Posts Tagged ‘public health’

Medicare Cost Transparency

April 9th, 2014

I’ve always believed that transparency improves the efficiency of any system.  Health care costs are no exception- and health care reimbursement costs are probably at the top of the list of systems that could be improved by applying a healthy dose of cost transparency.

Today the federal government took a giant step forward when they released a public data set called the “Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File”.  It’s a huge database that contains information on utilization, payment, and submitted charges organized by Provider Identifier, Code, and place of service.

Placing this data in the public domain will give researchers around the country access to critical data that can be used to determine where additional system efficiencies can be found and to propose new evidence-based solutions to improve public health outcomes- while making the Medicare and healthcare delivery system more cost effective.


March 31st, 2014

ebolaIf you’re like me, your introduction to Ebola virus came in the 1990s with the bestseller nonfiction thriller The Hot Zone and loosely-based film Outbreak.  The descriptions of a deadly hemorrhagic fever that quickly spread through the population were terrifying, as were the life-threatening dangers posed to the intervening infectious disease personnel.

The Guinea Ministry of Health has a total of 103 suspect and confirmed cases with 66 deaths.  They announced today that the disease has spread to the capital, Conakry.  Also, reports of suspected cases in neighboring countries are being investigated: Liberia reported to the WHO 8 suspected cases, including 6 deaths, in individuals with recent travel history to Guinea. Sierra Leone has reported 6 suspected cases, including 5 deaths.

Bats appear to be a reservoir and hosts for the ebolavirus. Initial infections in humans result from contact with an infected bat or other wild animal. Ebola spreads by contact with other patients’ infectious secretions and from consuming the meat of infected animals.  For Guinea’s particular strain, the fatality rate is nearly 90%, and is heralded by fevers and internal bleeding.   Doctors Without Borders and WHO both have teams in Guinea, working with the Health Ministry to contain the spread.

In countries with weak medical infrastructures, an outbreak like this can be devastating.  Historically, countries with poorer infrastructures and health status suffer far worse than more bolstered nations.  So while Arizona is under no threat from Ebola, maintenance of a strong public health and emergency preparedness program remains a top priority.

Now Hiring – Licensing Assistant Director

March 26th, 2014

Once in a while we have a tremendous opportunity for a great leader to join our team, but not very often.   We just posted the Assistant Director for Public Health Licensing.  The person we’re looking for will be able to take a great team and make it better.  This person will be collaborating with partners on the local, state and national level on everything from reducing healthcare-associated infections to quality improvement to managing a $17 million dollar budget.

This position is a real leverage point for improving public health outcomes in Arizona.  Our licensing area handles most of the licensed facilities in the department including medical, long-term care and residential facilities and childcare homes and centers.  There are also a few specialty licenses that fall into the division like speech-language and hearing therapists and midwives.  

If you feel you’re the right person at the right time, visit and check out the Assistant Director posting.

Tuberculosis & Mankind

March 24th, 2014

Tuberculosis and mankind share a dramatic and intertwined history.  TB has caused millions of deaths every year for centuries, been found in Egyptian mummies, has placed patients into sanatoriums, and has  even has a folklore link relating it with vampires,  The drama continues into this decade: in 2012, there were 8.8 million new cases of TB diagnosed worldwide and around 1.2 million deaths. 

Public health departments have been fighting for TB elimination since their creation.  Efforts in the 1950s decreased mortality by nearly 90%, but a resurgence in cases and deaths occurred after drug-resistant strains emerged in the ‘80s.  Soon after, the WHO declared TB a global health emergency, and the next decade saw TB control targets developed in an attempt to eliminate TB. 

Arizona continues to strive to hit these targets.  In 2013, there were 184 TB cases reported in the state, a 13% decrease from the year before.  Arizona also has a lower case rate compared to the nationwide average.  Our programs use “directly observed therapy”, evidence-based policies, and partnerships with counties and Cure TB to ensure patients are completing treatment and reducing their risk of developing drug-resistant TB

Our Arizona State Public Health Laboratory also supports TB control.  In 2013, we adopted the Cepheid GeneXpert, a test that detects TB in only 2 hours while identifying mutations associated with drug-resistant TB.  Specimens found to have these mutations are forwarded to the CDC for a full battery of molecular tests to confirm drug resistance. 

