Board of Public Health Meeting

Tuesday, February 10, 2015

Commissioner’s Update

Brenda Fitzgerald, MD Commissioner, DPH

March of Dimes Banner Program:

A March of Dimes, DPH and Georgia Hospital Association Initiative

Seema Csukas, MD, PhD Maternal and Child Health Section Director

Statewide Partnership

The Results

Early Elective Deliveries: Before

34-36 Weeks Gestation 37-38 Weeks Gestation

60 55 50 45 40 35 30 25 20 15 10 5 0 5 10 15 20 25 30 35 40 45 50 55 60

Percentage of Births

Data Source: 2006 Georgia Birth-Hospital Discharge linked file

Early Elective Deliveries: After

34-36 Weeks Gestation 37-38 Weeks Gestation

60 55 50 45 40 35 30 25 20 15 10 5 0 5 10 15 20 25 30 35 40 45 50 55 60

Percentage of Births

Data Source: 2012 Georgia Birth-Hospital Discharge linked file

Recognizing Success

Georgia EED Banner Recognition Initiative

Purpose: To work collectively to improve neonatal outcomes by supporting policies and practices to reduce EED <39 weeks

• • • Content: Statewide Pledge Quality Recognition: March of Dimes Banner Public Education Goal: Hospital EED Rates <5% by Sept. 2015

Eligibility for Banner

• • • • • Rate of EED below 5% as defined by The Joint Commission PC-01 performance measure Data provided for a least two consecutive quarters showing rate below 5% for each quarter – must include monthly data with numerators and denominators Hospitals have a written policy in place regarding non medically indicated deliveries <39 weeks gestational age The written policy clearly defines medical indications for deliveries less than 39 weeks Hospitals have a process to track and monitor the rate of non medically indicated deliveries <39 weeks gestational age

March of Dimes Banner Program

Congratulations!

• • • • • • • • • • • • Cartersville Medical Center Wellstar Kennestone Regional Medical Center Barrow Regional Medical Center Clearview Regional Medical Center Doctor’s Hospital of Augusta Floyd Medical Center Grady Health System Habersham Medical Center Houston Medical Center Newton Medical Center Phoebe Putney Memorial Hospital Phoebe Sumter Medical Center

Budget Update

Kate Pfirman, CPA Chief Financial Officer, DPH

Amended FY2015

Total Budget: $621,152,294 Other Funds $10 281 967 2% State General Funds $201,050,383 32% Federal Funds $396,102,084 64% Tobacco Funds $13 717 860 2%

Attached agencies not included

Amended FY2015 Budget

Public Health Programs

Administration Adolescent and Adult Health Promotion Emergency Preparedness Epidemiology Immunization Infant and Child Essential Health Treatment Services Infant and Child Health Promotion Infectious Disease Control

FY15 Budget

$ 21,684,527

Governor's Recommendation Total

$ 21,684,527 $ 3,685,272 $ 651,897 $ 4,337,169 $ 2,531,764 $ 2,531,764 $ 4,267,353 $ 2,520,627 $ 4,267,353 $ 2,520,627 $ 20,750,225 $ 12,760,063 $ 31,510,791 $ 20,750,225 $ 12,760,063 $ 31,510,791 Inspections and Environmental Hazard Control Public Health Grants to Counties Vital Records $ 3,714,938 $ 93,242,955 $ 3,729,971 $ 3,714,938 $ 93,242,955 $ 3,729,971

Public Health Programs $ 200,398,486 $ 651,897 $ 201,050,383

Attached Agency:

Georgia Trauma Care Network Commission $ 16,360,468

Total State General Funds $ 216,758,954 Tobacco Settlement Funds

$ 16,360,468

$ - $ 217,410,851

Administration Adolescent and Adult Health Promotion Adult Essential Health Treatment Services Epidemiology $ 131,795 $ 6,857,179 $ 6,613,249 $ 115,637

