Models of Excellence Georgia’s Health Prioritiesweb1.sph.emory.edu/media/MOE/fitzgerald/Models_Of... · 2015-08-07 · Models of Excellence Georgia’s Health Priorities August

Models of Excellence

Georgia’s Health Priorities August 07, 2015

Brenda Fitzgerald, M.D.

Commissioner and State Health Officer

Georgia Department of Public Health

Inform

The Hedgehog Concept

Protect Prevent

Mission of Public Health

• PREVENT

disease, injury,

disability

• PROMOTE

health and well

being

• PREPARE for

and respond to

disasters


Key Initiatives

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Access to Healthcare

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Telehealth

• Reduce preventable

infant mortality rate

from 6.3% to 5.3%

• Get all children on a

path to 3rd grade

reading competency

• Increase the

percentage of Georgia

students in the

healthy fitness zone

• Eliminate pediatric

asthma deaths by

2019

• Reduce the number of

adults hospitalized for

diabetes/hypertension

• Identify, establish and

maintain programs

and services to

increase access to

healthcare by 2019

• Develop infrastructure

to promote health

and wellbeing by

collecting, analyzing

and reporting health

data, tracking disease,

and applying science

and epidemiological

principles to support

decisions

• By 2019, improve

infrastructure to

prepare for and

respond to

emergencies

• Recruit, develop and

retain work force with

skills focused on the

following

competencies: core,

organizational,

leadership, and job

specific/professional

Prevent Disease, Injury

and Disability Promote Health and

Wellbeing

Prepare for and

Respond to

Emergencies


Key Initiatives

2

0

1

2

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n

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t

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O

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Asthma

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Prescription Drug Overdose

T

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Access to Healthcare

I

n

f

a

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t

M

o

r

t

a

l

i

t

y

Telehealth

• Reduce preventable

infant mortality rate

from 6.3% to 5.3%

• Get all children on a

path to 3rd grade

reading competency

• Increase the

percentage of Georgia

students in the

healthy fitness zone

• Eliminate pediatric

asthma deaths by

2019

• Reduce the number of

adults hospitalized for

diabetes/hypertension

• Identify, establish and

maintain programs

and services to

increase access to

healthcare by 2019

• Develop infrastructure

to promote health

and wellbeing by

collecting, analyzing

and reporting health

data, tracking disease,

and applying science

and epidemiological

principles to support

decisions

• By 2019, improve

infrastructure to

prepare for and

respond to

emergencies

• Recruit, develop and

retain work force with

skills focused on the

following

competencies: core,

organizational,

leadership, and job

specific/professional

Prevent Disease, Injury

and Disability Promote Health and

Wellbeing

Prepare for and

Respond to

Emergencies

Georgia Infant Mortality Rate America’s Health Rankings

Georgia

IMR

U.S.

Rank

2012 7.7 44

2013 6.93 34

2014 6.6 31

Source: America’s Health Rankings 2014

48% DECREASE SINCE 1990

Georgia Infant Mortality Clusters 2002-2006

Georgia Infant Mortality Clusters 2002-2006

Atlanta

Area

Augusta

Area

Columbus

Area

Macon

Area

Savannah

Area

Valdosta

Area

11.8

15.1

15.8

14.7

13.3

17.5

Georgia IMR 2002-2006 = 8.4 deaths per 1,000 live births

Leading Causes of Infant Death

by Cluster

A B C D E F

Congenital malformations, chromosomal

abnormalities 2 3 2 2 3 3

Newborn affected by maternal complications

of pregnancy 2

Respiratory distress of newborn 1

Short for gestational age, LBW, not otherwise

classified 1 2 1 1 1 1

Sudden infant death syndrome 3 3 3 2

Leading Causes of Infant Mortality

in Georgia 2002-2006

Cause of Death Number

% of

Total

Deaths

Rank

Disorders related to short

gestation and low birth

weight

1117 19.5 1

Congenital malformations,

deformations and

chromosomal abnormalities 964 16.8 2

Sudden unexpected infant

death 621 10.8 3

Projected Preventable

Infant Mortality Rate

4.0

5.0

6.0

7.0

8.0

9.0

10.0

Observed IMR Projected IMR

2019 PIMR

5.4

2013 PIMR

6.3

Source: GA Office of Health Indicators for Planning

Objective 1:

Strengthen the

Regional Perinatal

System

Objective 2:

Develop targeted

educational

campaigns

Objective 3:

