Transcript Health Status Review & Recommendations

Charlotte/Sarasota County
Health Status
Review & Recommendations
Zac Bielling
Peace River Regional
Medical Center
Lindsey Cooke
Charlotte Regional
Medical Center
Jack Lagrace
Fawcett Memorial Hospital
Shreeta Quantano
Sarasota Memorial
Hospital
1
AGENDA
 Purpose
 Overview
of Health Issues
 Statistics
Access to Care
 Obesity
 Mental Health
 Recommendations
 Next Steps

2
Purpose

Provide insight to critical health issues affecting
Charlotte and Sarasota Counties

Offer recommendations that will ultimately
improve the health of the community by:



Increasing access to healthcare resources
Better focus on prevention and health education for
chronic illnesses
Prevent unnecessary ER visits and hospitalizations
3
AGENDA
 Purpose
 Overview
of Health Issues
 Statistics
Access to Care
 Obesity
 Mental Health
 Recommendations
 Next Steps

4
Overview of Health Issues

Residents of Sarasota and Charlotte counties suffer
from:
 Barriers to access care
•
•

High prevalence of chronic diseases linked to inadequate
nutrition and sedentary lifestyles
•

Lack of coverage and public awareness of available healthcare
resources
Insufficient supply of physicians caring for the growing number of
under and un-insured residents, as well as those on Medicaid
These behaviors are initiated at younger ages where there is a lack
of resources to counteract these trends (i.e. lack of school-based
programs that encourage physical activity and proper nutrition)
Increasing rate of mental illness
•
High and growing rate of mental health-related issues (i.e. intentional
injuries, hospitalizations). These disorders often are undiagnosed
and untreated. There is a lack of resources to support counter-acting
these trends.
5
AGENDA
 Purpose
 Overview
of Health Issues
 Statistics
Access to Care
 Obesity
 Mental Health
 Recommendations
 Next Steps

6
Statistics: Access to Care
Health coverage:



Charlotte county: 21.8%
Sarasota county: 18.1%
Florida:
18.7%
CHIP Health Survey findings:






14% of all respondents report someone in family used ER for non emergent
care
32.6% of those who used ER for non emergent care did so because doctor
was closed
81% indicate not knowing of any clinics that treat the uninsured (2006,
Sarasota County Survey)
64.3% reported they were not aware of community programs to help become
healthier (2006)
41% indicated they did not have a dental exam or receive dental hygiene in
the past year due to cost
Fewer than 10 physicians are providing services to more than 45% of the
Medicaid population in Sarasota County
7
Florida Health Insurance Study, 2004
Statistics: Obesity Related
CHILDREN vs. ADULTS
Percent Children
Overweight
Percent Adults
Overweight

