October 21st, 2013 by Will Humble
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Our public health mission is closely linked to the public health mission of many groups, including those at the community, county and university levels. That’s why I frequently attend meetings watching for chances to work together. I also try to connect public health students with people in our shop doing cutting edge work.
Working together is a win-win…we get more great public health work accomplished, we help save more lives, and it benefits their education. It’s exciting when it works out. Two great examples of this teamwork are University of Arizona students receiving “Best Young Investigator Awards” from the American Heart Association’s Resuscitation Science Symposium. This is a really prestigious honor and we got two this year! One from a public health student Nate Heagerty who was working with our EMS and Trauma shop studying cardiac arrest survivors treated using hypothermia and when patients woke up after cardiac arrest. This has huge implications for our cardiac center program and how they take care of folks inside the hospital.
The other is from the work of Aaron Dunham – a UA med student working with our EMS and Trauma team studying traumatic brain injury. Aaron compared vital signs recorded electronically in the field with those recorded by EMS providers. His study has huge implications for treatment and outcome of traumatic brain injury victims and works into our EPIC Project. Both Nate and Aaron will receive their prestigious awards at the AHA meeting in November in Dallas. Congratulations to both of them and the entire Bureau of EMS and Trauma team who have mentored them!
October 18th, 2013 by Will Humble
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Over the last 18 months, our licensing team in collaboration with trade organizations from every sphere of healthcare delivery, partnered with Health Services Advisory Group (HSAG), Arizona’s Medicare Quality Improvement Organization, in its statewide initiative designed to reduce by 4000 the number of preventable hospital readmissions. Aptly named the No Place Like Home Campaign, because there really is no place like home when it comes to patient healing, the campaign not only met their 18 month goal, but exceeded it by a large margin. Under the skilled leadership of Barbara Averyt, BSHA, Catherine Price, MSEd and the Care Transitions team of HSAG, the coalition partners were able to prevent 5,872 Medicare readmissions, an improvement of almost 20% from the 2010 baseline data. These results propelled Arizona to the #1 position in the nation for highest relative improvement rate in reducing Medicare hospital readmissions and became a model for many other states to replicate in their own campaigns to reduce readmissions. These stellar results are a tribute to the close collaboration and responsive partnerships between ADHS, HSAG and the multiple stakeholder organizations in the campaign. For information on the NPLH campaign, please visit their website at www.noplacelikehomeaz.com.
October 17th, 2013 by Will Humble
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Public health surveillance is a cornerstone of public health practice… and the effectiveness of that surveillance system rests on a foundation of patient confidentiality. The public’s consent for allowing their personal medical information to be reported is made with the understanding that the data will be kept confidential. The moment we jeopardize the trust, we put the entire public health surveillance system at risk- which would erode the effectiveness of the entire public health system. For decades the U.S. and Arizona public health surveillance system has made it a core priority to protect patient confidentiality.
We protect patient confidentiality with a number of safeguards- both using policy and technology. Technological protections include making sure that we’re continually using I. T. best practices to stay ahead of the game. Policy initiatives are designed to make sure that our staff respects patient confidentiality and is mindful of the importance of protecting this trust.
For example… we require our entire team to take our HIPPA Training Course in their first 2 months on-board to help us create a culture of respect for our records. Refresher courses can be accessed in YES under Your Employee Services/Employee Training/Scheduled Training under “Annual HIPAA Awareness” (the HIPAA Privacy Refresher) and “Annual HIPAA IT Security” (the HIPAA Security Refresher). On the I.T. side, we’ve installed a new secure e-mail product called Proofpoint E-mail Security Gateway, which ensures that e-mail encryption is automatically applied to outbound e-mails using algorithms that detect confidential and or protected health information based on patterns.
Protecting patient confidentiality for the sake of our mission isn’t the only reason to take confidentiality seriously. There are legal sanctions that the Agency is subject to if we don’t adequately protect confidential patient data. There’s potential personal exposure as well. US Department of Justice fines against individuals start at $50,000- with up to a year in jail and go all the way to $250,000 and up to 10 years if a person releases information for malicious harm.
You get the idea… it’s critical that we protect the personal health information that crosses our desks and computers- especially for those who work in our infectious disease and behavioral health areas, and the Arizona State Hospital.
October 17th, 2013 by Will Humble
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A couple of weeks ago, I introduced the concept of “Over Triage”… which is when EMS transports a patient to the highest level of care (like a level I trauma center) when they could have taken them to a level III or IV trauma center closer to their home. The downside of over-triage is that care at high-end centers is expensive. There’s a nice primer on trauma systems if you want to read more.
This week’s focus is on “Under Triage” – when EMS transports a patient to a facility that’s not as qualified to care for their injuries. There are a number of factors that contribute to under triage: it’s sometimes hard to assess how badly someone is hurt at the scene; emergency workers who don’t have a lot of experience with children may not understand how quickly they can get worse; some adults have high pain thresholds and may make it difficult to see just how badly they’re injured. The perception of tort liability exposure might even play a role sometimes.