Develop external

collaborations to

support initiatives

RPC standards of care

17-Hydroxy P Registry

Fetal/Infant mortality

review committee

Maternal mortality

review committee

Community-based home

visitation programs

Tobacco Cessation

Safe Sleep

Breastfeeding and

Baby-Friendly

Hospitals &

Businesses

Early Elective

Deliveries

1115 Waiver Utilization

to Improve Birth

Spacing & Conception

Planning

Perinatal Quality

Collaborative

Infant Mortality Reduction Strategic

Plan (2012–2016)

LARC Placement

Smoking Before and During Pregnancy

Live Birth Delivery

Source: Georgia PRAMS 2008-2012

Georgia Tobacco Quitline

• 24 hours a day, 7 days a week

• English: 1.877.270.STOP (1.877.270.7867)

• Spanish: 1.877.2NO.FUME (1.877.266.3863)

• Hearing Impaired, TTY Services: 1.877.777.6534

GA Early Elective Deliveries

Reduced 39-week elective deliveries

• Public and private collaboration

Georgia Hospital Association

March of Dimes

GA OB/GYN Society

GA Chapter of American Academy of

Pediatrics

• 2009: 65%

4.73% 4.71% 4.59% 4.24%

5.94%

6.51% 6.19%

5.66%

37 weeks 38 weeks 39 weeks 40 weeks

All Deliveries Non-medically Indicated Elective Deliveries

Percent of 37-40 Weeks

Admitted to NICU

2.66% 2.78% 2.83%

2.60%

3.33%

3.86% 3.67% 3.68%




Assisted Ventilation

1.01% 1%

1.10%

0.94%

1.25% 1.19%

1.33%

1.14%




On Antibiotics

Math Standardized

Score

ELA Standardized

Score

Reading Standardized

Score

37 Weeks Gestation 335.4 326.9 337.5

39 Weeks Gestation 337.5 328.5 339.3

320.0

322.0

324.0

326.0

328.0

330.0

332.0

334.0

336.0

338.0

340.0

342.0

Sta

nd

ard

ized

Scale

Sco

re f

or

CR

CT

The Relationship Between Standardized

Test Scores and Gestational Age (Adjusted for mother’s age and education level)

35 weeks 39 - 40 weeks

A baby’s brain at 35 weeks

weighs only two-thirds

of what it will weigh at 39 to 40 weeks.

2015 % of

Hospitals

Reporting

January 0.76% 87%

February 0.63% 80%

March 0.44% 84%

April 0.62% 74%

May 0.79% 59%

Georgia Early Elective Deliveries

Source: Georgia Hospital Association

Georgia has

been under

the national

2% standard

for the past 21

months

Repeat Preterm Births

• Women who have a premature delivery are

approximately three times more likely to

have a subsequent preterm birth than

women whose prior birth was term

• The relative risks are lower (2.3) for Black,

non-Hispanic women than White, non-

Hispanic women (3.4)

• Hispanic women appear to be under-

represented in the linking of birth events

Source: Office of Health Indicators for Planning (OHIP)


Repeat

Preterm Births

2009-2013

This map presents data from

a preliminary analysis of

repeat preterm births using

GA resident singleton births

in 2009 linked to repeat

births in 2009 – 2013.

Immediate Postpartum

LARC Placement

• Prevents rapid repeat pregnancy-

associated risks Maternal mortality

Preterm labor

Low birthrate

Neonatal death

• Medicaid reimbursement (April

2014)

Increasing Postpartum

LARC Placement

• Collaboration with Georgia ObGyn

Society, Emory, Peach State

Provider training (186 providers

trained to date)

Online modules for training

resources

Peach State grant to purchase pelvic

models for residency training

programs

Patient information

Georgia Infant Sleep-Related Deaths

103 infants died

in Georgia

due to

sleep-related causes

2015

January 12

February 14

March 20

April 18

May 14

June 19

July 6

Source: CDC SDY Report January 1 – July 17, 2015

In just the first seven months of 2015

Georgia’s Safe to Sleep Campaign

Educational Flipchart for

Patient Education and/or

training for staff on

effective Safe Sleep

education.

Step by step guide

for starting a

hospital-based safe

to sleep program.

Patient Education

handouts, board

books and other

resources.

Alone – Babies should

always have their own

safe, firm sleep space. No

sharing of the sleep space

with others, adults or

children.

Back – Babies should be

placed on their backs every

sleep, every time, even

naps.