Total Tobacco Settlement Funds $ 13,717,860

$ 131,795 $ 6,857,179 $ 6,613,249 $ 115,637

$0 $ 13,717,860

FY2016 Governor’s Recommendation

FY2016

Total Budget: $628,630,991 Tobacco Funds $13 717 860 2% Federal Funds $396 102 084 63% State General Funds $208 529 080 33% Other Funds $10 281 967 2%

Attached agencies not included

FY2016 Changes by Program

Statewide Changes (All budget programs) - $6,647,862

*Merit Based pay adjustments and employee recruitment and retention initiatives *Increase funds to reflect and adjustment in the employer share of the Employee's Retirement System $2,441,096 $4,206,766

Administration ($38,574)

*Adjustment to agency premiums *Adjustment in Teamworks billings

PH Formula Grants to Counties - $1,521,306

*Fifth-year phase-in for the general grant-in-aid formula to hold harmless all counties *Increase funds for personal services

TOTAL STATE FUND CHANGES

($92,918) $54,344 $1,388,991 $132,315

$8,130,594

FY2016 Budget

Public Health Programs

Administration Adolescent and Adult Health Promotion Emergency Preparedness Epidemiology Immunization Infant and Child Essential Health Treatment Services Infant and Child Health Promotion

FY15 Budget Governor's Recommendation Total

$ 21,684,527 $ 523,140 $ 22,207,667 $ 3,685,272 $ 26,543 $ 3,711,815 $ 2,531,764 $ 52,961 $ 2,584,725 $ 4,267,353 $ 29,632 $ 4,296,985 $ 2,520,627 $ 7,079 $ 2,527,706 $ 20,750,225 $ 33,535 $ 20,783,760 $ 12,760,063 $ 53,416 $ 12,813,479 Infectious Disease Control Inspections and Environmental Hazard Control Public Health Grants to Counties Vital Records $ 31,510,791 $ 185,600 $ 31,696,391 $ 3,714,938 $ 61,413 $ 3,776,351 $ 93,242,955 $ 7,100,993 $ 100,343,948 $ 3,729,971 $ 56,282 $ 3,786,253

Public Health Programs $ 200,398,486 $ 8,130,594 $ 208,529,080

Attached Agency:

Georgia Trauma Care Network Commission $ 16,360,468 $ 12,026 $ 16,372,494

Total State General Funds $ 216,758,954 $ 8,142,620 $ 224,901,574 Tobacco Settlement Funds

Administration Adolescent and Adult Health Promotion Adult Essential Health Treatment Services Epidemiology $ 131,795 $ 6,857,179 $ 6,613,249 $ 115,637

Total Tobacco Settlement Funds $ 13,717,860

$ 131,795 $ 6,857,179 $ 6,613,249 $ 115,637

$0 $ 13,717,860

General Obligation Bonds

$10,000,000

• • •

$9,300,000

–

Clinical Billing Information Technology system.

$400,000

–

Replacement of second chiller at Decatur Lab

$300,000

–

Replacement of walk-in coolers at the Decatur Lab

Accreditation Update

Scott A. Uhlich, MCP, REHS

National Standards for Public Health Departments

12

Domains 32 Standards 109 Measures Documentation

Accreditation Requirements

– Prerequisites • • • Georgia Statewide Community Health Assessment Georgia Statewide Community Health Improvement Plan Georgia DPH Strategic Plan – Documentation • 12 Domains

Accreditation Structure

Steering Committee James Howgate, Pat O’Neal, Yvette Daniels, Carol Jakeway, Jean O’Conner, Christine Greene, Tom Wade, Scott Uhlich and Chanelle Jefferson CHA/CHIP Committee – Jean O’Conner, Carol Jakeway, Gordon Freymann, Cherie Drenzek, David Bayne, Chris Rustin, Scott Uhlich 12 Domain Leads Document Review Committee (PHAB site visitors) – James Howgate, Tom Wade, Jean O’Conner, Scott Uhlich Performance Management/Quality Improvement – Chanelle Jefferson

CHA/CHIP Development • •

Mobilizing Action through Planning & Partnership (MAPP) strategic approach for CHA/CHIP development approved CHA/CHIP committee - MAPP Oversight – Developing 4 assessment teams (Health Status Assessment, Community Themes and Strengths, State Public Health System Assessment and Forces of Change).