Florida
United States
14%
15%
58.2%
58.5%
Interesting facts about America



Obesity is less prevalent in Charlotte and Sarasota
counties, although currently trending toward Florida
and US levels
Approximately 1 in 4 people do not exercise regularly
75% of the population does not consume appropriate
levels of fruits and vegetables
8
Statistics: Obesity
Hospitalizations related to Obesity
Hospitalizations
due to:
Charlotte
County
Sarasota
County
Florida
U.S.*
Diabetes
2785.9
1992.6
2180.9
1708.4
Congestive Heart
Failure
582.9
450.1
427.3
369.7
Cellulitis
123.9
110.8
134.2
129.5
Hypertension
150.0
107.8
135.3
167.6
(per 100,000 population)
Source: CHIP Project, Health Profile for Sarasota and Charlotte Counties, 2002 data *U.S. is 2001 Data
• In the United States alone, the combined direct and indirect costs of
obesity were estimated to be $123 billion in 2001.1
1 Hossain, P (2007).Obesity and diabetes in the developing world — A growing challenge. The New England Journal of Medicine. 356, 213-215.
9
Statistics: Mental Health
Cause of
Death
Rank
Number
of
Deaths
2004
(Raw)
Percent
of Total
Deaths
2004
Crude
Death
Rate
2004
Ageadjusted
Death
Rate
Percent
change
from
2003 2004
Male to
Female
Ratio
Black to
White
Ratio
Hispanic
to NonHispanic
White
Intentional
Self-harm
(suicide)
11
32,439
1.4
11.0
10.9
+.9
4.0
.4
.5
Source: CDC/NCHS, 2004 Mortality Data. Death rates on annual basis per 100,00. Age-adjusted rates per 100,000.
Age Group
Cause
of
Death
Total #
of
Deaths
10-14
Raw
(%)
15-19
Raw
(%)
20-24
Raw
(%)
25-34
Raw
(%)
35-44
Raw
(%)
45-54
Raw
(%)
55-64
Raw
(%)
65-74
Raw
(%)
75-84
Raw
(%)
85+
Raw
(%)
Suicide
2,308
19
(.82)
82
(3.5)
124
(5.4)
293
(12.7)
430
(18.6)
520
(22.5)
339
(14.7)
199
(8.6)
196
(8.5)
104
(4.5)
Source: Florida Department of Health, 2005 Resident Deaths.
10
Statistics: Mental Health


County
2003 – 5 Average
Number of Deaths
2003 – 5 Average
Number of Total
Population
Age-Adjusted 3-yr
Death Rate
State Total
2,328
17,598,688
12.6
Charlotte
30
154,886
19.1
Sarasota
61
360,334
16.1
While hospitalization data (hospitalizations due to depressive
disorders and psychoses) have steadily declined for Charlotte and
Sarasota counties, rates are believed to reflect both missed
diagnosis and limited availability of psychiatric beds
It is estimated that one in five Americans suffer from moderate to
severe mental illness, but do not seek treatment due to continuing
social stigma
11
Statistics: Mental Health
 County-level trends
reflects increasing ageadjusted death rate for
suicide
12
AGENDA
 Purpose
 Overview
of Health Issues
 Statistics
Access to Care
 Obesity
 Mental Health
 Recommendations
 Next Steps

13
Recommendations: Access to Care
Models
1. Sarasota County’s Health Care Access
•
Potential framework and foundation for
Charlotte County
2. Hillsborough County Healthcare Plan, FL
3. Project Access, Dallas, TX
14
Recommendations: Access to Care
Models
1. Sarasota County Health Care Access




Target uninsured residents at or below 200% FPL
Universal referral system and patient information
among network providers
Establish volunteer health care provider network
Case management services for uninsured patients


Reduce unnecessary ED utilization/avoidable hospitalization
Increase access to low/no cost medications for
uninsured
Primary objective of enhancing community’s awareness
regarding availability of healthcare resources for uninsured
15
Recommendations: Access to Care
Models
2. Hillsborough County Healthcare Plan



Comprehensive managed care plan for uninsured
with incomes up to 100% FPL
Competitive contracts with providers and enrollees
are integrated into system
Funding support via state authorized sales tax (1/2
cent sales tax and later reduced to ¼ cent)
Outcomes:
 Reduced per patient costs by 65%
 Estimated savings of $100 million over 10 years
 $10 million Emergency care, $90 million medical
expenses
 Reduced hospital admission rates for chronic diseases
Strong emphasis on early intervention and health
education
16
Recommendations: Access to Care
Models
3. Project Access, Dallas, TX



Developed in 2001, Dallas County Medical Society and
community partners
Provides care for uninsured up to 200% FPL
Physicians, hospitals, and other providers care for a set
number of patients/year
Outcomes:


FY 2005 ED direct and indirect cost savings $553,375
PAD patients visit ED 61% less and spend 75% less days in
hospital post-enrollment


