women’s healthcare in georgia brenda fitzgerald, m.d. commissioner and state health officer...
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Women’s Healthcare in Georgia
Brenda Fitzgerald, M.D.Commissioner and State Health Officer Georgia Department of Public Health
Senate Women's Adequate Healthcare Study Committee
September 14, 2015
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IN 2013
MATERNAL MORTALITY
G E O R G I A RA N K S
# 50
N A T I O N A L LY
AWHONN 2013
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Maternal Mortality
• The death of a woman during pregnancy or up to one year after delivery Pregnancy-related death is a
death during or within one year of pregnancy that was caused by a complication of pregnancy
Pregnancy-associated death is the death of a woman from any cause while she is pregnant or within one year of pregnancy
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Maternal Mortality Case Reviews
2012 Case Reviews• 122 cases• 60 pregnancy-
associated deaths
• 25 pregnancy-related deaths
• 37 not pregnant
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Leading Causes ofPregnancy-Associated Death
Motor Vehicle Accidents
(MVA)
Homicides Suicides Drug Overdose0
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Leading Causes ofPregnancy-Related Death
Hemorrhage Hypertension Cardiac events Embolisms0
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Georgia Infant Mortality 2002-2006
• 5,743 babies in Georgia died before their first birthday
• Georgia’s Infant Mortality Rate was 15-20 percent higher than national average
• All live births grouped by one-mile squares, based on location of mothers’ residency at delivery
• Six significantly increased clusters of higher mortality rates identified
• The leading causes of death identified by cluster
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Georgia Infant Mortality Clusters2002-2006
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Georgia Infant Mortality Clusters 2002-2006
Atlanta Area
Augusta Area
Columbus Area
Macon Area
Savannah Area
Valdosta Area
11.8 15.1 15.8 14.7 13.3 17.5
Georgia IMR 2002-2006 = 8.4 deaths per 1,000 live births
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Leading Causes of Infant Death
by ClusterA B C D E F
Congenital malformations, chromosomal abnormalities 2 3 2 2 3 3
Newborn affected by maternal complications of pregnancy 2
Respiratory distress of newborn 1
Short for gestational age, LBW, not otherwise classified 1 2 1 1 1 1
Sudden infant death syndrome 3 3 3 2
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Objective 1: Strengthen the
Regional Perinatal System
Objective 2: Develop targeted
educational campaigns
Objective 3: Develop external
collaborations to support initiativesRPC standards of
care 17-Hydroxy P Registry
Fetal/Infant mortality review committee
Maternal mortality review
committeeCommunity-based home visitation
programs
Tobacco Cessation Safe Sleep
Breastfeeding and Baby-Friendly Hospitals & Businesses
Early Elective Deliveries
1115 Waiver Utilization to Improve Birth
Spacing & Conception Planning
Perinatal Quality Collaborative
Infant Mortality Reduction Strategic Plan (2012–2016)
LARC Placement
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Obstetric Care Provider Shortage• 38 Georgia counties with NO OB services
• 20 Georgia counties with a deficit of OB services
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Telehealth Goals• Increase access to care
Address Georgia’s health challenges▫Infant mortality▫Oral health▫Obesity and associated diseases
Connect Georgians with specialized care that may not exist in every community, i.e. monitoring of a high-risk pregnancy
• Increase capacity at DPH sites statewide
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GA Early Elective Deliveries
Reduced 39-week elective deliveries
• Public and private collaboration Georgia Hospital Association March of Dimes GA OB/GYN Society GA Chapter of American Academy of Pediatrics
• 2009: 65%
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Georgia Early Elective Deliveries
* As of October 1, 2013 Medicaid in Georgia no longer pays for early
elective deliveries
Source: Georgia Hospital Association
Quarter Rate
1Q12 7.83%
2Q12 6.32%
3Q12 5.81%
4Q12 4.60%
1Q13 3.51%
2Q13 3.11%
3Q13 3.35%
4Q13 1.88%*
1Q14 1.05%
2Q14 1.1%
3Q14 1.15%
4Q14 1.11%
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2015% of
Hospitals Reporting
January 0.76% 87%
February 0.63% 80%
March 0.44% 84%
April 0.62% 74%
May 0.79% 59%
Georgia Early Elective Deliveries
Source: Georgia Hospital Association
Georgia has been under the national 2% standard for the past 21 months
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Georgia Infant Mortality RateAmerica’s Health Rankings
Georgia IMR
U.S. Rank
2012 7.7 442013 6.93 342014 6.6 31
Source: America’s Health Rankings 2014
48% DECREASE SINCE 1990
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Cardiovascular Disease in Georgia
• Cardiovascular Disease (CVD) includes: heart disease, stroke, hypertension, atherosclerosis, and other diseases of the arteries or heart muscle
• Cardiovascular Disease in Georgia CVD is the leading cause of death 29 women die each day from CVD 4,012 women die annually from heart
disease 2,185 women die annually from
stroke Source: BRFSS 2013
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Cost of Cardiovascular Disease in Georgia
• $6.1 billion annually $4.2 billion for heart disease
o Average charge per heart-related hospitalization $45,700
$940 million for strokeso Average charge per stroke-
related hospitalization $39,453
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Obesity in Georgia• 3 million Georgians
are obese• Georgia's adult
obesity rate is 30%, up from 10% in 1990
• 66% of adults are either overweight or obese 73% males 59% females