Crib – Babies should sleep

in cribs without blankets,

quilts, crib bumpers or

toys. Babies should not be

placed on couches or adult

beds for sleep.

Safe Sleep for Babies

Provided by Georgia Bureau of Investigation

Georgia Childhood Obesity

Georgia ranks 17th in the nation

for childhood obesity

(Georgia ranked second in 2009)

Percent Meeting Physical

Activity Recommendations

Georgia FitnessGram Results

2013-2014 • 1,082,721 (71%) students tested

• 40% of Georgia students (grades 1-12) not

in Healthy Fitness Zone (HFZ) for body

composition (BMI)

• 19% of Georgia students (grades 4-12) in

the HFZ for every basic fitness test

component

• 22% of Georgia students (grades 4-12) not

in HFZ for any basic fitness test

component

Physical Activity and

Academic Performance • Physical Activity Across the Curriculum

(University of Kansas 2009) 26 elementary schools, 3 years

90 minutes a week during classroom lessons

10 minutes, intermittently during the day,

during language arts and mathematics

Significant improvements in academic

achievement in reading, math, and spelling

scores


Academic Performance

Average Composite 20 students taking the same test

Research Scan: Dr. Chuck Hillman,

University of Illinois

Power Up for 30 Goal

By 2019, 30 minutes of additional physical activity

every day, every school, every child in Georgia

• Children are healthier

• Children learn better

• Physical activity is an

important part of education

• PowerUp for 30 is additional

physical activity during the day

without losing classroom time

Power Up for 30

Pledge Status

602 Schools

Pledged

465 Schools

Trained

July, 2015

Georgia Childhood Obesity

Systems Model

• Originally created in 2007-2008 with

legislators, their staff and subject matter

experts

• Features healthcare, school, transportation,

education interventions or “levers” that are

funded through legislative decisions

• Informed by peer-reviewed journal articles

specifically, the caloric impact of an

intervention

• Georgia childhood obesity prevalence

across all age groups at baseline is 18%

Georgia SHAPE Impact Power Up for 30 in 50% of schools Power Up for 30 in 100% of schools

Reaching 50% of Georgia elementary

schools with Power Up for 30 and

sustaining it over time; within 5 years,

childhood obesity prevalence may

decline to 17%

Reaching 100% of Georgia elementary

schools with Power Up for 30 and

sustaining it over time; by 2034,

childhood obesity prevalence may

decline to 11.1%

Source: Georgia State University

One Year Physical Activity Pilot

63.7%

Improved

Aerobic

Capacity

57.2%

Improved

BMI

Percentile

Before

School

PA Time

Classroom

PA Time

Moderate to

Vigorous PA

in PE Class



Cobb County

School District

students in HFZ

for Aerobic

Capacity

Scored HIGHER

in math and

reading

Academic Scores by Aerobic Fitness HFZ



Cobb County

School District

students in HFZ

for Aerobic

Capacity

Reported

FEWER

discipline

referrals

Percentage of Discipline Referrals by

Aerobic Fitness HFZ



95.8%

95.9%

96.0%

96.1%

96.2%

96.3%

96.4%

96.5%H

un

dre

ds

ADA

Cobb County

School District

students in HFZ

for Aerobic

Capacity

Recorded

BETTER

average daily

attendance

Georgia SHAPE Collective Impact

Academic Research:

Programs & Policies

Investment Resources and TA:

• Action for Healthy Kids

• Alliance for a Healthier

Generation

• Children’s Healthcare

• Georgia Organics

• HealthMPowers

• Academic Institutions

Power Up for 30

SHAPE Mini-Grants

Professional Development

Georgia School PA

& Nutrition

Toolkits

Recognition

• SHAPE Honor Roll

• Quality Rated SHAPE

• Alliance Awards

State Agency Collaboration

DOE, DPH, AGR, DCH,

DFACS,

DOAS, DBHDD Private Companies & Foundations:

BCBS, Centene, The Coca-Cola

Company

GEORGIA

SCHOOLS

Source: Hart & Risley, 1995

THE GROWING BRAIN IS SHAPED BY

THE EXPERIENCES AROUND IT

Abuse

Hunger

Unsafe

housing

Maternal

depression

Poverty

Neglect

Adult resilience

Strong, supportive

relationships

Healthy communities &

families

Lots of loving words and

interactions

Laughter, serve & return

Proper nutrition & clinical care

30 Million Word Gap

High Income Working Class Poverty

43 MILLION

24 MILLION

11 MILLION

Source: Hart & Risley

Window of Opportunity

Language Nutrition

Increases neurological development

Leads to the ability to read

Leads to high school graduation

Influences economic

success

A Population-Based Approach:

