Inspiring Tomorrow’s Leaders

July 31st, 2014 by Will Humble No comments »

IMG_9029You’ve probably read about how we are working on the Arizona Health Improvement Plan to help us all live a better, healthier and longer life.  But one of the most important things we can do as today’s leaders is to inspire tomorrow’s leaders.

I had the opportunity to meet Cody Vasquez this week – he’s the Arizona winner of the national Healthy Lunchtime Challenge.  His Shrimp Tacos with Watermelon Jicama Salad won him a trip to the nation’s capital and dinner at the White House.  Cody’s a very bright young man who told me about several plans to keep up the healthy education in hopes of returning to the White House for a follow up visit.  Item one on his agenda, encourage kids to try new foods!  If you want to keep up with his work, you can follow him on twitter.com/Kidchefcody.

There are lots of great ideas for you to inspire kids to healthy eating and activities on our eatwellbewell.org webpage.  It’s great fun to take kids to farmers’ markets and the grocery store where the bright colors will prompt lots of questions.  Farmers’ Markets are good for families who may not know how to prepare some of the less common fruits and vegetables. You can download a calendar to learn what’s in season.

It’s also fun to have kids involved in the cooking – who knows you may be the parent of the next @kidchefcody.

Dramatic Results from AZ’s Cardiac Arrest Receiving Center Initiative

July 30th, 2014 by Will Humble No comments »

A few years ago our photoBureau of EMS & Trauma System enticed dozens of AZ hospitals to become a Cardiac Receiving Centers.  The initiative helps hospitals provide treatments scientifically proven to improve a patient’s survival rate (like using therapeutic hypothermia to improve the chances of survival).  The program also includes protocols for the pre-hospital teams (EMTs & Paramedics) to evaluate cardiac arrest patients.  We received 1st Place in the 2010 Association of State and Territorial Health Officials “Vision Award” for our creative Arizona Cardiac Receiving Center Program

Now we have proof-positive that our initiative is saving lives.  A study published last week in the Annals of Emergency Medicine (using our data) demonstrated that AZ cardiac arrest receiving centers paired with informed pre-hospital teams can increase survival from cardiac arrest by 50%!  The study also shows that there are better neurologic outcomes or less damage to the brain.

The study (led by Dr. Ben Bobrow from ADHS and Dr. Dan Spaite from the UA College of Emergency Medicine) is the first statewide report showing the benefit of this kind of regionalization of cardiac care.  The article summarizes the importance of how 55 EMS agencies and 31 hospitals from around the state successfully improved the outcomes for thousands of Arizonans who had an out of hospital cardiac arrest.

Sudden cardiac arrest is a leading cause of death in Arizona (at 7,600 per year).  Because Arizona’s EMS agencies and hospitals have implemented key interventions like our Cardiac Receiving Center Program, the survival rate from Sudden Cardiac Arrest in Arizona has increased by 300% in the last 10 years.  Arizona’s pre-hospital and EMS system has become a model that has been adopted across the country – and now is shaping international models for cardiac arrest.

The 5th “Vital Sign” & the Painkiller Epidemic (Part I of V)

July 29th, 2014 by Will Humble 1 comment »

Closeup of an elderly woman's hand being held by a doctor , focus on handsIn our lifetimes, each one of us is likely to experience pain.  The pain experience could be acute and resolve itself in short order (like a bee sting).  Pain can also be a chronic experience lasting a long time with varying levels of intensity (like rheumatoid arthritis).  Pain is also subjective and what one person considers excruciating pain, another person may barely notice.

Today, more than any other time in history, we know more about the physiological and pathological dimensions of pain.  However, we’re struggling with pain management at the population health level.  The US healthcare system has become much more aggressive in the treatment of pain over the last 15 years…resulting in an epidemic of painkiller misuse and abuse that’s killing large numbers of people.  In fact, misuse and abuse of opiate prescription painkillers takes out more people every year than car crashes.  How did we get here?

The origins of the story could be traced to November 11, 1996.  During his presidential address to the American Pain Society, James Campbell, MD introduced the phrase, “Pain as the 5th Vital Sign”.  In his speech, Dr. Campbell emphasized the importance of including pain as part of the four traditional vital signs: body temperature, blood pressure, heart rate, and respiratory rate…saying that “Vital Signs are taken seriously.  If pain were assessed with the same zeal as other vital signs are, it would have a much better chance of being treated properly.  We need to train doctors and nurses to treat pain as a vital sign.  Quality care means that pain is measured and treated.”

Shortly thereafter, two prominent stakeholders in the delivery of healthcare services embraced pain and pain management as a cornerstone of the care spectrum.  In 1999, the Veteran’s Health Administration included pain as the 5th Vital Sign in their national pain management strategy.  Two years later, the Joint Commission on Accreditation of Healthcare Organizations released Standards Related to the Assessment of Treatment of Pain.