• Obesity in women has increased 2.2% since 2011
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Cost of Obesity in Georgia$2.5 billion annually
Direct healthcare costs Lost productivity Disability Death
• Estimated $10.8 billion by 2018 if
obesity rate continues to increase• Average hospital stay for obese individuals is 60% longer than for healthy weight individuals
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Obesity in GeorgiaInterventions
• Promote and adopt healthy eating habits
• Increase physical activity
• Increase access to healthy food and physical activity in work place
• GA Shape• Power Up for 30
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Diabetes in Georgia • Diagnosed diabetes is
9.7% compared to prevalence of undiagnosed diabetes at 6.5%
• Between 2000-2010 prevalence of diabetes increased from 6.8% to 9.7%
• 11.7% of Georgia women are diagnosed with diabetes
• Gestational diabetes during pregnancy causes increased blood sugar levels and risk of complication for mother and baby
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Diabetes in Georgia
DISTRICT TOTAL %FEMALE
%7-0 West Central (Columbus) 15.9 20.43-3 Clayton (Morrow) 14.5 16.79-2 Southeast (Waycross) 13.9 16.26-0 East Central (Augusta) 15.1 15.49-1 Coastal (Savannah) 11.8 15.21-1 Northwest (Rome) 13.5 14.58-2 Southwest (Albany) 11.6 14.43-5 DeKalb 11.0 13.58-1 South (Valdosta) 13.3 13.35-1 South Central (Dublin) 9.3 13.24-0 La Grange 11.6 12.2
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Cost of Diabetes in Georgia
• $5.1 billion annually $3.3 billion direct medical
cost $1.8 billion loss of
productivity and sick days Does not account for
undiagnosed diabetes or those with prediabetes
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Diabetes in Georgia
Interventions• Increase the number of accredited
Diabetes Self-Management Education (DSME) sites in the state
• Increase the number of telehealth sites offering DSME programs
• Educate providers on the importance of referring patients DSME and diabetes prevention programs
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Tobacco Use in Georgia Women 2011-2013
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
2011 2012 20130
5
10
15
20
25
21.4 20.218.5
14.0 14.312.8
White Females Black Females
Perc
en
t (
%)
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• Early death• Cancer
Women who smoke are 26 times more likely than non-smokers to develop lung cancer
Risk factor for cancer of the cervix, ovary, colon, kidney
• Increased risk of heart disease and stroke• Lung Damage
Chronic coughing, wheezing, trouble breathing, and long-term lung disease
• Reproductive health problems Trouble getting pregnant Bleeding, premature birth, and emergency C-
section Miscarriages, stillbirths, and low birth-weight
babies
Health Effects of Tobacco Use
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Cost of Tobacco Use in Georgia
• $5.0 billion annually $1.8 billion direct medical
cost $3.2 billion loss of
productivity and sick days Tobacco use is the number
one preventable cause of death in Georgia
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Tobacco Use in Georgia
Interventions• Establish smoke free policies and social
norms• Promote cessation and assist tobacco users
to quit• Prevent initiation of tobacco use• Enacting comprehensive smoke free policies• Fund hard hitting mass-media campaigns• Making cessation services fully accessible to
tobacco users
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Georgia Tobacco Quitline• 24 hours a day, 7
days a week
• English: 1.877.270.STOP (1.877.270.7867)
• Spanish: 1.877.2NO.FUME (1.877.266.3863)
• Hearing Impaired, TTY Services: 1.877.777.6534
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Cancer in Georgia
• 44,000 new cases annually (all sites) 23,000 men 21,000 women
• Breast cancer is the leading cause of cancer in Georgia women 6,410 new cases annually
• 400 new cases of cervical cancer annually
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Cancer in Georgia2014 New Cancer Cases Female
Breast 7,050
Lung and Bronchus 3,130
Colon and Rectum 2,080
Uterine 1,200
Melanoma 970
Thyroid 850
Non-Hodgkin Lymphoma 810
Ovary 680
Kidney and Renal Pelvis 620
Pancreas 610
Leukemia 480
Cervical 400
All Sites 23,170
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Localized Regional Distant0
10
20
30
40
50
60
70
80
90
100 94
76
19
97
83
24
Five-Year Survival by Stage at Di-agnosis, Breast Cancer, Females,
Georgia, 2005-2011NH Black NH White
% S
urv
ivin
g 5
Ye
ars
% of tumors found at this stage
Localize
dRegion
alDistan
t
NH Black 52% 37% 9%
NH White 63% 30% 5%
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Cancer Cost in Georgia• $3.7 billion annually
Direct medical costs• $243 million annually
Lost productivity and sick days
More than one million days • 15,150 cancer deaths in
Georgia annually 8,013 males 7,135 females
2012 BRFSS State Summary
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Alzheimer’s Disease in Georgia• 120,000 Georgians currently
with Alzheimer’s disease• 160,000 Georgians by 2025
with Alzheimer’s disease • 63% of Georgians age 65+
with Alzheimer’s disease are women
• Women are twice as likely to develop Alzheimer's as breast cancer
• 12.6% of Georgia women age 45+ reported increased confusion or memory loss in the past year
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2014 Alzheimer’s DiseaseFacts and Figures
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Alzheimer’s Disease and Related Dementias Registry
Goals for Registry• Usable data in the preparation and
planning for aging population• Identify epidemiological trends• Bring awareness at state level to issues
that affect healthy aging• Inform stakeholders for planning and
future implementation needs• Improve urban and rural parity