From Universal Design to Targeted Interventions

All of Georgia’s Children

No Known

Factors

Medical

Factors

Trauma

Factors

Developmental

Factors

System

Community

Individual

State Agencies, Employers, Insurance, Professional Organizations

Non-profits, Faith-based Organizations, Hospitals & Practices,

Schools, Local Businesses, Local Governments, Early Childcare

Centers

Providers, Teachers, Families, Caregivers

Economic

Factors

No

Known

Factors

GA WIC- Talk With Me Baby

• Random sample of children (18-24 months)

assessed for language, speech, and

communication patterns

• 900 Georgia WIC staff trained on language

nutrition

• 199 WIC centers integrated language nutrition

messages into their centers

• Nutritionists discuss modeling behaviors with

clients, encouraging parents to talk with their

• DVDs play in waiting rooms

• Educational materials provided to clients

Georgia Pathway to

Language and Literacy

Coalition Partners

• Atlanta Area School for the

Deaf

• Atlanta Speech School

• Georgia Department of

Education

• Georgia Department of Public

Health

• Georgia Hands & Voices

• Georgia Pathway to Language

and Literacy

• Georgia School for the Deaf

• Get Georgia Reading

• The Auditory-Verbal Center

• Recognition that

interactions and

transactions from ages

0-5 are key

• Shift in focus from

professionals only to

include parents and

agencies

• Coalition focus,

increased work with

community

partnerships

Georgia’s Pathway to

Language Development

• 35 hours per week of meaningful language

with children

Native language in the home

Access to language regardless of modality

(ASL, LSL, or both)

• Diagnosis and intervention by 6 months

Significantly better language scores,

regardless of communication modality

Age At Identification Metro-Atlanta

Frequency Percent Cumulative

Percent

Newborn 43 30.9 30.9

1-6 months 22 15.8 46.7

7-12 months 15 10.8 57.5

13-18 months 17 12.2 69.7

19-24 months 18 12.9 82.6

25-30 months 10 7.2 89.8

31 months + 14 10.1 100

TOTAL 139 100 100

47% of D/HH children were identified

within 6 months

Source: Dr. Susan Easterbrooks, GSU

Age At Intervention Metro-Atlanta

Frequency Percent Cumulative

Percent

Newborn 1 .7 .7

1-6 months 30 21.6 22.3

7-12 months 25 18.0 40.3

13-18 months 13 9.4 49.6

19-24 months 32 23.0 72.7

25-30 months 8 5.8 78.4

31 months + 30 21.6 100

TOTAL 139 100 100

Only 22% of D/HH children were in

intervention at 6 months

Source: Dr. Susan Easterbrooks, GSU

Riley’s Path to Reading on Grade

Level by 3rd Grade By 2020, each child and every child who is deaf or hard of hearing (DHH)

will be on a path to grade level reading, regardless of language or

communication modality.

Georgia Newborns

• 130,000

babies born

annually

• 4 percent

require follow

up after initial

newborn

hearing

screening

100 Babies Program Overview

Collaborative Initiative • Georgia DPH, Georgia Department of Education,

Georgia Pathway

Program Goal • D/HH children in Georgia have Birth to Literacy Plan

• D/HH children read at grade level by third grade

Identification and Intervention • 100 Babies program children are assigned a

Georgia Testing Identification number

• Linked to Statewide Longitudinal Data System

• Track, match and collect hearing screening and

intervention data for evaluation

Diagnosis By 90 Days

66 71

76

0

10

20

30

40

50

60

70

80

90

100

2012 2013 2014*

Percent Diagnosed

by 90 Days

Georgia

National

Average

Strategy

• Strategic Placing of

Equipment

3 Diagnostic Machines

(Ringgold, Valdosta,

Albany)

