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Charlotte/Sarasota County Health Status Review & Recommendations

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Title: Charlotte/Sarasota County Health Status Review & Recommendations


1
Charlotte/Sarasota County Health Status Review
Recommendations
  • Zac Bielling
  • Peace River Regional Medical Center
  • Jack Lagrace
  • Fawcett Memorial Hospital

Lindsey Cooke Charlotte Regional Medical
Center Shreeta Quantano Sarasota Memorial
Hospital
2
AGENDA
  • Purpose
  • Overview of Health Issues
  • Statistics
  • Access to Care
  • Obesity
  • Mental Health
  • Recommendations
  • Next Steps

3
Purpose
  • Provide insight to critical health issues
    affecting Charlotte and Sarasota Counties
  • Offer recommendations that will ultimately
    improve the health of the community by
  • Increasing access to healthcare resources
  • Better focus on prevention and health education
    for chronic illnesses
  • Prevent unnecessary ER visits and hospitalizations

4
AGENDA
  • Purpose
  • Overview of Health Issues
  • Statistics
  • Access to Care
  • Obesity
  • Mental Health
  • Recommendations
  • Next Steps

5
Overview of Health Issues
  • Residents of Sarasota and Charlotte counties
    suffer from
  • Barriers to access care
  • Lack of coverage and public awareness of
    available healthcare resources
  • Insufficient supply of physicians caring for the
    growing number of under and un-insured residents,
    as well as those on Medicaid
  • High prevalence of chronic diseases linked to
    inadequate nutrition and sedentary lifestyles
  • These behaviors are initiated at younger ages
    where there is a lack of resources to counteract
    these trends (i.e. lack of school-based programs
    that encourage physical activity and proper
    nutrition)
  • Increasing rate of mental illness
  • High and growing rate of mental health-related
    issues (i.e. intentional injuries,
    hospitalizations). These disorders often are
    undiagnosed and untreated. There is a lack of
    resources to support counter-acting these trends.

6
AGENDA
  • Purpose
  • Overview of Health Issues
  • Statistics
  • Access to Care
  • Obesity
  • Mental Health
  • Recommendations
  • Next Steps

7
Statistics Access to Care
  • Health coverage
  • Charlotte county 21.8
  • Sarasota county 18.1
  • Florida 18.7
  • CHIP Health Survey findings
  • 14 of all respondents report someone in family
    used ER for non emergent care
  • 32.6 of those who used ER for non emergent care
    did so because doctor was closed
  • 81 indicate not knowing of any clinics that
    treat the uninsured (2006, Sarasota County
    Survey)
  • 64.3 reported they were not aware of community
    programs to help become healthier (2006)
  • 41 indicated they did not have a dental exam or
    receive dental hygiene in the past year due to
    cost
  • Fewer than 10 physicians are providing services
    to more than 45 of the Medicaid population in
    Sarasota County

Florida Health Insurance Study, 2004
8
Statistics Obesity Related
  • Interesting facts about America
  • Obesity is less prevalent in Charlotte and
    Sarasota counties, although currently trending
    toward Florida and US levels
  • Approximately 1 in 4 people do not exercise
    regularly
  • 75 of the population does not consume
    appropriate levels of fruits and vegetables

9
Statistics Obesity
Hospitalizations related to Obesity
Source CHIP Project, Health Profile for
Sarasota and Charlotte Counties, 2002 data U.S.
is 2001 Data
  • In the United States alone, the combined direct
    and indirect costs of obesity were estimated to
    be 123 billion in 2001.1

1 Hossain, P (2007).Obesity and diabetes in the
developing world A growing challenge. The New
England Journal of Medicine. 356, 213-215.
10
Statistics Mental Health
Source CDC/NCHS, 2004 Mortality Data. Death
rates on annual basis per 100,00. Age-adjusted
rates per 100,000.
Source Florida Department of Health, 2005
Resident Deaths.
11
Statistics Mental Health
  • While hospitalization data (hospitalizations due
    to depressive disorders and psychoses) have
    steadily declined for Charlotte and Sarasota
    counties, rates are believed to reflect both
    missed diagnosis and limited availability of
    psychiatric beds
  • It is estimated that one in five Americans suffer
    from moderate to severe mental illness, but do
    not seek treatment due to continuing social stigma

12
Statistics Mental Health
  • County-level trends reflects increasing
    age-adjusted death rate for suicide

13
AGENDA
  • Purpose
  • Overview of Health Issues
  • Statistics
  • Access to Care
  • Obesity
  • Mental Health
  • Recommendations
  • Next Steps

14
Recommendations Access to CareModels
  • 1. Sarasota Countys Health Care Access
  • Potential framework and foundation for Charlotte
    County
  • 2. Hillsborough County Healthcare Plan, FL
  • 3. Project Access, Dallas, TX

