diabetes measures in ehrs linked to improved care
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Diabetes Measures in EHRs Linked to Improved Care. Omar A. Contreras, MPH Diabetes Prevention and Control Program Arizona Department of Health Services June 27, 2014. What does What does medicine do? public h ealth do?. - PowerPoint PPT PresentationTRANSCRIPT
Health and Wellness for all Arizonansazdhs.gov
Diabetes Measures in EHRs Linked to Improved Care
Omar A. Contreras, MPHDiabetes Prevention and Control Program
Arizona Department of Health ServicesJune 27, 2014
Health and Wellness for all Arizonansazdhs.gov
What does What does medicine do? public health do?Saves lives one at a time Saves lives millions at a time
Health and Wellness for all Arizonansazdhs.gov
Essential Services of Public Health
Monitor health status Diagnose and investigate Inform, educate, and empower Mobilize community
partnerships Develop policies and plans
Enforce laws and regulations Link people to needed
services/assure care Assure a competent
workforce Evaluate health services Research
Source of Ten Essential Public Health Services: Core Public Health Functions Steering Committee, 1994
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Health Department
+PH System
+Community
Partners+
Workforce
OperationalCapacity
(Infrastructure)
EveryCommunity
Program and Public Health
Activity
(Chronic Disease, Inf. Disease, EH)
Builds Impacts
Whichleads
to
Investments here Pay big dividends here
Better HealthOutcomes
Reduced Disparities
Better Preparedness
Framework for Improving the Performance of Public Health
Source: D. Lenaway. Centers for Disease Control and Prevention, Office of Chief of Public Health Practice. 2009 (unpublished)
Health and Wellness for all Arizonansazdhs.gov
Governmental Public Health
State and Local Health Departments
Tribal Health Departments
Local Health Departments
State and the District of Columbia
Health Departments
Territorial Health
Departments
Retain the primary responsibility for health under the US Constitution
51** 8**2,565*
* Number based on 2010 National Profile of Local Health Departments (NACCHO, 2011)** Numbers cited from ASTHO, Profile of State Public Health, Volume Two, 2011
Health and Wellness for all Arizonansazdhs.gov
Tribal Health Departments
State and the District of Columbia
Health Departments
Territorial Health
Departments
51** 8**
Local Health Departments
2,565*
Federally Qualified
Health Centers
Health and Wellness for all Arizonansazdhs.gov
Outline• Arizona Department of Health Services/Arizona Diabetes
Program– Diabetes in Arizona– Epidemiology and Surveillance– Trends and Cost Analyses
• The Arizona Diabetes Coalition• Diabetes measures and systems change• Public Health in Action Grant• EHR and non-physician team base approach to diabetes
care• Summary
Health and Wellness for all Arizonansazdhs.gov
Arizona Department of Health ServicesHierarchy
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Arizona Diabetes ProgramWhat we do and what we provide?• Ongoing technical assistance to internal and
external partners• Information and guidance on funding resources• Develop diabetes specific strategies and public
health interventions at a systematic, policy, and environmental levels
• Supports and oversees the activities Arizona Diabetes Coalition and Leadership Council