Health Status Assessment •

Gordon Freymann – Lead – – – Assembling and Organizing Data Presentation “Georgia Annual Health Status Measures 2014” CHA Table of Contents

Community Themes and Strengths • • •

Daniel Thompson - Lead Facilitated Focus Group sessions – Georgia Southern University – Regional facilitated sessions.

– GSU will capture the primary discussion points at each session and generate a summary report for each session.

List of Community Assets / Partners

Public Health System Assessment • •

Terry Dumas - Lead Survey on 10 Essential Public Health Services – District Public Health staff – County Public Health Staff – Board of Health members

Forces of Change • •

David Bayne – Lead Group discussion on the future of public health.

CHA/CHIP Timeline

• • • • 2/2015 – Update DPH Board and DHD on the MAPP strategy – – Organizing health status assessment data Develop CHA Table of Contents Develop format for program area narrative for CHA – 3/2015 – Draft Georgia Annual Health Status Measures Presentation – Develop narrative program pages for CHA 4-5/2015 – Health Status Measures presentation to DPH Board and DHD 6/2015 – Health Status Measures presentation – final – Draft Community Health Assessment

CHA/CHIP Timeline • •

7/1/15 – Release draft CHA to public and key stakeholders 7 -12/2015 – Present Health Status Assessment to Focus Groups – – – Distribute DPH Public Health System Assessment survey Forces of Change discussion Present CHA to DPH for final comment and approval

• •

Community Health Improvement Plan Timeline

1/1/16 – Prioritize the key issues, develop action plans with measurable outcomes, policy changes and responsible parties. 7/1/16 – Release draft CHIP to public and key stakeholders – Present draft CHIP to DPH for final comment and approval

QI Program/Performance Management System Timeline • • •

Chanelle Jefferson – Director Priorities – QI training – Establish a QI Council – Develop a QI Plan 7/1/15 – Identify QI projects – Develop an action plan for performance management system; timeline, responsible parties, goals and objectives

• • • Documentation Timeline

3/1/15 – Formal review of existing documents meeting PHAB standards/measures 5/1/15 – Identify gaps in documentation, develop action plans for completing documentation 7/1/16 – Complete documentation creation and updating process to bridge identified gaps in existing documentation

No.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

Domain Leader/Subject Matter Expert

Conduct and disseminate assessments focused on population health issues and public health issues. Gordon Freymann – Directs our analytic health indicator data collection and reporting via our warehouse repository. Investigate health problems and environmental public health hazards to protect the community. Inform and educate about public health issues and functions. Dr. Chris Rustin – Environmental Health Director Shawn Ryan – Communications Director Engage with the community to identify and address health problems. Develop public health policies and plans. Dr. Jean O’Connor- Director of the Chronic Disease Prevention Christine Greene – Deputy Chief of Staff Enforce public health laws. Promote strategies to improve access to health care services. Carole Jakeway – Chief Nurse and Director of State-District Operations group. Maintain a competent public health workforce. David Bayne- Legislative Affairs and Liaison with other State agencies. Lee Rudd- Director of HR for DPH Evaluate and continuously improve health department process, programs, and interventions. Contribute to and apply the evidence base of public health. Chanelle Jefferson- Performance Improvement Manager Dr. Cherie Drenzek – State Epidemiologist Maintain administrative and management capacity. Maintain capacity to engage the public health governing entity. Kate Pfirman – CFO for DPH Scott Uhlich – Accreditation Coordinator.

PHAB application readiness • • • •

7/1/16 – Prerequisites Completed – – – CHA CHIP Strategic Plan 7/1/16 – Documentation assembled 10/1/16 – Documentation reviewed by DRC 12/1/16 - Ready to apply to PHAB

QUESTIONS?