Enrollees visited ED 1.8/year before enrolling, 0.7/year postenrollment
FY 2005 total hospital savings by avoided uncompensated
utilization estimated at $3,059 per enrollee/year
17
Recommendations: Obesity
 Partner
with Key Stakeholders for
Prevention Strategies
 Collaborate with Local Schools and
Community Agencies
 Develop Childhood Obesity Prevention
Strategies
 Research Funding for Prevention
Strategies
Financing Childhood Obesity Prevention Programs: Federal Funding Sources and Other Strategies by The Finance Project September 2004
18
Recommendations: Obesity Stakeholders & Strategies

Key Stakeholders
• Parents
• Schools
• Communities
• Government
• Health Care Providers

Childhood Obesity Prevention Strategies




Encouraging Healthy Lifestyles
Providing Fitness and Nutrition Education
Ensuring Access to Safe Environments
Ensuring Access to Adequate Amounts of Healthy
Food
Financing Childhood Obesity Prevention Programs: Federal Funding Sources and Other Strategies by The Finance Project September 2004
19
Recommendations: Obesity Schools

Nutrition and Eating Behaviors




Ensure all school meals meet dietary guidelines
Develop, implement and evaluate pilot programs to
expand school meal funding
Remove junk food from vending machines and limit
availability of machines during school hours
Physical Activity



Intramural and interscholastic sports programs
Partnering with local community centers for after
school and summer programs
Incorporate nutritional lessons into gym class lesson
plans
Koplan, J and IOM Committee on Progress in Preventing Childhood Obesity, Preventing Childhood Obesity: Health in Balance, Overview and Next
20
Steps
Recommendations:
Mental Health

Partner with Key Stakeholders for Mental Health
Prevention Strategies






Charlotte and Sarasota County Department’s of Health
Florida Department of Children and Families
Senior Friendship Centers
Parents, Family Members
Schools
Media Outlets

Develop Depression and Mental Health Prevention
Strategies
 Research/Develop Mental Health Funding Pathways
21
Recommendations:
Mental Health - Strategies
 Target: All

ages
Strategy Objective: Ensuring treatment of
mental health disorders – Community Based
Pharmacies
• Forge strategic partnerships with pharmaceutical
companies
• Streamline enrollment/application process for
medication
• Ensure adherence to treatment protocol
• Reduce/eliminate financial barriers
22
Recommendations:
Mental Health - Strategies
 Targeted


Population: Elderly
Strategy Objective: Reduce feelings of social
isolation and encourage maintenance of
active lifestyles
Best Practice Model: PEARLS (CDC-PRC
Sponsored Initiative)
• Home-based depression sessions
• Initiate senior-centered exercise programs
23
Recommendations:
Mental Health - Strategies
 Targeted

Population: Youth
Strategy Objective: Implement school-based
mental health promotion programs
• Promote social/emotional competencies
• Emphasize development of positive character
• Emphasize skills and attitudes consistent with
positive lifestyles
24
Recommendations: Mental Health
– Funding Pathways
 Substance Abuse
and Mental Health
Services Administration

Provides funding opportunities to improve the
quality and availability of mental health
services
 Florida
statewide initiative to transform the
publicly funded mental health system

Florida’s Mental Health Transformation
• Consumer and family-driven system
25
AGENDA
 Purpose
 Overview
of Health Issues
 Statistics
Access to Care
 Obesity
 Mental Health
 Recommendations
 Next Steps

26
Next Steps: Access to Care
Case Study Common Themes:
1.
2.
3.
Volunteer healthcare provider network
Case management services
-Cross agency case management (JaxCare)
Collaboration of several groups essential to leveraging
resources
 County objectives should focus on expanding Sarasota
Health Care Access program while developing a viable plan
for Charlotte County
 Schedule future meetings with exemplary organizations for
benchmarking
 Charlotte County restructure Access to Care Task Force
and seek future Lower Income Funding support and other
grant opportunities
27
Next Steps: Obesity

Meeting with School Superintendents



Vending Machines with Healthy Food Options
& Limited Accessibility
Healthy Cafeteria Options
Increased Physical Activity at each grade
level
 Meeting
with Local Community Centers
 Educate parents and facilitate healthy
lifestyles
28
Next Steps: Mental Health