World TB Day is coming up on March 24th, which is commemorated annually to bring global awareness about the effects of TB.  You can join us for a Twitter Chat at 10 a.m., March 24, 2014 to discuss TB in Arizona.  Follow us on Twitter and follow the chat using #azhealthchat.

A Key Measure of Preparedness Improves in AZ

March 18th, 2014

During a major crisis, such as an influenza pandemic, we might need to take extraordinary steps to ensure that healthcare workers have the medicines and supplies on hand to treat patients.  State, local, and federal agencies all participate in the Strategic National Stockpile program to help ensure that these critical resources are available during disaster situations.

The main purpose of our Strategic National Stockpile program is to distribute medicines, vaccine, and supplies during all types of public health emergencies.  This year, we improved that capability once again.  Scores for our state and local programs rose this year according to the CDC’s annual Technical Assistance Review.  Every year, the CDC looks at key “functional areas” across the state and in select local jurisdictions.  The Review score rose up to 97%, Maricopa County maintained its high mark of 99%, and Pinal County achieved a 100% in all 12 areas. 

These outstanding scores demonstrate our statewide commitment to the Strategic National Stockpile program, and highlight the extraordinary efforts of our public health preparedness teams.  Here’s how to learn more about the Strategic National Stockpile program.


Improving Arizona’s Birth Outcomes

March 13th, 2014

Arizona ranks in the middle of the pack in infant mortality.  We’re doing many things right to improve the health of our babies-  but we have a way to go. Last fall we participated in a learning collaborative sponsored by the National Governors Association.  About 160 folks met to begin the process developing a statewide plan.  They included physicians, public health, nutrition, behavioral health, city planners, business leaders and many more. 

After looking at the data on the health of Arizona’s women and children and reviewing some best practices from around the state, participants broke into groups to talk about the issues and to develop strategies to address these issues. These strategies will be the foundation for the statewide plan to improve birth outcomes.  

Our next step is to form workgroups to develop action plans for the different strategies identified. You can look at the presentations from the day and learn more about our efforts by going to the Healthy Babies web page. Many people have volunteered to be a part of these workgroups and have signed commitment forms.  It’s important to know that this is not an ADHS plan but Arizona’s plan.

National Audit: Room for Improvement at Skilled Nursing Facilities

March 6th, 2014

Data collection and analysis is public health’s most valuable  renewable resource- which is why we’ve made data analysis such a high priority.  Yesterday, the Office of the Inspector General for HHS published a document that highlights the fact that disciplined data analyses can identify key factors that result in poor outcomes- giving us the information we need to intervene and improve results. 

Yesterday’s report is entitled Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries, and it examines “adverse events” that occurred in skilled nursing facilities nationwide between 2008 and 2012.  “Adverse events” are basically events related to medication, ongoing resident care, or infections. 

The study found that about 22% (of Medicare beneficiaries) had an “adverse event” while at a skilled nursing facility.  Of course, not all of these were preventable, but the study found that almost 60% of the adverse (and temporary harm) events were preventable. The report attributes much of the preventable harm to substandard treatment, inadequate resident monitoring, or a delay in administering necessary care. 

Part of our core mission as an agency is to protect public health and safety by addressing quality of care issues in our licensed healthcare institutions.  As part of that mission, we license and inspect 147 skilled nursing facilities statewide.  The facilities range in size from as few as 10 to as many as 200 patients. 

Today’s study will be a valuable as a tool for us because it’ll help us focus our inspections and facility surveys on areas where we can have the biggest impact on improving care and outcomes.  Over the coming weeks, our skilled nursing survey team will be diving into the details of the report so we can become more familiar with the areas that we should focus on while we’re in the field- including updating our focused reviews of nursing home practices to identify and reduce adverse events. 