Health and Wellness for all Arizonansazdhs.gov
Diabetes in Arizona
Health and Wellness for all Arizonansazdhs.gov
Leading causes of death in the United States for 2011
Leading Death Death rate per 100,000
1. Heart disease 191.4
2. Cancers 184.6
3. Chronic lung diseases 46.0
4. Strokes 41.4
5. Accidents 39.4
6. Alzheimer’s disease 27.2
7. Diabetes mellitus 23.5
8. Pneumonia and influenza 17.2
9. Kidney diseases 14.7
10. Suicides 12.3Source: National Center for Health Statistics, www.cdc.gov/nchs.
Health and Wellness for all Arizonansazdhs.gov
Diabetes in Arizona• 1/9 Arizonans have diabetes• 1/3 of those who have diabetes in Arizona are
unaware that they have it• Diabetes is the leading cause of new cases of
blindness and kidney failure• Known risk factors
– Obesity – Physical inactivity or increase in sedentary lifestyle– Built environment
Health and Wellness for all Arizonansazdhs.gov
How do rate by county?County* Diabetes Arizona Hypertension** Arizona Obesity Arizona
Apache 8.0% 10.6% 17.5% 28.1% 25.1% 26.0%Cochise 15.7% 10.6% 44.4% 28.1% 27.4% 26.0%Coconino 13.3% 10.6% 17.2% 28.1% 22.3% 26.0%Gila 15.6% 10.6% 28.8% 28.1% 25.1% 26.0%Graham 17.0% 10.6% 27.5% 28.1% 34.5% 26.0%Greenlee 15.9% 10.6% 27.0% 28.1% 34.3% 26.0%La Paz 16.0% 10.6% 34.8% 28.1% 32.0% 26.0%Maricopa 10.0% 10.6% 26.5% 28.1% 26.0% 26.0%Mohave 14.6% 10.6% 38.2% 28.1% 29.4% 26.0%Navajo 12.1% 10.6% 34.8% 28.1% 31.1% 26.0%Pima 12.2% 10.6% 25.6% 28.1% 23.5% 26.0%Pinal 14.4% 10.6% 35.7% 28.1% 25.7% 26.0%Santa Cruz 10.3% 10.6% 34.5% 28.1% 33.7% 26.0%Yavapai 10.6% 10.6% 38.5% 28.1% 33.8% 26.0%Yuma 11.8% 10.6% 40.8% 28.1% 28.6% 26.0%
*Source: Arizona Behavioral Risk Factor Surveillance System, (AZ-BRFSS, 2013)** 2011 Numbers shown as 2012 data not available
Health and Wellness for all Arizonansazdhs.gov
Arizona Adults with Diabetes by Race/Ethnicity, 2012
Black Hispanic Other White Overall 0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
14.7%
12.5%
9.9% 9.4%10.6%
Source: AZ Health Matters (2012), AZ BRFSS
Prev
alen
ce (%
)
Health and Wellness for all Arizonansazdhs.gov
Arizona Age-adjusted Death Rate due to Diabetes, by Gender (2012)
Female Male Overall 0
5
10
15
20
25
30
35
18.6
29.2
23.5
Rate
per
100
,000
pop
ulati
on
Source: AZ Health Matters (2012), AZ BRFSS
Health and Wellness for all Arizonansazdhs.gov
Arizona Age-adjusted Death Rate due to Diabetes, by Race/Ethnicity (2012)
Source: AZ Health Matters (2012), AZ BRFSS
American
Indian
/Alas
ka Nati
ve
Asian/Paci
fic Islan
der
Black/A
frican
American
Hispan
ic/Lati
no
White, N
on-Hisp
anic
Overal
l 0
10
20
30
40
50
60
70
80
9080.2
27.6
49.4
40.8
18.323.5
Rate
per
100
,000
pop
ulati
on
Health and Wellness for all Arizonansazdhs.gov
Health and Wellness for all Arizonansazdhs.gov
Estimated Costs of Diabetes, 2007Total $174 billion
Direct medical costs
$116 billion
Indirect medical costs
$58 billion
Source: http://www.diabetes.org/advocate/resources/cost-of-diabetes.html, retrieved 11/25/2013
Estimated costs
Estimated Costs of Diabetes, 2012Total $245 billion
Direct medical costs
$176 billion
Indirect medical costs
$69 billion
Health and Wellness for all Arizonansazdhs.gov
Estimated costs AZ, cont.
Arizona Diabetes Cost Data (2010) – CDC Chronic Disease Cost Calculator
2011 Arizona Hospital Discharge Data indicated a total of 7,065 discharges related to diabetes and chronic conditions.
$167,815,464
Parameter Treated Population
Cost per Person
Total Costs (2010)
Adjusted to 2013
All Payers 416,200 $5,420 $2,258,000,000 $2,412,300,000
MEDICAID 81,800 $3,750 $307,000,000 $327,980,000
MEDICARE 168,100 $3,580 $602,000,000 $643,140,000
Private Insurers 236,500 $2,580 $610,000,000 $651,680,000
Health and Wellness for all Arizonansazdhs.gov
Arizona Diabetes Coalition
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VisionA state without diabetes
MissionTo reduce the health, social, and economic
burden of diabetes in Arizona
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How are the Coalition and Council structured?
