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CDC Domains

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Michelle Mitchell

on 7 November 2013

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Transcript of CDC Domains

CDC Domains
Four domains were developed by CDC as a framework for state health departments.

Domain 1: Surveillance and Evaluation
Domain 2: Environmental
Domain 3: Health Systems
Domain 4: Community-Clinical Linkages
Strategies to ensure that communities support and clinics refer patients to programs that improve management of chronic conditions.
Notes from the 10/31 Fish Diagram
Stats
Data
Trending
Analyzing
Disseminating
Translation
Learning collaborative
Communication with legislatures
Not just reporting
Not formative evaluation?
Notes from the 10/31 Fish Diagram
Policy (school and childcare) because policy contributes to environmental change (i.e., school nutrition activity)
Can include legislated policy
Change in built environment
Institutional policy change
Municipal policy change
Includes media for health education
Healthy choice = Easy choice
Not advertising
Media supports all domains
Notes from the 10/31 Fish Diagram
Improve Health Systems (Medical/Dental Home)

EHR Algorithm
Health systems interventions
Offering providers tools
Embed EMPH into health systems
Cause change in clinical care
Embed Patient Navigator into system to improve clinical outcome
Prevention, detection, management
A policy?
Notes from the 10/31 Fish Diagram
Integrate community resources to clinical settings
Referral to community
Providers know when/where to refer
CHW/Pharmacy/Community Organizations/Community Providers knowing when to refer to clinicians
Helps patients use services that are available
Embed Patient Navigator into system to improve clinical outcome
Dymek C., Johnson M Jr., McGinnis P., Buckley D., Fagnan L., Mardon R., Hassell S., Carpenter D. (March 2013) Clinical-community relationships measures atlas.Agency for healthcare research and quality.
Potential Strategies
1. Increase access to healthy foods and beverages
2. Implement nutrition standards where foods and beverages are available.
3. Increase physical activity access and outreach
4. Implement physical activity in early care and education (ECE)
5. Increase access to breastfeeding friendly environments
Division of nutrition, physical activity and obesity's Implementation Guidance and Resources for Cooperative Agreement DP-13-1305. Domain 11. pp. 1.
From PAC RFP
Strategies to improve community-clinical linkages ensures that communities support and clinics refer patients to programs that improve management of chronic conditions. The investment in this activity addresses those with or at high risk for chronic diseases and facilitates access, referral and payment for quality community resources, to best manage their condition or disease. These supports include interventions such as clinician referral, community and school delivery and third-party payment for effective programs that increase the likelihood that people with high blood pressure, diabetes or prediabetes and other chronic conditions in school-age children such as asthma and food allergies will better manage their conditions.
From PAC RFP
Health system interventions to improve the quality, effective delivery and use of clinical and other preventive services in order to prevent disease, detect disease early, and reduce or eliminate risk factors and mitigate or manage complications. Health systems interventions improve the clinical environment to more effectively deliver quality preventive services and help Americans more effectively use and benefit from those services. The investment in this activity supports health system and quality improvement changes such as electronic health records, systems to prompt clinicians and deliver feedback on performance, and requirements for reporting on outcomes such as control of high blood pressure and the proportion of the population up-to-date on chronic disease preventive services, as well as outreach to consumers to help reduce barriers to accessing these services.
From PAC RFP
Environmental approaches that promote health and support and reinforce healthful behaviors facilitate improvements in social and physical environments to make healthy behaviors easier and more convenient for Americans. The investment in this activity supports state-level and/or statewide programmatic efforts and targeted efforts in schools, early care and education (ECE), worksites, and communities.
From PAC RFP
Epidemiology and surveillance is a core public health function in which all state departments of health are engaged. The investment in this activity supports states to build and maintain expertise to collect data and information and to develop and deploy effective interventions, identify gaps in program delivery, and monitor and evaluate progress in achieving program goals. Data and information from these efforts can and should be used routinely to inform decision makers and the public about the effectiveness of preventive interventions (including program effectiveness and public health impact) and the burden and unmet need of chronic diseases and associated risk factors.
Source: Maylahn C, Fleming D, Birkhead G. Health Departments in a Brave New World. Prev Chronic Dis 2013;10:130003. DOI: http://dx.doi.org/10.5888/pcd10.130003
