Pain, Aching, Stiffness and Swelling Growing and Sustaining State Arthritis Programs: Results and Im

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Pain, Aching, Stiffness and SwellingGrowing and
Sustaining State Arthritis ProgramsResults and
Implications of a Systematic Review of State
Arthritis Programs

• Joe Sniezek
• CDC Arthritis, Epilepsy, and Quality of Life
  Branch
• Lee Ann B. Ramsey
• CDC Arthritis Program
• Mari T. Brick
• NYS Department of Health
• NACDD General Member Call
• February 22, 2007

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Presentation Format

• Overview of CDC and State Arthritis Programs
• Purpose Goals of Comprehensive Site Visit
  Project
• Project process
• Key Findings and Application
• Q A

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CDC Arthritis Program -- Overview

• CDCs public health role for arthritis
• Current environment
• Setting goals and objectives
• Innovation and efficiency

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ArthritisProgress and Future Directions

• Our goal
• - Improve the quality of life, by decreasing pain
  and disability, and improving function, among
  people affected by arthritis.

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CDC Arthritis Program

• Focus of our activities
• Expand population-level programs to improve the
  health and quality of life for people with
  arthritis
• Measure burden of arthritis, risk factors, and
  program reach

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Arthritis CDCs Public Health Roles

• Monitor the burden of arthritis
• Build the science base
• Build public health capacity to reach people with
  arthritis
• State-based programs

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A Budding LandscapeCDC - State Arthritis
Programs1999--present
Level B - 8
Level A- 28
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CDC Cooperative Agreement

• Establish full-time program manager
• Establish partnerships and form an advisory group
  or coalition
• Conduct surveillance activities
• Monitor prevalence using BRFSS data/standard
  tables
• Issue periodic State of Arthritis Reports

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CDC Cooperative Agreement

• Implement Evidence-based Interventions
• Work with partners to embed programs in
  sustainable delivery systems
• Implement and monitor/report reach for at least 2
  interventions across the 3 categories
• SME
• PA
• Health Communications

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CDC-funded State Arthritis Programs

• Key issues
• We MUST do a better job to expand reach
• Systems
• Sustainability
• Monitoring our reach

Arthritis Program
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Comprehensive Site Visit Project

• The Process..
• Lee Ann Ramsey
• Public Health Advisor

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Comprehensive Site Visit Project

• Build on previous work done by NACDD to assess
  State program capacity
• Review progress of State Arthritis Programs from
  1999 to 2005
• Gather information on successes and challenges
• Extract lessons learned
• Identify facilitators and barriers to success

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The Process

• Brainstorming Team
• NACDD/Arthritis Council
• NACDD consultant
• 2 CDC project officers
• 2 CDC scientists
• Brainstorming Topics
• Components of interest
• Potential questions
• Materials
• Pilot sites

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The Process

• Brainstorming team
• Draft checklist
• Pre-assessment
• Protocol
• Sample agenda
• Review team
• NACDD Arthritis Councilidentified 5 program
  coordinators
• Feedbacksuggestions and concerns
• Excitement vs. skepticism

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The Project

• Pilot
• New York (January 2005)
• Utah (February 2005)
• Conference call with pilot sites
• Checklist?
• Pre-assessment?
• Time commitment?
• Assistance?
• Visit and questions?
• Value?

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The Project

• CDC
• Coordinated 16 site visits over 9 months
• 15 states were visited
• NACDD Arthritis Council consultant
• Finalized all materials
• Communicated with states
• Provided materials between states and CDC
• Finalized agenda
• Drafted individual state reports

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Comprehensive Site Visit Project

• What did we learn?
• How will we apply our lessons learned?
• Arthritis-specific
• Chronic Disease
• Nationally

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Comprehensive Site Visit Project

• Overarching Lessons.
• Mari Brick
• Chair, Arthritis Council

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Overarching Lessons

• Arthritis is more visible as a public health
  problem than in 1999
• State arthritis programs still lack visibility
• Arthritis is not a high priority problem
• in the health department
• within chronic disease programs

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Overarching Lessons

• State arthritis data is available and have been
  disseminated to
• partners
• policy makers
• the public

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Overarching Lessons

• Measurable goals and objectives have not been
  available.
• Program direction has changed (i.e., become more
  specific) over the past five years.

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Overarching Lessons

• Staff turnover seriously interferes with
  progress.
• Program managers often lacked the tools to
  develop, maintain and enhance partnerships.

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Overarching Lessons

• Partnerships have been difficult to develop and
  maintain.
• Partners may now expect to get monetary
  compensation for activities they did before
  CDC/state funding became available.
• Specific roles for partners are often unclear
  resulting in
• unclear or unreasonable expectations and
• lack of progress.

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Overarching Lessons

• States are interested in CDC being more
  directive when providing program guidance.
• Communication has not been adequate
• surveillance expectations from CDC have not been
  clear.

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GOLDEN RULES(and technical assistance needs)

• Partner with those that have interest in
  evidence-based interventions
• Limit partnerships to those that are productive
• Clearly define roles, define expectations
• Emphasize embedding programs in systems with
  access to population and multiple delivery points
• Focus on limited number of interventions

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GOLDEN RULES(and technical assistance needs)

• For campaign, recruit strong community partner
  and on-the-ground implementation force
• Limit awareness activities to those that lead to
  expanding reach of interventions
• Limit surveillance activities to BRFSS standard
  tables and tracking reach/location of
  intervention programs
• Develop burden documents that reach states need

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FROM LESSONS TO ACTION

• Three new options for each intervention category
• Established NACDD Arthritis Council Workgroup
• Orientation site visits and conference session
• Comprehensive site visit results shared
• CDC
• PGO
• States
• AF

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FROM LESSONS TO ACTION

• Revised national goals and objectives
• Infrastructure improvement project with Arthritis
  Foundation
• Integrated public health affairs strategy to
  improve visibility
• Training for Program Coordinators

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Comprehensive Site Visit Project

• Questions?