15
Recommendations Access to CareModels
  • 1. Sarasota County Health Care Access
  • Target uninsured residents at or below 200 FPL
  • Universal referral system and patient information
    among network providers
  • Establish volunteer health care provider network
  • Case management services for uninsured patients
  • Reduce unnecessary ED utilization/avoidable
    hospitalization
  • Increase access to low/no cost medications for
    uninsured

Primary objective of enhancing communitys
awareness regarding availability of healthcare
resources for uninsured
16
Recommendations Access to CareModels
  • 2. Hillsborough County Healthcare Plan
  • Comprehensive managed care plan for uninsured
    with incomes up to 100 FPL
  • Competitive contracts with providers and
    enrollees are integrated into system
  • Funding support via state authorized sales tax
    (1/2 cent sales tax and later reduced to ¼ cent)
  • Outcomes
  • Reduced per patient costs by 65
  • Estimated savings of 100 million over 10 years
  • 10 million Emergency care, 90 million medical
    expenses
  • Reduced hospital admission rates for chronic
    diseases

Strong emphasis on early intervention and health
education
17
Recommendations Access to CareModels
  • 3. Project Access, Dallas, TX
  • Developed in 2001, Dallas County Medical Society
    and community partners
  • Provides care for uninsured up to 200 FPL
  • Physicians, hospitals, and other providers care
    for a set number of patients/year
  • Outcomes
  • FY 2005 ED direct and indirect cost savings
    553,375
  • PAD patients visit ED 61 less and spend 75 less
    days in hospital post-enrollment
  • Enrollees visited ED 1.8/year before enrolling,
    0.7/year post-enrollment
  • FY 2005 total hospital savings by avoided
    uncompensated utilization estimated at 3,059 per
    enrollee/year

18
Recommendations Obesity
  • Partner with Key Stakeholders for Prevention
    Strategies
  • Collaborate with Local Schools and Community
    Agencies
  • Develop Childhood Obesity Prevention Strategies
  • Research Funding for Prevention Strategies

Financing Childhood Obesity Prevention Programs
Federal Funding Sources and Other Strategies by
The Finance Project September 2004
19
Recommendations Obesity -Stakeholders
Strategies
  • Key Stakeholders
  • Childhood Obesity Prevention Strategies
  • Encouraging Healthy Lifestyles
  • Providing Fitness and Nutrition Education
  • Ensuring Access to Safe Environments
  • Ensuring Access to Adequate Amounts of Healthy
    Food

Financing Childhood Obesity Prevention Programs
Federal Funding Sources and Other Strategies by
The Finance Project September 2004
20
Recommendations Obesity - Schools
  • Nutrition and Eating Behaviors
  • Ensure all school meals meet dietary guidelines
  • Develop, implement and evaluate pilot programs to
    expand school meal funding
  • Remove junk food from vending machines and limit
    availability of machines during school hours
  • Physical Activity
  • Intramural and interscholastic sports programs
  • Partnering with local community centers for after
    school and summer programs
  • Incorporate nutritional lessons into gym class
    lesson plans

Koplan, J and IOM Committee on Progress in
Preventing Childhood Obesity, Preventing
Childhood Obesity Health in Balance, Overview
and Next Steps
21
RecommendationsMental Health
  • Partner with Key Stakeholders for Mental Health
    Prevention Strategies
  • Charlotte and Sarasota County Departments of
    Health
  • Florida Department of Children and Families
  • Senior Friendship Centers
  • Parents, Family Members
  • Schools
  • Media Outlets
  • Develop Depression and Mental Health Prevention
    Strategies
  • Research/Develop Mental Health Funding Pathways

22
RecommendationsMental Health - Strategies
  • Target All ages
  • Strategy Objective Ensuring treatment of mental
    health disorders Community Based Pharmacies
  • Forge strategic partnerships with pharmaceutical
    companies
  • Streamline enrollment/application process for
    medication
  • Ensure adherence to treatment protocol
  • Reduce/eliminate financial barriers

23
RecommendationsMental Health - Strategies
  • Targeted Population Elderly
  • Strategy Objective Reduce feelings of social
    isolation and encourage maintenance of active
    lifestyles
  • Best Practice Model PEARLS (CDC-PRC Sponsored
    Initiative)
  • Home-based depression sessions
  • Initiate senior-centered exercise programs

24
Recommendations Mental Health - Strategies
  • Targeted Population Youth
  • Strategy Objective Implement school-based mental
    health promotion programs
  • Promote social/emotional competencies
  • Emphasize development of positive character
  • Emphasize skills and attitudes consistent with
    positive lifestyles

25
Recommendations Mental Health Funding Pathways
  • Substance Abuse and Mental Health Services
    Administration
  • Provides funding opportunities to improve the
    quality and availability of mental health
    services
  • Florida statewide initiative to transform the
    publicly funded mental health system
  • Floridas Mental Health Transformation
  • Consumer and family-driven system

