Posts Tagged ‘intervention’

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AZ’s 911 Telephone-Assisted CPR Initiative Goes Global

April 12th, 2013

If you’re a regular reader, you know how much value I place on using data to decide if interventions are successful and then sharing successful interventions with others. The way we helped change to hands-only CPR is a great example. We used evidence to craft our intervention (modifying how CPR is done), measured its effectiveness, and published the results. Now, most of the country and some of the world is shifting to the new CPR. 

Dr. Ben Bobrow (our EMS Medical Director) bounded into my office about a year ago with a similar idea to train 911 dispatchers to coach callers through CPR instructions more effectively. We cobbled together the money from some voter initiative funds, and our ADHS Telephone-Assisted CPR program was born.  Of course, we built measurement into the front end, and the results showed that we’ve almost cut in half the time it takes for 911 callers to start CPR. That’s real important- because survival drops by 10% for every minute delay in starting CPR- and the typical wait time for an ambulance is 5-8 minutes. 

Now that successful program is going international. One of the Clinton Global Initiative meetings this week in St. Louis highlighted our dispatch training initiative as a scalable evidence-based best-practice with a high return on investment.  Basically, it’s quickly becoming a global model for saving lives. In fact, the Global Dispatch CPR Intervention is already underway in 10 countries in Asia (including Singapore this week)… and will last about 3 years, focusing on Asia, the Middle East and North America.

 

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The Health Care/Public Health Continuum

March 13th, 2013

In the world of health care- the clinician works with patients individually. They examine various indicators of health for their patient including direct observations and laboratory or other diagnostic tests and implement interventions to help their patient improve their health. Providers also encourage their patients to live healthy lifestyles and take safety precautions- and help patients with preventative care by providing vaccinations and the like. Over time, the health care provider follows the patient and measures how they’re doing with patient centered criteria. 

In the world of public health, the practitioner works with communities… in other words the community is the patient. Public health folks look at outcome indicators to determine the health of the community so they can take action and implement interventions at the wholesale level to improve population health. In other words- public health uses community indicators like infant mortality, communicable disease rates, obesity and diabetes to assess the patient (the community). Of course, public health relies on health care providers in the health care world to carry out public health objectives and interventions. 

So you can see that there is a strong interface between health care and public health- but the distinction is that in health care the patient is the patient while in public health the community is the patient- the interventions are community based, and community indicators are the primary assessment tool. By the way, reports suggest that behavior accounts for roughly 50% of health outcomes, genetics about 20%, the environmental about 20%, with medical care about 10%… 96% of our national health expenditures are focused on medical care with about 4% dedicated to prevention. Does prevention sound like a good investment?

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50 Years of Newborn Screening

January 29th, 2013

Last year we welcomed about 87,000 newborns to Arizona.  Our Newborn Screening Program (in our State Lab) ensures that each are tested for 28 inherited disorders and hearing problems.   The goal is to help kids avoid illness, developmental delays and even death.  Teamwork, communication and coordination are critical in making this program effective.  A quick look at the numbers reveals how monumental this screening task really is.

On any given day our newborn screening team receives and tests from 600 to 1,500 bloodspot samples for each of the 28 disorders. Our demographics team verifies the results and confirms all of the data associated with each sample as well as ensuring that lab results are sent out to the health care provider.  Our case management team follows up on about 140 potentially positive results (including hearing) each week, coordinates the confirmation test and works with pediatricians, clinical specialists and families.

 

The end result?  Because of the dedication and commitment of each member of the Team, hundreds of families have the opportunity for their newborn to receive the early treatment, intervention and support services that will allow them to lead normal lives.  Of course, none of this would be possible without the gasoline that runs the engine, the billing department brings in the money that keeps this effective machine helping families every day.

The first state-mandated newborn screening programs began in Massachusetts, Oregon, and Delaware 50 years ago this week.  Now, 97% of U.S. newborns are screened by state public health labs like ours.  The Association of Public Health Laboratories is partnering with the CDC to launch a year-long public awareness campaign to celebrate this milestone. The campaign website includes a calendar of events and informational resources for expectant parents, healthcare providers, and health decision-makers.