Scott A. Uhlich, MCP, REHS [email protected]

Heart Disease in Georgia

Jean O’Connor, JD, DrPH Director, Chronic Disease Prevention, DPH Shana Scott, JD, MPH, Chronic Disease Team Lead, DPH Marsi Thrash Advocacy Director, AHA

Leading* Causes of Death, Georgia Number of Deaths 2009-2013

Diseases of Heart Cancers Chronic Lower Respiratory Diseases Stroke Unintentional Injury Alzheimer's Disease Diabetes Kidney Disease Septicemia Influenza and Pneumonia 0 79,083 77,740 10,210 9,877 8,361 7,204 19,375 18,055 17,928 7,167 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 90,000 Number of Deaths

Leading* Causes of Premature Deaths (before age 75), Georgia

Years of Potential Life Lost 2009-2013 Cancers Diseases of Heart Unintentional Injury (incl. MVA) Perinatal Period Conditions Suicide Homicide Stroke Chronic Lower Respiratory Disease Diabetes Birth Defects 0 454,288 541,513 177,448 160,995 125,382 101,837 91,409 85,259 80,282 200,000 400,000 Years of Potential Life Lost 600,000 675,094 800,000

Leading Actual Causes of Death*, Georgia

Tobacco Poor diet & physical inactivity Alcohol Microbial agents Toxic agents Motor vehicle Firearms Sexual behavior Illicit drug use 10,196 0 2,348 2,079 1,543 1,207 805 537 470 2,000 4,000 6,000 8,000 Number of deaths 10,000 12,141 12,000 14,000

Age-Adjusted 1 Heart Attack Mortality Rates, U.S. and Georgia 1994-2013 300 250 200 150 100

224.5

219.7

212.1

203.6

197.1 194.6

186.7

202.3

196.3

189.6

181.5

177.8

170.9

162.8

174.4

168.4162.6

154.1 151.1

141.8

150.2

144.4

135.0

126.0 122.7

129.9

118.6

111.0

101.5

117.7 113.6

93.2 91.1

109.2 105.4

86.3 84.1

78.4 81.5

50 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13

Georgia Age-Adjusted Mortality Rate due to Obstructive Heart Disease including Heart Attack U.S. Age Adjusted Mortality Rate due to Obstructive Heart Disease including Heart Attack Healthy People 2010: Coronary Heart Disease 166 per 100,000 (age-adjusted)

Age-Adjusted 1 Stroke Mortality Rates, U.S. and Georgia 1994-2013 150.0

100.0

50.0

72.8 73.5 74.5

72.6

69.0 70.0

62.6

63.1

62.5

61.1

59.3

61.6

72.9

67.9 66.4 65.3

60.6

60.9

58.4

57.2

54.7 52.7

49.9 49.1 46.6

44.8 42.2

40.5 41.0

54.6

51.2

48.0

44.8

43.5

42.1

39.6

39.1

37.9

36.9

0.0

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Georgia Age-Adjusted Stroke Mortality Rate U.S. Age-Adjusted Stroke Mortality Rate

Rate of Premature Death (Years of Potential Life Lost (YPLL)) from 1,300.0

Obstructive Heart Disease (Heart Attack) and Stroke, Georgia, 1994-2013 1,200.0

1,100.0

1,000.0

1,139.7 1,149.3

1,169.6

1,092.9

1,075.3

1,034.7

1,010.1

980.5

947.8

954.9

903.8

900.0

800.0

700.0

842.4

837.3

808.3

761.1

784.7

735.2

700.9

672.2

733.2

600.0

500.0

400.0

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Georgia YPLL Rate - Heart Attack and Stroke

Age-Adjusted 1 Cardiovascular Mortality Rates, U.S. and Georgia 1994-2013 500.0

400.0

300.0

200.0

411.9 411.3 405.8

382.5 378.7

370.3

396.5

360.6

388.3 392.1 386.3

352.0

Georgia Tobacco Quitline and Coverdell Stroke Registry est.