11 Screeners

• Revised and standardized

sent to families and

physicians

• Audiology Facility Finder

https://sendss.state.ga.us

/sendss/!audiologist_loca

tor.search

*Preliminary Data; 2014 CDC Data Not Available

https://sendss.state.ga.us/sendss/!audiologist_locator.search




Loss to Follow-Up

Percent Loss to Follow-Up

44

32

0

10

20

30

40

50

60

70

80

90

100

2012 2013

Georgia

National

Average

• Communication to

Audiologists

• Follow-up Protocol built

into SendSS

Minimum 13 steps before

closing

• Fully Staffed

• Created notifications in

SendSS

Strategy

Enrolled in Intervention by 6 Months

60 66

0

10

20

30

40

50

60

70

80

90

100

2012 2013

Percent Enrolled in

Intervention by

6 Months

Georgia

National

Average

Strategy

• Intervention logs

from Georgia PINES

received and entered

monthly

• Three private

intervention providers

documenting

intervention

enrollment in SendSS

Georgia 2012

Ranking

2013

Ranking

Babies

diagnosed by

three months

26 19

Loss to follow-

up 34 26

Babies enrolled

in intervention

by six months

30 27

Source: CDC State Ranking for Deaf and Hard of Hearing

Performance Measures

Georgia’s Progress

Brain Trust 4 Babies Participants

• Department of Community

Health

• Department of Early Care and

Learning

• Department of Public Health

• Division of Family and Children’s

Services

• Head Start of Georgia

• Emory University School of

Medicine, Department of Pediatrics

• Emory University School of

Nursing

• Georgia State University

• Morehouse School of Medicine

Public Agencies

• Arthur M. Blank Family

Foundation

• Atlanta Speech School

• Children’s Healthcare of

Atlanta

• Concerned Black Clergy

• Georgia Chapter, American

Academy of Pediatrics

• Georgia Family Connection

Partnership

• Georgia Hospital Association

• La Amistad

• Marcus Autism Center

• Urban League

• Voices for Georgia’s Children

Academics

Private Organizations

Community Engagement &

Awareness Education & Training

Research Funding Policy

Increased access through

partnerships Data & Evaluation

Brain Trust 4 Babies

Early Brain Development as Statewide Priority

Family Engagement

Primacy of Language

Prenatal

Care Newborn

Care

Co-

Morbidities Trauma

Prevention

Language-

rich

Interactions

Safe,

Supportive

Communities

Mental

Health

Georgia Post-Arrival Ebola Monitoring October 24, 2014-August 6, 2015

Georgia DPH Epidemiology Section 08-06-15

• Individuals monitored: 2,095

• Clinical inquiries: 312

• Individuals from Sierra Leone and

Guinea currently being monitored: 93

• Individuals from Liberia currently self-

monitoring: 85

• Children monitored: 124

• Individuals medically evaluated for fever

or symptoms: 34

• Medical/healthcare professionals

monitored for fever or symptoms: 32

• Travelers tested for Ebola: 6

Measles in Georgia Case diagnosed Feb. 7, 2015

• 9 month old from Kyrgyzstan (no connection to

Disneyland outbreak)

• Unvaccinated

• Symptomatic on overseas flight

• Hospitalized, treated, released

• Previous measles case in Georgia was 2012

Contact Investigation • Individuals exposed: 332

• Susceptible individuals identified: 32

• Individuals receiving IG or MMR: 23

• No IG or MMR (monitored and self-isolated at

home): 9

• No secondary measles cases

Cyclospora Investigation Cyclosporiasis in Georgia

• 28 cases statewide

• 4 cases with history of international travel

• 13 cases in Fulton County

• 202 contacts (not all cyclospora infections)

• Disseminated electronic survey through known

confirmed cases, through nextdoor.com, and

social media to identify additional cases

• Multiple restaurants being investigated

• Traceback investigation is on-going

• No epidemiological link at this time to cilantro

from Puebla, Mexico

• Current FDA ban on cilantro from Puebla,

Mexico

Georgia Medical Marijuana Registry

Doctors

registered: 124

Patients

registered: 123

2012 Maternal Mortality

Case Reviews

122 maternal mortality deaths • 60 pregnancy-associated deaths

• 25 pregnancy-related deaths

• 37 not pregnant

Leading causes of pregnancy-associated deaths • Motor vehicle accidents

• Homicide

• Suicide

• Drug overdose

Leading causes of pregnancy-related deaths • Hemorrhage

• Hypertension

• Cardiac

• Embolism

Leading Causes of

Pregnancy-Related Death

0

1

2

3

4

5

6

7

8

9

10

Hemorrhage Hypertension Cardiac events Embolisms

Nu

mb

er

of

death

s

Thank You

Brenda Fitzgerald, M.D.

Commissioner and State Health Officer


Documents

Models of Excellence Georgia’s Health Prioritiesweb1.sph.emory.edu/media/MOE/fitzgerald/Models_Of... · 2015-08-07 · Models of Excellence Georgia’s Health Priorities August