Increase awareness of mental health
illness/reduce stigma



Meet with Community Organizations



Eliminating Barriers Initiative – Pilot Program with
Florida participation
Involves various stakeholders and increases
awareness of mental health issues and resources
Develop community based pharmacies
Develop more mental health outreach programs
Meet with School Superintendents

Discuss implementation of school-based mental
health promotion programs
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THANK YOU
QUESTIONS?
30
References
Behavioral Risk Factor Surveillance System, 2001
Behavioral Risk Factors Telephone Survey 2002 from Health Planning Council of Southwest Florida
http://www.hpcswf.com/PlanningProjects.asp
Community Health Improvement Partnership. Health profile for Sarasota and Charlotte Counties. 2003
and 2004.
Community Health Improvement Partnership. Summary of best practices. 2006
Elimination of Barriers Initiative – Modules and toolkits to reduce mental health stigma
http://www.dcf.state.fl.us/mentalhealth/ebi/index.shtml
Florida Health Insurance Study. 2004
Health Planning Council of Southwest Florida. Accessed http://www.hpcswf.com/PlanningProjects.asp
July, 2007
U.S. Census Bureau, State and County Quick Facts
31
Appendix
32
Appendix A
Behavioral Risk Factors Telephone Survey, 2002
Percent
Charlotte
Sarasota
Florida
Smoke
18.3%
19.6%
22.2%
Drink heavily
15.0%
9.9%
14.7%
High blood
pressure
38.2%
30.4%
27.7%
High cholesterol 46.5%
37.8%
35.2%
Diabetes
8.4%
7.7%
8.2%
Overweight
35.6%
39.5%
35.7%
Obese
27.8%
16.9%
22.3%
Health Planning Council of Southwest Florida
33
Appendix B
Top Five Avoidable Hospital Admissions rates, Charlotte County
Diagnosis
Charlotte Area 81 Florida
CHF rate/100,000 (age 18+)
765.2
620.4
577.8
Bacterial Pneumonia/100,000
(total population)
434.3
364.5
333.3
COPD/100,000 (age 18+)
367.0
295.8
281.3
Perforated Appendix /1,000
abdomen w/ appendicitis
321.7
339.4
291.2
Adult Asthma rate
246.5
11.1
134.7
34
1 Area 8 represents data for the seven SW Florida Counties: Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota
Appendix C
Top Five Avoidable Hospital Admissions rates, Sarasota County
Diagnosis
Sarasota Area 81 Florida
CHF Admissions
Rate/100,000 (age 18+)
1400.5
620.4
577.8
COPD/100,000 (age 18+)
492.9
295.8
287.3
Bacterial Pneumonia/100,000
(total population)
635.6
364.5
333.3
Perforated Appendix /1,000
abdomen w/ appendicitis
465.6
339.4
291.2
Angina without Procedure
admission rate/100,000
364.9
45.2
39.7
35
1 Area 8 represents data for the seven SW Florida Counties: Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota
Appendix D
Obesity Census Data
Charlotte County
Sarasota County
State of Florida
Caucasian
88.8%
87.5%
62.1%
African-American
5.3%
4.5%
15.7%
American
Indian/Alaska Natives
0.2%
0.2%
0.4%
Asian
1.1%
1.1%
2.1%
Native
Hawaiian/Pacific
Islander
0.0%
0.0%
0.1%
Hispanic
4.2%
6.3%
19.5%
Source: U.S. Census Bureau, State and County Quick Facts
36
Appendix E
Prevalence of Overweight and Obese by Ethnicity
NonHispanic
White
NonHispanic
Black
Hispanic
Asian
Native
American
Pacific
Islander
Overweight
(BMI ≥ 25)
39.2%
39.5%
42.2%
32.8%
35.1%
40.8%
Obese
(BMI ≥ 30)
21.8%
34.8%
28.3%
4.8%
34.3%
33.0%
26.8
28.7
27.9
24.0
28.5
27.8
129,116
12,561
12,153
3,071
2,299
626
BMI (Mean)
Sample
Size
Source: 2001 BRFSS, Behavioral Risk Factor Surveillance System
37
Appendix F
Obesity and Diabetes
OVERALL
Charlotte County
Sarasota County
State of Florida
Percent
Overweight
35.6%
39.5%
35.1%
Percent Obese
21.8%
16.9%
22.3%
Percent with
Diabetes
8.4%
8.2%
7.7%
1 Behavioral Risk Factors Telephone Survey 2002 from Health Planning Council of Southwest Florida
http://www.hpcswf.com/PlanningProjects.asp
• Prevalence of diabetes is increasing due to the escalation of the
overweight and obese population.2
• More than 1.1 billion adults worldwide are overweight, and 312 million of
those are obese. 2
38
2 Hossain, P (2007).Obesity and diabetes in the developing world — A growing challenge. The New England Journal of Medicine. 356, 213-215.
Appendix G
Barriers to Establishing a Volunteer Physician Network
 Physician







