Public Health and Clinical Care How Do We Meet?

1. Public Health and Clinical CareHow Do We Meet? Paul E. Jarris, MD, MBA Executive Director ASTHO

2. Health Rankings America’s Health Rankings – A Call to Action for People & Their Communities United Health Foundation, 2007

3. Determinants of Health Determinants of Health and their Contribution to Premature Death, Adapted from McGinnis, et al., 2002

5. The Clinical and Community Guides Are Complementary • Individual level • Clinical settings • Delivered by • healthcare providers • Screening, Counseling &Treatment Clinical Guide: US Preventive Services Task Force Recommendations • Community, population-based • Health system changes • Access to/provision of services • Informational • (Group Education, Media) • Behavioral, Social • Environmental & Policy Change Community Guide: Task Force on Community Preventive Services Recommendations

6. The Triple Aim

7. CMS Three Part Aim

8. Managing Population Health: The Role of the Hospital American Hospital Association Association for Community Health Improvement Managing Population Health: The Role of the Hospital. Health Research & Educational Trust, Chicago: April 2012. Accessed at www.hpoe.org

11. Source: HRET, 2012

13. Hospital Community Benefit

14. County Health Rankings Model

15. County Health Rankings: Population Health-Related Measures and Sources Mortality premature death - National Center for Health Statistics 2006-2008 Morbidity poor or fair health - Behavioral Risk Factor Surveillance System 2004-2010 Poor physical health days - Behavioral Risk Factor Surveillance System 2004-2010 Poor mental health days - Behavioral Risk Factor Surveillance System 2004-2010 Low birthweight - National Center for Health Statistics 2002-2008

16. County Health Rankings: Socio-Economic Status-Related Measures • Education high school graduation - National Center for Education Statistics and state-specific sources2008-2010 • Some college - American Community Survey 2006-2010 • Employment - Unemployment Bureau of Labor Statistics 2010 • Income children in poverty small area - Income and Poverty Estimates 2010 • Family and social support/ inadequate social support - Behavioral Risk Factor Surveillance System 2006-2010 • Children in single-parent households - American Community Survey 2006-2010

17. County Health Rankings:Physical Environment-Related Measures Air pollution-particulate matter days - U.S. Environmental Protection Agency 2007 Air pollution-ozone days - U.S. Environmental Protection Agency 2007 Access to recreational facilities - Census County Business Patterns 2009 Limited access to healthy foods - U.S. Department of Agriculture 2006 Fast food restaurants - Census County Business Patterns 2009

18. CDC: Prevention Status Report http://www.ipha.wildapricot.org/Resources/Documents/Annex_50%20states.pdf 2 Components: Public Health and Policy Indicators The rationale for each indicator includes references to related indicators, objectives, or recommendations from Healthy People, the Institute of Medicine (IOM), and The Guide to Community Preventive Services (Community Guide)

19. Prevention Status Report Tobacco Control Nutrition, Physical Activity, and Obesity Food safety Teen Pregnancy Prevention HIV Prevention Health Care Associated Infection Prevention Motor Vehicle Injury Prevention

20. Prevention Status Report Tobacco Indicator 1: Proportion of adults who smoke cigarettes Definition: Adults aged 18 years and older who reported ever smoking at least 100 cigarettes and who currently smoke every day or on some days… Rationale: Healthy People 2020 Objective TU–1: Reduce tobacco use among adults. TU–1.1: Cigarette smoking. Source of data: Behavioral Risk Factor Surveillance System (BRFSS), 2009 Indicator 2: Proportion of high school students who smoke cigarettes Definition: High school students who reported that they had smoked cigarettes on at least 1 day during the 30 days before the survey… Rationale: Healthy People 2020 Objective TU–2: Reduce tobacco use by adolescents. TU–2.2: Cigarettes (past month). Source of data: Youth Risk Behavior Surveillance System (YRBSS), 2009

21. Prevention Status ReportMotor Vehicle Injury Prevention Indicator 1: Motor vehicle-related death rate Definition: Motor vehicle-related death rate per 100,000 population among all ages. Rationale: Healthy People 2020 Objective IVP–13: Reduce motor vehicle crash-related deaths. IVP–13.1: Deaths per 100,000 population… Source of data: National Highway Transportation Safety Administration, Fatality Analysis Reporting System (http://www-fars.nhtsa.dot.gov/Main/index.aspx), 2009 Indicator 3: Seat belt use Definition: Observed belt use based on probability samples in all 50 states and DC. Rationale: Healthy People 2020 Objective IVP–15: Increase use of safety belts. (Note: HP 2020 objective uses National Occupant Protection Use Survey data.)

