NCCHC Updates in Correctional Health Care April 24-27, 2010 Nashville, TN.
-
Upload
tina-byers -
Category
Documents
-
view
214 -
download
2
Transcript of 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
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
Healthy People 2020 Topic Areas
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
Healthy People 2020 Topic Areas
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
Healthy People 2020 Topic Areas
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
Chronic Kidney Disease
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
Heart Disease and Stroke
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
Heart Disease and Stroke (cont…)
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
Heart Disease and Stroke (cont…)
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
Access to Health Services
Arthritis, Joint Pain, and Chronic Back Conditions
Chronic Kidney Disease
Diabetes
Health Communication
Healthy Inmates 2020Focus Areas 6-10
Heart Disease and Stroke
Nutrition, Weight Status and Exercise
Older Adults
Respiratory Disease
Special Groups: Adolescent and Women’s Health
Access to Health Services
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
Chronic Kidney Disease
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
Their health care provider
explains things so that they can
understand them
Their health care provider shows respect for what they have to say
Their health care provider
spends enough time with them
Heart Disease and Stroke
Reduced the mean total cholesterol levels among inmates
Reduce the proportion of inmates with high total cholesterol levels
Heart Disease and Stroke
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
Heart Disease and Stroke
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
Nutrition, Weight and Exercise
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
Nutrition, Weight and Exercise
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