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Suicide Prevention: A Winnable Battle

December 18th, 2012

Back in 2009, AZ had the 9th highest rate of suicide in the U.S.  In that year 1,060 Arizonans took their own lives- so it’s easy to see why suicide prevention is an agency priority and is featured in our Strategic Map as a Winnable Battle.  Since we’re responsible for the state’s behavioral health system- we have a leverage point…  especially for the folks that receive services through our public behavioral health system including crisis services. 

One of our primary interventions for this Winnable Battle has been our collaborative Suicide Deterrent System, which was launched in 2009 by Magellan (our Regional Behavioral Health Authority in Maricopa County).  It’s evolved into a training initiative for behavioral health professionals to a comprehensive national model addressing one of the most at-risk populations – folks diagnosed with mental illness. Since kickoff, the initiative has trained more than 3,000 behavioral health care staff to recognize the signs and symptoms of suicide in persons with mental illness, and to help them stay safe and seek help.  The program has also addressed family engagement and support groups for suicide attempt survivors- and has developed clinical tools and procedures for assessing risk and appropriately intervening. 

The ADHS and Magellan Health Services of Arizona won a Council of State Governments Innovation Award this year for the Suicide Deterrent System.  The objective of the Suicide Deterrent System is to make suicide a “never event” for those served by our public behavioral health system.  Nationally, most public sector behavioral health care systems have made suicide prevention a business side-line…  relying mostly on crisis interventionist specialists.  Our model recognizes that to be successful, we need to provide safe, effective, patient-centered, timely, efficient, and equitable care. Our systems approach brings the core business of state-funded behavioral health care to tackle the challenge, including a systematic “do whatever it takes” approach, top leadership commitment, measurement and reporting and robust performance improvement. 

Our collaborative initiative has changed the mindset about suicide prevention. By providing knowledge, skills, tools and management support, this project has made suicide intervention a core responsibility of all behavioral health staff. It recognizes the complexities of suicide and addresses: 1) Behavioral health workers’ skills/confidence to intervene (Applied Suicide Intervention Skills Training – ASIST); 2) Connectedness for those contemplating suicide (attempt survivor support groups, family engagement); and 3) Risk identification and stratification (clinical care and intervention).

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Guide to Community Prevention Services

October 3rd, 2012

Every so often- you run into a resource guide that stands above the rest.  I discovered one of those a couple of weeks ago when I was at a conference with the people in my job from around the country.  It’s called the Guide to Community Preventive Services – and it’s a free resource to help you choose programs and policies to improve health and prevent disease in communities.  The easy to read resource guide answers questions like: 1) Which program and policy interventions have been proven effective; 2) Are there effective interventions that are right for my community; and 3) What might effective interventions cost and what’s the return on investment? 

There are modules on different public health topics- and the evidence-based information is printed in colorful, easy-to-read formats.  Subjects include much of our core strategic plan activities in health and wellness including: Adolescent Health; Alcohol; Asthma; Birth Defects; Cancer; Cardiovascular Disease; Diabetes; Emergency Preparedness; Health Communication; Health Equity; HIV/AIDS,STD’s, Pregnancy; Mental Health; Motor Vehicle Injury; Nutrition; Obesity; Oral Health; Physical Activity; Social Environment; Tobacco Use; Vaccines; Violence; and Worksites.  Learn more about The Community Guide, collaborators involved in its development and dissemination, and methods used to conduct the systematic reviews.

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H7N3

June 29th, 2012

Remember the 2009 H1N1 influenza pandemic?  That brand new virus that caused the pandemic was a combination of RNA from four different flu viruses – North American swine influenza, North American avian influenza, human influenza, and swine influenza virus typically found in Asia and Europe.  The natural laboratories for new influenza viruses that end up causing pandemics (like the ’09 pandemic) are birds and pigs- so it’s important to pay attention to new viruses that emerge in these species so interventions can be implemented to manage outbreaks and potentially prevent human outbreaks or even pandemics. 

Last week Mexican veterinary authorities found a new strain of influenza virus called H7N3 that has been infecting and killing large numbers of poultry at several large commercial farms.  This is the first major outbreak in Mexican flocks since the country battled H5N2 influenza virus in the mid 1990s.  Luckily, there are no human cases and no suggestion yet that it is a kind of virus that can infect humans- but it’s still important to follow up on  Follow-up report No. 1 (25/06/2012). 