The institutionalization of pain by these respected entities was motivated by their interest in delivering comprehensive and appropriate pain care – but doing so also sparked a wildfire of unintended consequences that continues to ravage our healthcare landscape to this day.  Part 2 of 5 next week.

Behavioral Health “Summer Institute”

July 28th, 2014 by Will Humble 1 comment »

conferenceSeveral staff from the Division attended and conducted presentations at the annual summer institute held by ASU’s Center for Applied Behavioral Health Policy.  This is the largest local conference for behavioral health professionals.  This conference was originally created by our Behavioral Health Division in collaboration with ASU 15 years ago.

Today, it continues to provide professional development and continuing education opportunities in addition to networking and updates of the latest industry trends.  This year’s theme was “Resiliency and Whole Health,” and it offered various workshops on recovery, integrated care, and related evidence-based practices.  Sessions included “Lessons Learned from Behavioral Health RFPs” presented by Cory Nelson, along with Victoria Navarra, who leads the program that coordinates the work for the RFPs, and Claudia Sloan, who led the communications strategies for the RFPs.

Another interesting session was: “SBIRT – A Step into Integrated Care” and was presented by NARBHA but received support developing and preparing for the presentation from Alexandra O’Hannon, our contact lead for the SBIRT initiative.  “Healthy Living: Implementation of Stanford’s CDSMP in Behavioral Health” was presented by Claudia Sloan along with partners from the Arizona Living Well Institute and NARBHA.

Kelli Donley, who has been project-managing our exit from the historical Arnold vs. Sarn suit presented “Arnold v. Sarn and the Implementation of SAMHSA Fidelity Tools in Maricopa County”.  Our staff also collaborated with ASU during the planning for this year’s town-hall which focused on the needs of vulnerable adolescents and young adults.  Thanks to all of you that helped make this year’s Summer Institute a success again.

New Abortion Clinic Regulations Filed

July 25th, 2014 by Will Humble No comments »

LAW hammer on computer folder. 3D Icon isolated on white backgroLast Spring the Legislature passed and the Governor signed a new law that provided our agency with the same inspection authority at abortion clinics that we have at all the other healthcare institutions we license.  The previous authority required us to give abortion clinics a 10 day notice before we conduct a routine inspection.  We also used to have to get an administrative search warrant to conduct a surprise complaint investigation.  That new statute went into effect yesterday.

While the new law provides us with the authority to treat abortion clinics just like all of our other licensed facilities, we still needed to adjust our Rules in order to actually exercise that authority.  Yesterday we filed new Rules with the Secretary of State that synchronize our inspection regulations with that new statute.  Here’s the Filed Version of New Rules.

Adjusting Our Vital Records Business Model

July 25th, 2014 by Will Humble No comments »

vital-recordsOur Vital Records team has a wide range of business functions.  We’re responsible for maintaining and issuing certified copies of vital records, including birth and death certificates, registration of adoptions, and corrections and amendments to these vital records.  Much of our work also includes helping the county vital records offices with their mission of verifying and issuing birth and death certificates including ensuring data integrity.  We also maintain the statewide database that’s used as the gold standard for all vital record activities by the county health departments as well as ensure timely and accurate data submission to our national partners (CDC’s National Center for Health Statistics).

A few years ago we began a Vital Records strategic planning process with the goal of ensuring the long-term fiscal health of Arizona’s vital records system.  Part of the plan included implementing a $4 surcharge on each county issued certificate that goes into an ADHS technical support fund to help maintain and enhance our computer infrastructure.  The next step in the plan was to shift our business model toward wholesale support of the counties, phasing out some of our retail work (like issuing on-site birth and death certificates at the service window), and developing our electronic certificate platform.

Consistent with our strategic plan, we’ll be redirecting our efforts toward our mail-in services, county support services, data submission to our national partners (CDC’s NCHS), and implementation our new electronic certificate business model.  Beginning January 1, 2015 we’ll be closing the walk-up service counter in our 1818 West Adams building.  The county health departments (mostly Maricopa) will pick up most of our current walk-up birth and death certificate services.  We’ll also be physically moving our medical marijuana patient, caregiver and agent services team into the 1818 West Adams building in January.

We’ve worked out the budget, and we’ll be able to make this transition with our existing staff – so we won’t be doing any layoffs or anything like that.  Maricopa has agreed to do better advertising between now and January in order to drive traffic to their walk-up service locations during the transition period (to form a glide-path for customer sales).

We’ll also be modifying our website and the hospital birth certificate forms to drive retail traffic Maricopa’s way in the next few months.  Of course – we’ll also need to make some modifications to the 1818 Building to accommodate the medical marijuana registration card and patient relations staff (our plans are to make modifications to the current lobby for work-stations).

