Archive for the ‘General’ category

Dramatic Results from AZ’s Cardiac Arrest Receiving Center Initiative

July 30th, 2014

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

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.

New Abortion Clinic Regulations Filed

July 25th, 2014

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

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

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.

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

July 22nd, 2014

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.

Car Seat Delivery

July 17th, 2014

CarSeatExchange4This week we took a huge step forward in our efforts to keep kids safe on both sides of the border.  Rural Metro was helping us transport child car seats to Mexico as part of our commitment to A Safe Ride Home.  Last year during the Arizona Mexico Commission’s summer plenary session, we signed an agreement with Sonora to work to help all kids be safer in cars.

While we focused in Arizona on messaging to ensure that parents have the right seat for the child and that it’s facing the right way, we worked with Univision, Rural Metro and Courtesy Chevrolet to gather gently used car seats to give to Sonora.  We learned that fewer than 20% of babies in Sonora go home from the hospital in a child seat…and the seats are pretty expensive there.  We collected almost 250 seats from people all around the state, but after checking to make sure they were still safe to use, we sent 140 seats to the Arizona border.

You can continue to donate car seats and, most importantly, make sure your kids are safe in the car.

WIC Going More Electronic

July 14th, 2014

wic2Arizona’s Women, Infant, and Children (WIC) is moving from paper checks to an electronic system thanks to a $5M grant we received from USDA this week.  WIC electronic benefit transfer (or EBT) will provide enhanced service and benefits to participants, clinic staff, and WIC vendors (grocery stores authorized to accept Arizona WIC benefits).  Stores in Arizona that provide WIC services sell about $150 million in healthy foods to WIC participants each year.  Our goal is to pick an EBT implementation contractor in the next several months.  We plan on piloting WIC EBT by spring 2016 and complete state-wide rollout by early 2017.

WIC is a national nutrition and breastfeeding program that serves low income women, infants, and children and provides nutrition education, breastfeeding information and support, referrals to community services, and healthy foods. The Arizona WIC Program serves more than 160,000 women, infants, and children each month with services provided by 21 local agencies.

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

July 11th, 2014

brother and sister enjoying day on playgroundOur Office of Children with Special Healthcare Needs has been working with UnitedHealthcare Community Plans and the AHCCCS to support an important free Conference on 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 acquiring continuing medical education (CMEs) and tools to take back to their practices as well as networking 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 Stakeholder networks know about this important training event.

Ladders: Useful But Potentially Hazardous

July 11th, 2014

ambulanceI’ve fallen off ladders at my house twice in the last month which has inspired me to do a post about falls and injuries. The #1 reason people show up in Arizona emergency rooms is from slipping, tripping or stumbling on something.  Falls are the #2 cause of accidental death in Arizona…with 870 deaths recorded last year (overdoses from prescription painkillers is the leading cause of accidental death). Last year there were 122,187 visits to AZ emergency departments from falls.  According to the CDC 20% – 30% percent of people who fall suffer moderate to severe injuries such as fractures, head traumas and lacerations.

Ladder falls are a persistent source of injury in many jobs and in the home. Falls are the number one cause of construction-worker fatalities, with falls from ladders a common yet preventable construction injury.  Health services and the wholesale and retail industries have the largest number of non-fatal fall-related injuries.

Ladder accidents are common during home maintenance and repair when people access higher places in the home such as cutting away trees and prepping for the monsoon season (I fell while turning off my cooler for the season and trimming mesquite branches off of our internet connection wire). It’s no surprise that in Arizona men between 45 and 65 are responsible for 77% of ladder falls (so I’ve done my part for the year).

The National Institute for Occupational Safety and Health released its first smart phone app for mobile devices aimed at improving extension ladder safety by providing real-time safety information delivered via the latest technology.  The AZ Stop Falls Coalition helps coordinate existing efforts, provides technical assistance and increases the opportunities for older adults to enhance their quality of life.  You can also take a look at these tips from the U.S. Consumer Product Safety Commission about how to use a ladder safely… or simply use some good old-fashioned common sense.