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Arizona Diabetes Leadership Council• Reorganized Fall 2006• >18-21 member leadership council
– Representation from academia, health plans, government, private companies, non-profit organizations, etc.
• Meet 6 times a year as a council and quarterly with the coalition
• Each Coalition workgroup chair is represented in the Leadership Council.
• Ex-Officio members• Well established by-laws: www.azdiabetes.gov• Constant communication between leadership body and ADHS
Diabetes Program
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Diabetes Measures and Systems Change
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Health Care Flowchart
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Pillars of Health Care Reform
Cost Access Coverage Quality
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Quality and access to CareThere are thousands of new doctors and nurses in communities around the country
and millions more patients getting care.
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Improving Quality• Increase the utilization of EHR in multiple healthcare
systems• Encourage completion of NQF standard measures for
diabetes and hypertension• Require reporting and accountability for health plans
Coordinate care and medical home models Improve patient safety, reduce medical errors, promote
health and wellness• Capacity development for FQHCs and other health
systems
Health and Wellness for all Arizonansazdhs.gov
National Quality Forum (NQF) Measures (Diabetes)
Measure Recommended Measure Title
0055 Eye Exam (no evidence of retinopathy)
0056 Foot Exam
0059 HbA1c Poor Control (HbA1c >9%)
0061 Blood Pressure Management
0062 Urine Screening
0064 LDL Management and Control
0575 HbA1c Control (<8%)
0018 Controlling High Blood Pressure
Health and Wellness for all Arizonansazdhs.gov
Role of EHR systems in FQHCs
• Advocate for your patients• Referral mechanism for DSME and prevention
programs• Provision of preventative care for chronic care
patients• EHRs can help avoid re-admission rates and
improve and adherence to self-management
Health and Wellness for all Arizonansazdhs.gov
Public Health in Actions Grant
Health and Wellness for all Arizonansazdhs.gov
What is the Public Health in Actions Grant?
• 5 year collaborative grant • Focuses on policy, system, and environmental
change• 32 states funded
– Basic and Enhanced components • Year 1 has been completed
Health and Wellness for all Arizonansazdhs.gov
Implementation of EHR system change and performance measures
• Proportion of health care systems reporting on NQF measures 18 and 59
• Proportion of health care systems with EHRs appropriate for treating patients with high blood pressure and diabetes
• Increase the institutionalization and monitoring of aggregated/standardized quality measures at the provider and systems level
Health and Wellness for all Arizonansazdhs.gov
System level changes and non-physician team based care in Federally Qualified Health
Centers
Health and Wellness for all Arizonansazdhs.gov
Summary• Diabetes remains a prevalent disease in Arizona,
specifically in rural areas• Diabetes NQF measures offers the ability to detect care
when the recommended care was given or when recommended care was not received.
• Non-physician staff will continue to be on high demand and integration into a team base approach to diabetes health should be warranted
• Health systems changes via the utilization of electronic health records show positive trends in the improvement of diabetes care
Health and Wellness for all Arizonansazdhs.gov
Looking into the future
• Establish a data sharing agreement between ADHS and FQHCs and/or the Alliance for Community Health Centers
• Ability to generate standardize reports on patients with diabetes and hypertension
• Reducing the gaps and inconsistencies resulting in lack of data within the EHR
Health and Wellness for all Arizonansazdhs.gov
Our ever changing public health system
MCDPHHome Health
Parks
Economic Development
Mass Transit
Employers
Nursing Homes
Mental HealthDrug
Treatment
Civic Groups
Laboratory Facilities
Hospitals
EMS
FQHCS
Doctors
ADHS
Churches
Philanthropist
Elected Officials
Tribal Health
Schools
Police
Fire
Corrections
Environmental Health
Urban Planners
Health and Wellness for all Arizonansazdhs.gov
Questions?
Contact InformationOmar A. Contreras, MPH
Diabetes Prevention and Control Program Manager
Arizona Department of Health [email protected]
(602) 542-2758