Additionally, the Affordable Care Act requires nursing homes to develop Quality Assurance and Performance Improvement (QAPI) programs to address quality problems and improve facility performance. Our survey teams will be including an assessment of adverse event identification and reduction in our evaluations of Arizona’s skilled nursing facilities QAPI plans with a focus on the elements of care identified in today’s report.

Arizona’s First Ever State Health Assessment

February 13th, 2014

Today we published Arizona’s first ever comprehensive State Health Assessment. The objective of the State Health Assessment is to give Arizona’s public health and health care systems a clear tool to help drive future decision-making and resource allocation as we collectively design and implement evidence-based interventions to improve health and wellness outcomes across Arizona.  

The Assessment uses Arizona-specific data to assess the state of the public’s health in Arizona and has been a collaborative effort among all of the health departments in each AZ county as well as the ADHS.  The 15 priority health issues in the Report are obesity, tobacco use, substance abuse, healthcare associated infections, suicides, teen pregnancy, creating healthy communities, behavioral health services, diabetes, heart disease, other chronic diseases (cancer, respiratory disease, asthma), accidents and injuries, oral health, access to well care, and access to health insurance. 

Each public health indicator is summarized for its significance and scope, trending, and comparative analysis against national data.  The report also provides in-depth analysis for a number of indicators in each of Arizona’s 126 Community Health Analysis Areas. 

Please take time to look at the State Health Assessment and the county level community health assessments.  After you’re done, we’d appreciate hearing from you through the survey monkey as we take the next giant step to create Arizona’s first State Health Improvement Plan.

Electronic Birth Certificate Rollout Going Smoothly

January 6th, 2014

We rolled out a new electronic birth certificate system this week that will be a game-changer for public health.  Our system (which took about 18 months to plan, create & launch) will help us collect better surveillance data for our Winnable Battles like obesity, tobacco use, substance abuse, and better data about birth outcomes that will help with our maternal and child health interventions.  It’ll also help us do a better job ensuring that our licensed professional midwives are meeting our expectations.  And of course the reason we keep track of data is to find interventions that work to improve outcomes, like the home visiting program

Hospitals, birthing centers, county health departments and several state agencies will be able to enter and retrieve information more efficiently and quickly.  With the various levels of access, there are more protections for parents and babies alike.  

The system uses a standard that’s consistent with the National Center for Health Statistics- producing critical information on public health topics like teenage births and birth rates, prenatal care and birth weight, risk factors for adverse pregnancy outcomes, infant mortality rates, leading causes of death, and life expectancy. 

Thanks to the Office of Vital Records led by Krystal Colburn, our Vital Statistics Bureau and more than a dozen IT folks who made this happen including (but not limited to) Dimiter Pekin, Shobha Vaddireddy, Ellen Rayer, Michael Conklin, Shandy Odell, Michael Shaw, Alan Landucci-Ruiz, Matthew Marshall, Gordon Esra, Loretta Jackson, Smita Sahoo, Avinash Veerlapati, Cameron Pulcifer and Carl Farmis.


Arizona Public Health Association gets National Recognition

December 18th, 2013

Congratulations to Arizona Public Health Association (AzPHA) for gaining national recognition for its work- snagging the 2013 National Affiliate of the Year Award from the American Public Health Association.

For 85 years, AzPHA has helped shape public health in Arizona working to create smoke-free environments and access to healthcare.  In this year alone, the Arizona affiliate reviewed more than a 1,000 legislative bills, visited AZ Congressional offices, put on professional development events and webinars and advocated for the restoration of Medicaid.  The current President, Patti Taylor, attributes the success to the membership, volunteers and partners.  I think it is also because of the leadership and dedication of the organization. 

AzPHA is a professional group that welcomes those who are interested in promoting public health in Arizona’s communities.  If you want to make a commitment to join, find out more online.