GA Cig. Excise Tax Increased to $.37

GA Smoke-free Indoor Air Law Enacted Federal cigarette excise tax increased 349.3

339.7

365.5 356.9

326.5

317.4

347.8

327.0

306.1

286.5

Funding cut to GTUPP 309.5

294.5

280.7

267.8 262.6

252.1

Funding cuts to SHAPP 242.5

233.1 237.4

277.3

261.2

249.9 243.5

234.8 234.2 227.3

223.0

100.0

19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13

Georgia Age-Adjusted Cardiovascular Mortality Rate U.S. Age-Adjusted Cardiovascular Mortality Rate

Evidence on the Relationship Between Tobacco Use/Exposure and Heart Disease

• • • • Secondhand smoke exposure increases CHD risk by 25% to 30% Risk of acute coronary syndrome (ACS) falls rapidly after smoking cessation, even brief cessation Community-level studies suggest a reduction in secondhand smoke exposure after enactment of ordinances reduces hospital admissions

for ACS from a range of 11% to 40%

Random-effects meta-analysis and a meta-regression of several studies to measure AMI reductions in affected communities found— – A reduction of approximately 15% in hospital ACS admission rates during the first year, and – Continuing exponential declines reaching approximately 36% in the 3 years following the implementation of comprehensive smoke-free legislation.

Gupta R, Luo J, Anderson RH, Ray A. Clean indoor air regulation and incidence of hospital admissions for acute coronary syndrome in Kanawha County, West Virginia. Prev Chronic Dis 2011;8(4):A77.

http://www.cdc.gov/pcd/issues/2011/jul/10_0200.htm

. Accessed [

8 Feb 2015

].

• • • • • •

AHA Community Involvement

Priority population focus Community programs (including faith based) Sodium reduction Blood pressure checks Healthy food access Smoke and tobacco-free indoor air ordinances

American Heart Association

Partners with DPH in Chronic Disease Prevention

• • • • •

Key Facts

Cardiovascular disease is the #1 killer in Georgia $2.2 billion annual health cost to state About another quarter are attributable to poor quality care or lack of access to care About a quarter are attributable to poor nutrition or lack of physical activity About half are attributed to tobacco use or secondhand smoke exposure

Take Action—Make the Pledge to follow the ABC’S

American Heart Association and DPH Partnership on Smoke-free Georgia Cities

• • •

Georgia 2005 Clean Indoor Air Act

– Exempts bars and restaurants that exclude minors – – Exempts hotels Does not include hospitals or physicians offices Allows stronger city or county ordinances to be passed –

AHA Partners on DPH 5 Cities Project

– Augusta – Columbus Atlanta – Out of the 60 most populated cities in the U.S., 45 have passed a comprehensive smoking ban –

Atlanta is among those that have not passed a ban

– Even New Orleans recently passed a comprehensive smoke-free ordinance, including casinos

Georgia’s Heart Disease Prevention Strategy Request for Input

• State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health (CDC RFA DP13-1305). • Planning now for funding of approximately $1.3 million in this Cooperative Agreement in SFY16 • Support statewide implementation of cross-cutting approaches to promote health and prevent and control chronic diseases and other risk factors including heart disease and stroke prevention, (3) nutrition, and (4) school health.

6 7 8 9 10 11 12 13 14 15

Georgia’s Heart Disease Prevention Strategy Request for Input

4 5 1 2 3

1305 Cooperative Agreement Heart Disease and Selected Worksite Performance Measures

Proportion of health care systems reporting on National Quality Forum (NQF) Measure 0018 Proportion of adults in the state aware they have high blood pressure Proportion of health care systems with EHRs appropriate for treating patients with high blood pressure Proportion of patients that are in health care systems that have EHRs appropriate for treating patients with high blood pressure Proportion of adults with high blood pressure in adherence to medication regimens Proportion of patients with high blood pressure that have a self-management plan (may include medication adherence, self-monitoring of blood pressure levels, increased consumption of nutritious food and beverages, increased physical activity, maintaining medical appointments) Proportion of adults with known high blood pressure who have achieved blood pressure control Proportion of health care systems with policies or systems to encourage a multi-disciplinary team approach to blood pressure control Proportion of patients that are in health care systems that have policies or systems to encourage a multi-disciplinary approach to blood pressure control Proportion of health care systems with policies or systems to encourage patient self-management of high blood pressure Proportion of health care systems that engage CHWs to link adult patients with high blood pressure to community resources that promote self-management Number of worksites that develop and/or adopt policies to implement food service guidelines/nutrition standards, including sodium (cafeterias, vending, snack bars) Number of employees who work in worksites that have developed and/or adopted policies to implement food service guidelines/nutrition standards Number of community settings that develop and/or adopt policies to implement food service guidelines/nutrition standards, including sodium (cafeterias, vending, snack bars) Number of persons who access community settings that have developed and/or adopted policies to implement food service guidelines/nutrition standards

Vital Records Transformation Update

Donna Moore, MBA, PMP Vital Records Director, DPH

Back in October….