Outstanding Success by Newborn Screening Team

July 24th, 2014 by Will Humble No comments »

strangepolioLast month I bragged about how our newborn screening team beat the deadline I gave them to improve our system – a system that ensure blood spots taken from newborns are quickly screened for life-threatening diseases. Now that the actual deadline is past, it’s good to see the team and our licensed hospitals exceeded what I asked them to do.  The goal was to have 95% blood spots to the lab within 3 days from every licensed hospital in the state.  The team and hospitals beat it with 99% making it to the lab within 3 days and 100% within 4 days!

The Newborn Screening Transit Time Project team did a fabulous job tackling training for hospitals, eliminating issues with delivery contractors and ensuring that everyone involved is on the same page. Thanks to Celia Nabor for her excellent leadership and the whole team’s work to supersede the goal. Well done team.

Rocky Mountain Spotted Fever

July 23rd, 2014 by Will Humble No comments »

rocky-mountain1The monsoon season marks the tick season here in Arizona, and one of most important tick-borne disease threats in the state is Rocky Mountain spotted fever.  The symptoms usually start with a fever of two or more days and can lead to a nasty “spotted” rash (although the rash is not always present in the cases seen in Arizona).  Early treatment with the correct antibiotic is critical because delayed or untreated cases are often fatal.

The hard part about this disease is that doctors need to use patient symptoms to diagnose the disease rather than wait for lab results – which can take weeks to complete.  Public health officials and doctors have worked together to create special protocols in high-risk areas to make sure people who might have been exposed to ticks are treated correctly in order to prevent deaths caused by this disease.

You can take steps to protect yourself, your family, and your pets from Rocky Mountain spotted fever.  Dogs should be treated with tick control products year-round, and pets and people should be checked for ticks after being in rural or wilderness areas.  If ticks are found, they should be removed carefully with tweezers, grasping close to the skin’s surface and to the tick’s mouthparts, and pulling straight up without twisting or jerking.  Weeds and grass should also be trimmed and any debris should be regularly removed to get rid of tick habitats.  If ticks are found around homes, it might be necessary to treat the area with pesticides.

Opening the Doors to People with Special Needs: Solutions to Prepare Your Practice

July 22nd, 2014 by Will Humble No comments »

opening-doorsOur Office of Children with Special Healthcare Needs has been working with UnitedHealthcare Community Plans and AHCCCS to support an important free conference on Friday, July 25, to improve the care delivery system in Arizona for children and youth with special health care needs and disabilities and their families.

The goal of the free conference is to provide tools to primary care physicians, behavioral health providers and their staff to incorporate innovative best practice approaches as they care for children and youth with special health care needs and disabilities and their families.  It’s called “Opening the Doors to People with Special Needs: Solutions to Prepare Your Practice.

The conference offers health professionals an opportunity to interact with peers throughout the state and acquire continuing medical education (CMEs) and tools to take back to their practices.  The conference also provides a networking opportunity with community-based organizations that promote health advocacy for individuals with disabilities across the lifespan.  Providers can attend in person or via Webex.  It’s easy to sign up and it’s free- including a complimentary lunch.

Please let your provider and stakeholder networks know about this important training event.

AZ Losing Traction on Vaccine Front

July 21st, 2014 by Will Humble No comments »

Boy getting an injection.Arizona law requires kids to get certain vaccines in order to attend school unless a doctor signs a medical exemption form or a parent signs a religious or personal belief exemption form.  There’s been an increasing number of parents who are signing personal belief exemption forms- putting herd immunity at risk.

Every year we examine our exemption rates…which gives us information about how we’re doing and where we need to focus our efforts.  This year’s analysis found that exemption rates increased again.  Childcare exemption rates went from 3.8% to 4.1% over the last 2 school years.  Kindergarten exemption rates went from 3.9% to 4.7%.  For some perspective-in 2004 only 1.6% of school kids in Arizona were vaccine exempt.

This year’s report shows a noticeable difference in exemption rates between school types.  Public, charter, and private schools all reported higher exemption rates than last year…but exemptions are much higher in charter & private schools than in public schools.  More than 9% of charter school kindergartners were exempted by their parents.  Likewise, 7.5% of private school kindergartners were exempted by their parents (compared to 3.6% of public school kindergartners).

Over the last 18 months we’ve been working with partners using data collected by the U of A to stem the tide.  Last year’s initiatives included implementation of our Action Plan to Address Vaccine Exemptions which included updating the vaccine exemption form (which reinforces to parents know how important it is to vaccinate their kids and the consequences if they don’t).  The form also makes it clear that if there’s an outbreak of a vaccine-preventable disease in a school and their child isn’t vaccinated, he or she may not be allowed to attend school for up to 3 weeks or until the risk period ends.

We’ve also been working with partners to increase information about what vaccines are needed and how the public can find the needed vaccines easily.  We also created a reference and resource document to help schools and childcare facilities better understand the requirements.  We’ll be analyzing this year’s report to identify additional evidence-based strategies to combat this troubling trend toward lower vaccination rates in our schools.

With school about to start, it’s a great time to make an appointment and talk to your healthcare provider to see if your child needs any vaccinations and pick up a copy of those records for the school.