The on scene EMS person needs to consider all these things when deciding which hospital is the best choice for their injured patients… and it’s a critical decision. Under triage delays getting the patient the care they need and increases the chance that an injury may be overlooked and under-treated.
Under and over-triage are like a teeter-totter. Under triage is to the left of the balance point and over triage is to the right. The sweet spot is the point when you have just enough over triage necessary to guard against under- triage. So – how do we get to the sweet spot? I’ll cover that in a couple weeks. In the meantime, the State Trauma Advisory Board finished a couple of great products this week. A new five year State Trauma Plan and the 2013 Annual Trauma Report.
October 16th, 2013 by Will Humble
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The California Department of Public Health, the California Endowment, and the Public Health Institute released a document called “Health in All Policies: A Guide for State and Local Governments” this week… which provides best practices to improve the public’s health and safety by incorporating health considerations into decision-making across all sectors and policy areas.
The guide features strategies for achieving good health and sustainability across the community and tips for engaging stakeholders, building relationships, and making joint decisions across sectors. The publication also includes guidance on developing messages around health in all policies, as well as examples of benefits that can be attained through strong public health policy.
This new report ties in nicely with our new azhealthcommunities.org website, which is another tool that provides information on the influence of community design, accessibility and transportation on health. You can even find some recent examples of how communities in Arizona are working to create healthier environments and learn to create a Health Impact Assessment, which can be used to help city projects improve population health. These are just some examples of how we can work to promote healthy and safe community environments – one of our priority areas of our Strategic Map.
October 15th, 2013 by Will Humble
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A study came out in Pediatrics last week that looked at how vaccine exemptions were related to a statewide outbreak of pertussis (also known as whooping cough) in California in 2010. As you might expect, the authors found that there were more whooping cough cases in areas with higher rates of vaccine exemptions.
These findings were true even when the authors controlled for certain demographic factors like race/ethnicity, population density, family size, education level, and household income. Findings of this study underscore the need for everyone to be vaccinated in order to prevent personal risk of getting vaccine-preventable diseases, and to prevent passing these diseases along to those who are too young or not able to be vaccinated.
October 11th, 2013 by Will Humble
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A few weeks ago a Superior Court judge decided that a portion of our medical marijuana regulations are unreasonable because they lack a formal appeal process for dispensary registration certificate holders who don’t earn their approval to operate within 1 year. Because of the ruling, we approved renewal requests for all the current dispensaries (open or not). The ruling also means we need to modify our rules.
Now that we’ve completed the overhaul of our medical, skilled nursing, assisted living and behavioral health rules (18 Articles in all)- we’ve turned our attention toward amending our medical marijuana rules. We began that process this week by scoping out modifications to the rules for renewing dispensary certificates. We’re also planning to make some modifications to the “25-mile rule” (measuring by road rather than “as the crow flies”), eliminating the former “year 2” selection criteria for dispensaries by focusing on vacant CHAAs rather than patient density, and removing the lifetime disqualification for those applicants that receive a dispensary registration certificate but don’t execute.
Once we have an initial “straw-man” draft, we’ll solicit public comment and have oral proceedings just like we did for the original rules in 2011. We think we’ll be able to work through the process and establish the modified rules by the Fall of 2014.
October 10th, 2013 by Will Humble
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The Arizona WIC Program is airing outreach ads in border counties, to ensure WIC clients know about the availability of WIC services in their communities. Several local WIC agencies in the border region are undertaking special actions to promote WIC along with making healthy eating and active living the easy choice in their communities.
The Mariposa WIC Program is a key partner in the Harvesting Well-being Initiative. The idea is to build a local food system in Santa Cruz County so that everyone has access to healthy food. The Mariposa WIC Program has been integral to the development of the Nogales Mercado, a new Farmers’ Market that just celebrated its six month anniversary.
The Cochise County Health Department is working with the Naco Wellness Initiative, a non-profit organization working with both US and Mexican professionals, volunteers, and community members. Their mission is to model health and wellness with people living in the rural and very poor communities near Naco in Arizona and Sonora. The Cochise County WIC Program is specifically working to refer obstetrical patients who are Arizona residents and may qualify for WIC services.
October 9th, 2013 by Will Humble
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A cooperative partnership between Arizona and Sonora highlights the importance of a safe ride home for all children and their families. Car seat use in Arizona is about 90%, yet car seat use in Sonora is less than 20%. A lot of this is because car seats cost more in Mexico than they do in the US- making them less affordable. As part of an initiative that we launched with Sonora at this summer’s Arizona Mexico Commission, Arizonans will be able to conveniently donate new and gently used child safety seats for distribution to families in Mexico. All donated child safety seats will be inspected to insure they will provide the protection needed.
We recently established a new website called A Safe Ride Home which promotes car seat safety in Arizona. We’re in the process of creating community collection points for the car seat donations. The collection sites will be posted to the website. People will also be able to find resources for getting low cost seats in Arizona, including the Arizona Governor’s Office of Highway Safety CAPP Program at the new website.
Having a properly installed car seat is as important as having a car seat. Next week, we’re sending staff to work with our partners from Mexico to provide best practices for how to implement programs to teach folks how to safely and properly install car seats. More to come on this initiative this winter.