Public health surveillance now focuses on monitoring chronic diseases and their precursors in the population by examining data from large information systems such as vital records for cause of death; hospital discharge data for causes of hospitalization, particularly preventable hospitalizations; and population-based telephone surveys such as the behavioral Risk Factor Surveillance System, conducted by all states and some large cities... The impending revolution in electronic health information and its potential to better monitor population health provides an opportunity to greatly improve chronic disease surveillance for health department programs. Chronic disease practitioners need to use existing and potential electronic data sources innovatively to best leverage this electronic revolution to improve population health.
Chronic disease programs can improve surveillance by making better use of existing electronic health data and exploring new data sources. For example, information on weight status of the preschool population for obesity surveillance can be provided by electronic data from the Special Supplemental Nutrition Program for Women, Infants, and Children and can fill a gap in public health surveillance for this important population
The next frontier in chronic disease surveillance is health departments’ use of electronic health record (EHR) data from clinical care systems. For example, an idea that arose from the national “Million Hearts” campaign (11) is to focus on control of hypertension, a major risk factor for heart disease and stroke.
Challenges
Data standards must be agreed on not only in public health practice but also in curative medicine. Health departments must do a better job of providing surveillance data, distilled to “information for action,” to educate and guide both the clinical and broader communities to prevent and control chronic diseases. The recent requirements of the Affordable Care Act that hospitals develop a community health needs assessment with input from public health practitioners is an ideal opening for state and local health departments to demonstrate the value of surveillance data. Finally, the public health workforce will need to adapt to the electronic health revolution by acquiring new, interdisciplinary skills in the areas of informatics, information technology, and quality improvement.
Make healthy behaviors easier and more convenient for more people.
Examples
A primary clinic with a robust IT infrastructure may be well equipped to make electronic referrals to community-based organizations.
A community-based organization that employs allied health professionals-mental heal specialists, alcohol and drug counselors, or lactation coaches-increases capacity to deliver preventative services.
Clinicians who take the time to obtain knowledge of existing community resources.
Community organizations who market activities that promote clinical/clinician and patient awareness of services offered.
Clinical-community relationships exist when a primary care clinician makes a connection with a community resource to provide certain preventative services such as tobacco screening and counseling and when the clinical practice and the community resource engage in at least one of Himmelman's strategies for working together - networking, coordinating, cooperating, and collaborating (p 7)
Purpose
Supports states to build and maintain expertise to collect data and information and to develop and deploy effective interventions, identify gaps in program delivery, and monitor and evaluate progress in achieving program goals
Used to routinely inform decision makers and the public about the effectiveness of preventive interventions
Example
Conduct surveillance of behavioral risk factors, social determinants of health, and monitor environmental change policies related to healthful nutrition, physical activity, tobacco, community water fluoridation, and other areas.
Source: Chronic Disease Prevention and Health Promotion Domain Document (November 2012)
Gather, analyze and disseminate data and information and conduct evaluation to inform, prioritize, deliver, and monitor programs and population health
Environmental approaches that promote health and support and reinforce healthful behaviors (statewide in schools and childcare, worksites, and communities).
Purpose
These interventions have a broad reach, sustained health impact, and are a good investment for public health.
Example
Increase access to physical activity for employees through worksite wellness initiatives
Expand access to and availability of healthy food and beverages through supporting access to community based food and nutrition programs such as WIC
Source: Chronic Disease Prevention and Health Promotion Domain Document (November 2012)
Source: Chronic Disease Prevention and Health Promotion Domain Document (November 2012)
Purpose
To promote consumer outreach and reduce barriers to accessing services so some chronic diseases and conditions are avoided completely, and others can be detected early or managed better to avert complications and progression and improve health outcomes.
Example
Health care information systems with automated physician prompts or patient reminder letters for screening and follow-up clinical counseling or referral.
Interventions to improve the effective delivery and use of clinical and other preventative services in order to prevent disease, detect diseases early, and reduce or eliminate risk factors and mitigate and mange complications
Purpose
Helps ensure that at-risk individuals have access to community resources and support to prevent, delay or manage existing chronic conditions.
Examples