By the way- the Influenza virus strains get their names from compounds called hemagglutinin and neuraminidase.  The H in the name refers to the kind Hemagglutinin on the virus and the N stands for the strain of Neuraminidase on the virus.

 

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AZ Leads the Way to Reducing Teen Pregnancies

April 10th, 2012

Teen pregnancy is a key public health indicator because of the profound negative health outcomes related to a lack of education and economic opportunity.   For example, only about 50% of teen mothers receive a high school diploma versus approximately 90% of their peers.  The disadvantages caused by a teen pregnancy can last a lifetime- and even spill over to the next generation.  Teen pregnancy is expensive too- costing about $11B per year in increased health care, foster care, incarceration, and lost tax revenue.  That’s why we’ve made reducing teen pregnancy in AZ a key element in our strategic map. 

Today’s good news is that teen pregnancy made a historic drop over the last 3 years in AZ.  In fact, teen pregnancy dropped by almost 30% in AZ over the last 3 years- the steepest decline in the nation.  

How did we get here?  As is the case with most things in public health- our success is tied to a host of interventions and circumstances.  No doubt our community-based contracts under the Personal Responsibility Education Program is a factor along with our federal Abstinence Education contracts.  The study that was published today shows that teens are becoming more educated about how to effectively prevent teen pregnancies and are using that info.  Another factor is probably the economy.  There’s a well known link between lower pregnancy rates in general and challenging economic times. 

The bottom line is that the trend toward lower teen pregnancy rates in AZ and the US is encouraging- but we need to do even better by using tried and true evidence-based practices to keep up the pressure on this important health indicator. 

 

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Surveillance & Intervention Treasure Trove

March 15th, 2012

We’ve got a treasure trove of statewide public health indicators website called “Arizona Health Matters” http://www.arizonahealthmatters.org/ which has a wealth of information about the health status of Arizonans- and includes lots of other interesting data including Promising Practices and Evidence Based Interventions.  The site includes more than 100 health and quality of life indicators, an ability to search and compare data by County and zip code within Arizona, promising practices on a variety of topics that affect community health, and a Report Assistant to create quick reports and summaries.

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Leveraging Community Partners for Change

December 9th, 2011

A few months ago our tobacco & chronic disease prevention team was awarded a CDC grant to increase coordination and collaboration on evidence-based interventions addressing the leading causes of chronic diseases in Arizona (heart disease, cancer, pulmonary disease, stroke, diabetes, and arthritis).  The Chronic Disease Prevention and Health Promotion grant will look for ways we can leverage community partners to improve the health of all Arizonans through health policy, school-based initiatives, community health impact assessments, increased preventive health screenings, chronic disease self-management and worksite wellness.  

From now through December 12th our team will be meeting with stakeholders throughout Arizona in a series of partner meetings to gather input on the development of a chronic disease strategic plan surrounding these issues and interventions.  Hundreds of community partners have been invited to participate in sessions taking place in Yuma, Tucson, Flagstaff and Phoenix.  Simply visit our Chronic Disease Blog for details.

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The Health Care/Public Health Continuum

November 29th, 2011

In the world of health care- the clinician works with patients individually.  They examine various indicators of health for their patient including direct observations and laboratory or other diagnostic tests and implement interventions to help their patient improve their health.  Providers also encourage their patients to live healthy lifestyles and take safety precautions- and help patients with preventative care by providing vaccinations and the like. Over time, the health care provider follows the patient and measures how they’re doing with patient centered criteria.  

In the world of public health, the practitioner works with communities…  in other words the community is the patient.  Public health folks look at various outcome indicators to determine the health of the community so they can take action and implement interventions at the wholesale level to improve population health. In other words- public health uses community indicators like infant mortality, communicable disease rates, obesity and diabetes to assess the patient (the community).  Of course, public health relies on health care providers in the health care world to carry out public health objectives and interventions. 

So you can see that there is a strong interface between health care and public health- but the distinction is that in health care the patient is the patient while in public health the community is the patient- the interventions are community based, and community indicators are the primary assessment tool.  By the way, studies and reports suggest that behavior accounts for roughly 50% of health outcomes, genetics about 20%, the environmental about 20%, with medical care about 10%… 96% of our national health expenditures are focused on medical care with about 4% dedicated to prevention.

 

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