PRESENTATION TO DSHS PUBLIC HEALTH IMPROVEMENT STAFF November 9, 2010

1. PRESENTATION TODSHS PUBLIC HEALTHIMPROVEMENT STAFFNovember 9, 2010 Mike Gilliam, Jr., M.S.W., M.P.H. Office of Priority Initiatives Coordination

2. ORGANIZATIONAL CHANGES: • Mike Gilliam (Assessment & Benchmarking Specialist) moved from Centers for Program Coordination, Policy & Innovation to the Office of Priority Initiatives Coordination (OPIC). • Olga Rodriguez is Director of OPIC. • Assessment & Benchmarking Specialist will “conduct benchmarking activities, preventable hospitalization efforts and activities associated with performance management, quality improvement and data analysis.”

3. REQUESTING A COMMUNITY HEALTH ASSESSMENT INVOLVING OPIC: • County judge emails DSHS Regional Director (RD) requesting assistance in developing a community health assessment. • If RD approves county judge’s request, RD sends an email to Mike Gilliam requesting OPIC work with PHI in developing a Plan of Action for the community health assessment. • Mike Gilliam sends Plan of Action to RD and OPIC Director for approval. • Project begins once RD and OPIC Director approve Plan of Action in writing (via email).

4. QUESTIONS TO ASK BEFORE REQUESTING ASSISSTANCE FROM OPIC IN DEVELOPING A COMMUNITY HEALTH ASSESSMENT: • Why does the county want to develop a community health assessment? • Do county leaders have a need to obtain community health assessment data/information for a specific health-related purpose? • Who will the county judge appoint to work with DSHS in developing the community health assessment? Can this “appointed” person devote a significant amount of time to the project? • Are county leaders committed to post-assessment activities? • During the project period, can PHI staff devote at least 50% of their time to the project?

5. POSSIBLE PARTNERS IN PLANNING/IMPLEMENTING A COMMUNITY HEALTH ASSESSMENT: • Non-profit Hospitals • EMS/Trauma Regional Advisory Councils

6. ONLINE DATA/INFORMATION COLLECTION (Question Pro): DSHS has a corporate license to Question Pro (www.questionpro.com). Mike Gilliam is DSHS’ license administrator. • Program emails Mike hard copy of survey. • Mike puts the survey online in a draft format. • Program reviews/tests/approves draft online survey. • Mike provides program with web-link of final online survey to send via email to target audience. • Mike provides program with real-time web-link to monitor survey results. • Program requests Excel file of survey data/information when survey closes.

7. ADULT POTENTIALLY PREVENTABLE HOSPITALIZATIONS: • Exceptional Item (2011/12) • MHSA Co-morbidity • Presentations (e.g., TMA, TACHC, EMS/Trauma RAC) • HHSC • 2009 Data

8. Adult Potentially Preventable Hospitalizations in Texas • The purpose of this information is to assist in improving health care and reducing health care costs in Texas. • This information is not an evaluation of hospitals or other health care providers. • The preventable hospitalization conditions were selected by the Agency for Healthcare Research and Quality (AHRQ).  AHRQ (www.ahrq.gov) is the lead federal agency responsible for research on health care quality, costs, outcomes and patient safety. • The data comes from the Texas Health Care Information Collection in the Center for Health Statistics at the Texas Department of State Health Services (www.dshs.state.tx.us/thcic).

9. Adult Potentially Preventable Hospitalizations in Texas Hospitalizations for the following ten conditions are called “potentially preventable,” because if the individual had access to and cooperated with outpatient health care, the hospitalization would likely not have happened: • Bacterial Pneumonia; • Dehydration; • Urinary Tract Infection; • Angina (without Procedures); • Congestive Heart Failure; • Hypertension (High Blood Pressure); • Asthma; • Chronic Obstructive Pulmonary Disease; • Diabetes Short-Term Complications; and • Diabetes Long-Term Complications.