•

Talked of Plans for Transformation through People, Processes, Electronic & Physical Space

•

Today’s Agenda – Results from our Data Integrity Strategy and the deployment of 4 Regional Consultants in Territories – – Using Data to Manage our Business Strategic Agenda for the Future

Data Integrity Strategy

• • “Integrity” defined as completeness and accuracy via how data is

created

, modified, reported, & retained 4 regional consultants in territories working with

stakeholders who create data

• • Using data and information to manage our business Able to track penetration rates of each stakeholder group to plan future programs and initiatives

From 58% to 80% overall From 5.2% to 6.5% overall

Data Integrity Strategy

• “Integrity” defined as

completeness and accuracy

• Tracking data captured and entered into the system • Surveillance of data to explain business results

and

surveillance to focus efforts • Information that is integral to refreshing and implementing programs through DPH’s Health Promotion and Health Protection divisions Quality Birth Data Report (State Office of Vital Records) All records registered from Facility GEORGIA Total Births registered Average days to register a birth Percent of births registered late Mother Pre-pregnancy Weight Unknown Mother's first pregnancy Unknown Mother received prenatal care Unknown Apgar at 5 minutes Unknown Infant breastfed Unknown Received Hep B vaccine Unknown Metabolic screen performed Unknown Hearing screen performed Unknown 01/01/2015 to 01/31/2015 11556 7.3

40.5% Needs Improvement 6.9% 6.5% Borderline Borderline 9.3% 0.2% Borderline OK 5.1% Borderline 17.7% Needs Improvement 25.0% Needs Improvement 21.7% Needs Improvement

Metrics since launching the Quality Birth Report

Avg # Days to Register a Birth % Births Registered Late

Sep ’14

8.4 days 51%

Oct ’14

7.5 days 42%

Nov ’14

6.7 days 35%

Dec ‘14

8.8 days 53%

Jan ’14

7.3 days 41%

Monthly Scorecard

Using Data to Explain our Business Results and Predict Needs

Strategic Agenda

Goals

Build the Vital Records Organization of the Future Work Smarter Shift the Paradigm from a Paper to an Electronic Record Vision

Be known as an operationally excellent unit of DPH

Mission

Create, maintain, protect, and provide access to vital event records in order to implement programs that promote health and well-being of Georgia constituents Goals

Promote Data Integrity High-grade the Customer Experience Secure New Revenue Contracts

Strategic Agenda

Future State Targets

: New State Office vital records organization in place by 6.30.15

85% of births registered within 5 days 85% of deaths registered within 10 days 85% of key data fields populated in new records 85% of amendments processed within 15 days 85% of State Office front counter transactions processed within 15 minutes

Strategic Agenda

Strategies: Implement the New Organizational Design and Performance Management System Leverage Regional Resources to Deepen Relationships with Data Creation Partners and Record Providers Position the State Office as the Centralized Authority and Governance of Local Registrar Operations Standardize Processes, Policies, Offerings, and Metrics for All Vital Records Operations Enhance the Customer Experience Through Automation, Value-Added Service, and Communications Establish the OVOT (“one version of the truth”) Data Integrity Strategy Re-engineer Inefficient, Ineffective, or Broken Processes Seek Partners for Data Contracts and Maximize Value of Existing Contracts

Closing Comments

Kathryn Cheek, MD, FAAP Chair

The next Board of Public Health meeting is currently scheduled on Tuesday, March 10, 2015 @ 1:00 PM.

To get added to the notification list for upcoming meetings, send an e-mail to [email protected]