22. Prevention Status ReportNutrition, Physical Activity, and Obesity Policy Indicators: Indicator 1: Sale of less nutritious foods and beverages in secondary schools Definition: Can students purchase each of the following snack foods or beverages from vending machines or at the school store, canteen, or snack bar –candy; salty snacks that are not low in fat, such as regular potato chips; cookies, cakes, pastries… Rationale: Healthy People 2020 Objective NWS–2: Increase the proportion of schools that offer nutritious foods and beverages outside of school meals. Public Health Indicators: Indicator 3: Proportion of low income children 2- < 5 years of age who are obese Definition: Obesity is defined as a body mass index (weight (kg)/height (m)2) ≥ the 95th percentile for age and sex based on the 2000 CDC Growth Charts… Rationale: Healthy People 2020 Objective NWS–10: Reduce the proportion of children and adolescents who are considered obese…

23. Measurement Public Health Data Clinical Data Accountability

24. Potential for Population Health Measures Accountable Care Organizations Patient Centered Medical Homes Community Health Assessments Community Health Improvement Plans IRS 990 Requirements for Tax Exempt Hospitals PHAB Requirements for Health Agencies Public Health Agencies/Governments

25. Priorities for the National Quality Strategy From the Population/Community Health Subcommittee: • Promote healthy living and well-being through community interventions that result in improvement of social, economic, and environmental factors. • Promote healthy living and well-being through interventions that result in adoption of the most important healthy lifestyle behaviors across the lifespan. • Promote healthy living and well-being through receipt of effective clinical preventive services across the lifespan in clinicaland communitysettings.

26. NQF Call for Measures • Health outcomes • Health outcomes of individuals, including health/functional status, mortality, and quality of life; • Measures that assess the health of a total population or a subset of a population (sub-population), including disparities across the population. • Measures that cover the lifespan, including those that focus on children, adolescents, and the elderly. • Determinants of health • Adoption of healthy lifestyle behaviors; • Population-level measures in the following priority areas are encouraged: • Overweight/obesity; • Physical activity; • Tobacco use (e.g., screening, smoking cessation); and • Nutrition • Receipt of health promotion and education services; • Modifiable social, economic, and environmental determinants of health with demonstrable relationship to population health outcomes.

27. NQF Call For Measures #0421: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up (endorsed) Percentage of patients aged 18 years and older with a calculated BMI documented in the medical record AND if the most recent BMI is outside the parameters, a follow up plan is documented. Parameters: age 65 and older BMI > or = 30 or < 22; age 18-64 BMI > or = 25 or< 18.5. Provider Level #1999: Late HIV Diagnosis (new) Percentage of persons 13 years and older diagnosed with Stage 3 HIV infection (AIDS) within 3 months of a diagnosis of HIV infection. Population Level

28. NQF-endorsed Population-level Measures Diabetes • 0272: Diabetes Short-Term Complications Admission Rate • 0274: Diabetes Long-Term Complications Admission Rate • 0638: Uncontrolled Diabetes Admission Rate Potential • Prevalence of Diabetes in the community • Prevalence of Obesity in the community

29. NQF-endorsed Population-level Measures Children • 0717: Number of School Days Children Miss Due to Illness • 0728 : Asthma Admission Rate (pediatric) • 1334 : Children Who Received Preventive Dental Care • 1346 : Children Who Are Exposed To Secondhand Smoke Inside Home • 1348 : Children Age 6-17 Years who Engage in Weekly Physical Activity

30. Maternal and Child Health (MCH) Block Grant Performance Measures (May 2012) Percent of 19 to 35 month olds who have received full schedule of age appropriate immunizations against Measles, Mumps, Rubella, Polio, Diphtheria, Tetanus, Pertussis, Haemophilus Influenza, Hepatitis B. The rate of birth (per 1,000) for teenagers aged 15 through 17 years. The rate of deaths to children aged 14 years and younger caused by motor vehicle crashes per 100,000 children. The percent of mothers who breastfeed their infants at 6 months of age.

31. CMS Three Part Aim

33. Measurement Public Health Data Clinical Data Accountability

34. Thank You Paul Jarris, MD, MBA Executive Director Association of State and Territorial Health Officials 202-371-9090 pjarris@astho.org www.astho.org