10. Adult Potentially Preventable Hospitalizations in Texas • From 2005-2008, adult residents (18+) of Texas received $24.9 billion in hospital charges for the ten conditions. This amount equals $1,418 for every adult Texan. • Bacterial Pneumonia and Congestive Heart Failure comprise 52% of these hospital charges. • Hospital Charges Billed: Medicare $16.0 billion (64%) Private Health Insurance $ 4.4 billion (18%) Uninsured $ 2.2 billion (09%) Medicaid $ 1.7 billion (07%) Other $ 600 million (02%)

11. * Average Length of Hospital Stay Source: Center for Health Statistics, Texas Department of State Health Services

12. Source: Center for Health Statistics, Texas Department of State Health Services

13. Source: Center for Health Statistics, Texas Department of State Health Services

14. Source: Center for Health Statistics, Texas Department of State Health Services

15. Source: Center for Health Statistics, Texas Department of State Health Services

16. Source: Center for Health Statistics, Texas Department of State Health Services

17. Source: Center for Health Statistics, Texas Department of State Health Services

18. Adult Potentially Preventable Hospitalizations in Texas Sixty-three (63) high impact counties whose adult residents had a rate more than 50% higher than the state rate/average for adult potentially preventable hospitalizations for 2005, 2006, 2007 and 2008. …Angelina, Atascosa, Brooks, Brown, Burleson, Caldwell, Camp, Coke, Collingsworth, Comanche, Crosby, Delta, Dickens, Duval, Fannin, Franklin, Freestone, Gray, Grayson, Gregg, Grimes, Henderson, Hill, Hockley, Houston, Howard, Hunt, Jasper, Jefferson, Jim Hogg, Jim Wells, Johnson, Kleberg, Lamar, Lampasas, Leon, Liberty, Limestone, Maverick, Moore, Morris, Nacogdoches, Navarro, Orange, Palo Pinto, Panola, Polk, Red River, Robertson, Runnels, Sabine, San Augustine, San Jacinto, Shelby, Sutton, Terry, Tom Green, Trinity, Upshur, Victoria, Willacy, Wood and Zapata County. Source: Center for Health Statistics, Texas Department of State Health Services

19. Adult Potentially Preventable Hospitalizations in Texas 63 High Impact Counties Source: Center for Health Statistics, Texas Department of State Health Services

20. Adult Potentially Preventable Hospitalizations in Texas Source: Center for Health Statistics, Texas Department of State Health Services

21. Adult Potentially Preventable Hospitalizations in Texas Source: Center for Health Statistics, Texas Department of State Health Services

22. Adult Potentially Preventable Hospitalizations in Texas Results of Community Interventions: Under the leadership of the county judge, community health coalitions in Freestone and Red River County used the potentially preventable hospitalization data to implement community interventions (e.g., vaccine outreach campaign) to reduce hospitalizations for Bacterial Pneumonia. Freestone County: 32% decrease in hospitalizations for Bacterial Pneumonia for 2008 as compared to 2007 ($1,055,448 in hospital charges were avoided). Red River County: 29% decrease in hospitalizations for Bacterial Pneumonia for 1st Quarter 2008 as compared to 1st Quarter 2009 ($317,658 in hospital charges were avoided).

23. Adult Potentially Preventable Hospitalizations in Texas Upcoming Community Interventions : Community interventions to reduce hospitalizations for Bacterial Pneumonia are currently being planned for the following counties: • Fannin County (Health Service Region 2/3) • Montague County (Health Service Region 2/3) • Runnels County (Health Service Region 2/3) • Stonewall County (Health Service Region 2/3) • Liberty County (Health Service Region 6/5S) • Waller County (Health Service Region 6/5S)

24. Adult Potentially Preventable Hospitalizations in Texas Website (www.dshs.state.tx.us/ph): • Profiles on all 254 counties in Texas; • Clinical Interventions; and • Maps illustrating the impact of the ten adult potentially preventable hospitalization conditions. Contact: Mike Gilliam, Jr., M.S.W., M.P.H. Texas Department of State Health Services mike.gilliam@dshs.state.tx.us (512)458-7111 (Ext. 2708)