perspectives:
Too many referrals, too few volunteers
Concerns for malpractice litigation
Not equitable among community providers
Other services not available to patients
Lack of patient responsibility
Low appreciation/recognition
Inconsistent Administrative Support
39
Appendix H
Potential Solutions to Establishing a Volunteer Network







Equitable distribution of referrals to physicians
Malpractice immunity (Access to Healthcare Act)
Shared community responsibility
Access to prescriptions for patients in specialty
care
Increased patient responsibility
Recognition of profession
Consistent Administrative Support
40
Appendix I
Recommendations: Obesity - Schools

Healthy Schools – Nutrition and Eating
Behaviors





Develop and implement nutritional standards for all
food and beverages sold or served
Ensure all school meals meet dietary guidelines
Develop, implement and evaluate pilot programs to
expand school meal funding
Remove junk food from vending machines and limit
availability of machines during school hours
Provide more nutritious options for school
lunches
Koplan, J and IOM Committee on Progress in Preventing Childhood Obesity, Preventing Childhood Obesity: Health in Balance, Overview and Next
41
Steps
Appendix J
Obesity - Examples of Funding
Strategy
Programs
Promoting Healthy Lifestyles*
Targeting Obesity
State Nutrition and Physical Activity Programs to Prevent
Obesity and Related Chronic Diseases and Prevention
and Treatment of Childhood Obesity in Primary Care;
Promoting Healthy Lifestyles
Target Special Populations
Health Disparities in Minority Health Grant Program;
Children, Youth and Families at Risk State Strengthening
Projects; Community Programs to Improve Minority Health
Promoting Healthy Lifestyles
General Health and Wellness
Preventive Health and Health Services Block Grant
Promoting Healthy Lifestyles
Physical Fitness
Carol M. White Physical Education Program; National
Youth Sports Program Fund; After School Program with a
Focus on Fitness
Fitness and Nutrition Education
Team Nutrition Training Grant Program; 21st Century
Community Learning Center Block Grant
Parental Involvement
Even Start Program: State Agency Block Grant
Access to Safe Environments
Community Development Block Grant Entitlement
Communities Program
Access to Adequate Amounts of Healthy Food
National School Lunch Program; National School
Breakfast Program; Summer Food Service Program; Child
and Adult Care Food Program; Food Stamps; Community
Food Projects
42
*Currently Florida receives funding for the Florida Diabetes Prevention and Control Program (DPCP) since 1996
Appendix K
Recommendations: Obesity – Schools
 Healthy

Schools – Physical Activity
Intramural and interscholastic sports
programs
• After school use of school facilities
• Use of schools as community centers


Partnering with local community centers for
after school and summer programs
Incorporate nutritional lessons into gym class
lesson plans
Koplan, J and IOM Committee on Progress in Preventing Childhood Obesity, Preventing Childhood Obesity: Health in Balance, Overview and Next
43
Steps