

Evaluate (and

share) your

progress over time

Questions and Discussion

For the most up-to-date version of this presentation,

for Healthy Inmates 2020 implementation tools,

and for links to other useful public health resources,

visit

www.care4cons.com

ncchc updates in correctional health care april 24-27, 2010 nashville, tn

Documents

proportion of adults

proportion of persons

year slide

health statistics

good health

health equity

strokehiv slide

fitness slide