Mark B Horton, MD, MSPH 22 March 2011

Transcription

1 Mark B Horton, MD, MSPH 22 March 2011

2 Major Points Need for better data Focus on disparities Focus on social determinants Focus on healthy communities Focus on health care quality

3 Public Health Data Sources Vital Records Reportable diseases Health surveys Disease registries Hospital discharge/er data

4 Leading Causes Crude Mortality in Los Angeles County, 2005 Coronary Heart Disease 14,846 Stroke Lung Cancer Emphysema Alzheimer's/Other Dementia Diabetes Mellitus Influenza/Pneumonia Hypertension Colon/rectum Cancer Breast Cancer 3,905 3,663 2,890 2,530 2,361 2,340 1,882 1,716 1, ,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 Number of Deaths

5 Leading Causes of Years of Life Lost (YLLs) in Los Angeles County, 2005 Coronary Heart Disease 72,155 Homicide/Other Violence Lung Cancer Motor Vehicle Crash Injuries Stroke Diabetes Mellitus Breast Cancer Emphysema Cirrhosis Suicide 31,250 24,630 21,086 19,771 16,883 13,668 13,350 13,284 13, ,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 90,000 YLLs

6 Leading Causes of Disability-Adjusted Life Years (DALYs) in Los Angeles County, 2005 Coronary Heart Disease 79,281 Alcohol Dependence 65,198 Diabetes Mellitus Alzheimer's/Other Dementia Depression 47,698 53,364 52,463 Homicide/Other Violence Osteoarthritis 40,069 39,931 Motor Vehicle Crash Injuries Stroke Emphysema 30,691 30,642 28, ,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 90,000 DALYs

7 Meaningful Use Per statute, a provider must demonstrate meaningful use by: 1. Use of certified EHR technology in a meaningful manner such as e-prescribing; 2. That the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of care; and 3. In using this technology, the provider submits to the Secretary information on clinical quality measures and such other measures selected by the Secretary

8 EHR: Meaningful Use Stage 1 List of patients by specific conditions Electronic data to immunization registries Electronic data on reportable lab results Electronic syndromic surveillance data

9 EHR: Meaningful Use Stage 1, cont. Record demographics Maintain an up-to-date problem list of current and active diagnoses Record and chart changes in vital signs Record smoking status for patients 13 years and older

10 Access-to-Care(Health Disparities: A Case for Closing the Gap, 2010) Low-income Americans are three times less likely to have a regular source of care, compared to those with higher incomes. 50% of Hispanics and more than 25% of African Americans do not have a regular doctor. 20% of low-income Hispanic youth have gone a year without a health care visit a rate three times greater than for higher-income whites. January 2011

11 Cardiovascular Health (American Heart Association, 2006) The death rate per 100,000 population from high blood pressure is: 15.6 for white males vs.51.1for black males 14.3 for white females vs for black females January 2011

12 Diabetes (HHS Office of Minority Health) African American, Hispanic, American Indian, and Alaska Native adults are twice as likely as white adults to have diabetes. 15% of African Americans, 14% of Hispanics, and 18% of American Indians have adult onset diabetes. The mortality rate from diabetes among Hispanics was 60% higher than that of non-hispanic whites in January 2011

13 Asthma (AHRQ, 2009) Blacks and Hispanics with current asthma were less likely than whites to take daily preventive medicine (24.6% vs. 33.6%) in The prevalence of asthma is 60% higher among African- American children, as compared to white children. African-American children visited the ER for asthmarelated treatment 4.5 times more often than white children in Asthma rates are almost 3 times as high among Puerto Rican Americans, as those of the overall Hispanic population. January 2011

14 Ethnicity and Race (CDC, 2009) Smoking rates per 100,000, among distinct racial and ethnic groups in 2009: Adults reporting multiple races had the highest prevalence (29.5%), followed by American Indians/Alaska Natives (23.2%). January 2011

15 A PUBLIC HEALTH FRAMEWORK FOR REDUCING HEALTH INEQUITIES BAY AREA REGIONAL HEALTH INEQUITIES INITIATIVE UPSTREAM DOWNSTREAM SOCIAL INEQUITIES Class Race/ethnicity Immigration status Gender Sexual orientation INSTITUTIONA L POWER Corporations & businesses Government agencies Schools Laws & regulations Not-for-profit organizations LIVING CONDITIONS Physical environment Land use Transportation Housing Residential segregation Exposure to toxins Social environment Experience of class, racism, gender, immigration Culture, incl. media Violence Economic & Work Environment Employment Income Retail businesses Occupational hazards Service environment Health care Education Social services RISK BEHAVIORS Risk Behaviors Smoking Poor nutrition Low physical activity Violence Alcohol & other Drugs Sexual behavior DISEASE & INJURY Communicabl e disease Chronic disease Injury (intentional & &unintentional ) MORTALIT Y Infant mortality Life expectancy Strategic partnerships Advocacy Community capacity building Community organizing Civic engagement Individual health education Case management Health care Emerging Public Health Practice POLICY Current Public Health Practice

16 What is a Healthy Community? Meets basic needs of all Quality and sustainability of environment Adequate levels of economic and social development Health and social equity Social relationships that are supportive and respectful

17 ACOs and Chronic Disease Prevention Early identification Management Clinical Community referral

18 ACA Mandated Clinical Preventative Services USPSTF (A & B) ACIP Bright Futures Prevention for Women

19 USPSTF Recommended Prevention Services Counseling to reduce alcohol misuse (B) ASA to prevent CVD (A) Screening for HBP (A) Screening for cholesterol abnormalities (A & B) Screening for depression (adol) (B)

20 USPSTF Recommendations, cont. Screening for Diabetes (with HBP) (B) Counseling for a healthy diet (certain risk factors) (B) Screening and counseling for obesity (B) Screening for osteoporosis (B) Counseling for tobacco use