Available, accessible arthritis, diabetes, chronic disease self-management education programs, including physical activity programs, to reach at risk populations in community settings, such as worksites, YMCA/YWCAs, schools, senior centers, and other local organizations.
Increase use of the CDC-approved evidence-based lifestyle change program to prevent or delay onset of type 2 diabetes among people at high risk.
Implement systems to increase provider referrals of people with prediabetes
Coverage/reimbursement for diabetes self-management education and chronic disease self-management support programs.
Delivery of school-based dental sealant programs.
Source: Chronic Disease Prevention and Health Promotion Domain Document (November 2012)
Provide data and conduct research to inform, prioritize, deliver, and monitor programs and population health.
Morrison, M.M., Glover, D., Gilchrist, S.M., Casey, M.O., Lanza, A., Lane, R.I., Patanian, M. (2012) A program guide for public health: partnering with pharmacists in the prevention and control of chronic disease.
Morrison, M.M., Glover, D., Gilchrist, S.M., Casey, M.O., Lanza, A., Lane, R.I., Patanian, M. (2012) A program guide for public health: partnering with pharmacists in the prevention and control of chronic disease.
Improve delivery and use of quality clinical services to prevent disease, detect diseases early, and manage risk factors.
Morrison, M.M., Glover, D., Gilchrist, S.M., Casey, M.O., Lanza, A., Lane, R.I., Patanian, M. (2012) A program guide for public health: partnering with pharmacists in the prevention and control of chronic disease.
Ensure those with or at high risk for chronic diseases have access to quality community resources to best manage their conditions.
Morrison, M.M., Glover, D., Gilchrist, S.M., Casey, M.O., Lanza, A., Lane, R.I., Patanian, M. (2012) A program guide for public health: partnering with pharmacists in the prevention and control of chronic disease.
Role of Community Pharmacists
Community pharmacists provide many services in addition to drug dispensing: medication therapy management; immunizations for children and adults; screening for diabetes and cardiovascular disease; and health education consultation for a range of health risks and conditions such as diabetes, smoking cessation, weight management, hypertension, osteoporosis, and substance abuse. These practice changes highlight the fact that pharmacies are important partners for the expansion of public health access... To strengthen community pharmacies as public health partners, we must fully join the conversation about pharmacy-based public health by focusing on the following areas: policy, research, and the meaningful integration of pharmacy and public health in practice and education.
Meyerson, B.E., Ryder, P.T. & Richey-Smith, C. (2013). Achieving pharmacy-based public health: A call for public engagement. Public Health Reports. 128.
Why is this important?
Ensure capacity to collect, analyze, and apply data and information to:
Develop and deploy effective interventions
Identify and address gaps in program delivery
Monitor and evaluate progress in achieving program goals.
Communicate risk, burden, and progress.
Who might share in this?
Decision makers
State government (i.e. Medicaid)
Communities
Schools
Insurers
Funders
Researchers
Health program managers
Planners
Voluntary organizations
National Association of Chronic Disease Directors. (2013). Key note address: chronic disease and the new public health. Retrieved on November 7 2013 from http://www.goodandhealthysd.org/partnersmeeting/files/KeynoteAddressChronicDiseaseandtheNewPublicHealth.pdf.
Why is this important?
Improvements in social and physical environments make healthy behaviors easier and more convenient
Broad reach
Sustained health impact
Best buys for public health
National Association of Chronic Disease Directors. (2013). Key note address: chronic disease and the new public health. Retrieved on November 7 2013 from http://www.goodandhealthysd.org/partnersmeeting/files/KeynoteAddressChronicDiseaseandtheNewPublicHealth.pdf.
Why is this important?
Improve delivery of preventive services.
Early detection and effective management lead to better health outcomes.
Quality improvement processes yield system-­wide changes.
Technology potential is more fully realized to improve coverage of prevention services.
National Association of Chronic Disease Directors. (2013). Key note address: chronic disease and the new public health. Retrieved on November 7 2013 from http://www.goodandhealthysd.org/partnersmeeting/files/KeynoteAddressChronicDiseaseandtheNewPublicHealth.pdf.
Who might share in this?
• Health care providers
• Hospital associations
• Health care purchasers
• Medicaid
• Quality Improvement Organizations
Ensure that people with or at high risk of chronic diseases have access to community resources and support.
Link community members with effective interventions to prevent, delay or manage chronic conditions once they occur.
National Association of Chronic Disease Directors. (2013). Key note address: chronic disease and the new public health. Retrieved on November 7 2013 from http://www.goodandhealthysd.org/partnersmeeting/files/KeynoteAddressChronicDiseaseandtheNewPublicHealth.pdf.
Who might share in this?
Community-­based organizations
Community health workers
Health care providers
Advocacy organizations
Schools
Worksites
Pharmacists
Why is this important?
Who might share in this?
Communities
Schools
Worksites
Planners
Healthcare purchasers
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