26
AGENDA
  • Purpose
  • Overview of Health Issues
  • Statistics
  • Access to Care
  • Obesity
  • Mental Health
  • Recommendations
  • Next Steps

27
Next Steps Access to Care
  • Case Study Common Themes
  • 1. Volunteer healthcare provider network
  • 2. Case management services
  • -Cross agency case management (JaxCare)
  • 3. Collaboration of several groups essential to
    leveraging resources
  • County objectives should focus on expanding
    Sarasota Health Care Access program while
    developing a viable plan for Charlotte County
  • Schedule future meetings with exemplary
    organizations for benchmarking
  • Charlotte County restructure Access to Care Task
    Force and seek future Lower Income Funding
    support and other grant opportunities

28
Next Steps Obesity
  • Meeting with School Superintendents
  • Vending Machines with Healthy Food Options
    Limited Accessibility
  • Healthy Cafeteria Options
  • Increased Physical Activity at each grade level
  • Meeting with Local Community Centers
  • Educate parents and facilitate healthy lifestyles

29
Next Steps Mental Health
  • Increase awareness of mental health
    illness/reduce stigma
  • Eliminating Barriers Initiative Pilot Program
    with Florida participation
  • Involves various stakeholders and increases
    awareness of mental health issues and resources
  • Meet with Community Organizations
  • Develop community based pharmacies
  • Develop more mental health outreach programs
  • Meet with School Superintendents
  • Discuss implementation of school-based mental
    health promotion programs

30
THANK YOUQUESTIONS?
31
References
  • Behavioral Risk Factor Surveillance System, 2001
  • Behavioral Risk Factors Telephone Survey 2002
    from Health Planning Council of Southwest Florida
    http//www.hpcswf.com/PlanningProjects.asp
  • Community Health Improvement Partnership. Health
    profile for Sarasota and Charlotte Counties. 2003
    and 2004.
  • Community Health Improvement Partnership. Summary
    of best practices. 2006
  • Elimination of Barriers Initiative Modules and
    toolkits to reduce mental health stigma
  • http//www.dcf.state.fl.us/mentalhealth/ebi/index.
    shtml
  • Florida Health Insurance Study. 2004
  • Health Planning Council of Southwest Florida.
    Accessed http//www.hpcswf.com/PlanningProjects.as
    p July, 2007
  • U.S. Census Bureau, State and County Quick Facts

32
Appendix
33
Appendix A
Behavioral Risk Factors Telephone Survey, 2002
Health Planning Council of Southwest Florida
34
Appendix B
Top Five Avoidable Hospital Admissions rates,
Charlotte County
1 Area 8 represents data for the seven SW
Florida Counties Charlotte, Collier, DeSoto,
Glades, Hendry, Lee and Sarasota
35
Appendix C
Top Five Avoidable Hospital Admissions rates,
Sarasota County
1 Area 8 represents data for the seven SW
Florida Counties Charlotte, Collier, DeSoto,
Glades, Hendry, Lee and Sarasota
36
Appendix D
Obesity Census Data
Source U.S. Census Bureau, State and County
Quick Facts
37
Appendix E
Prevalence of Overweight and Obese by Ethnicity
Source 2001 BRFSS, Behavioral Risk Factor
Surveillance System
38
Appendix FObesity and Diabetes
1 Behavioral Risk Factors Telephone Survey 2002
from Health Planning Council of Southwest Florida
http//www.hpcswf.com/PlanningProjects.asp
  • Prevalence of diabetes is increasing due to the
    escalation of the overweight and obese
    population.2
  • More than 1.1 billion adults worldwide are
    overweight, and 312 million of those are obese. 2

2 Hossain, P (2007).Obesity and diabetes in the
developing world A growing challenge. The New
England Journal of Medicine. 356, 213-215.
39
Appendix GBarriers to Establishing a Volunteer
Physician Network
  • Physician perspectives
  • Too many referrals, too few volunteers
  • Concerns for malpractice litigation
  • Not equitable among community providers
  • Other services not available to patients
  • Lack of patient responsibility
  • Low appreciation/recognition
  • Inconsistent Administrative Support

40
Appendix HPotential Solutions to Establishing a
Volunteer Network
  • Equitable distribution of referrals to physicians
  • Malpractice immunity (Access to Healthcare Act)
  • Shared community responsibility
  • Access to prescriptions for patients in specialty
    care
  • Increased patient responsibility
  • Recognition of profession
  • Consistent Administrative Support

41
Appendix IRecommendations Obesity - Schools
  • Healthy Schools Nutrition and Eating Behaviors
  • Develop and implement nutritional standards for
    all food and beverages sold or served
  • Ensure all school meals meet dietary guidelines
  • Develop, implement and evaluate pilot programs to
    expand school meal funding
  • Remove junk food from vending machines and limit
    availability of machines during school hours
  • Provide more nutritious options for school lunches

Koplan, J and IOM Committee on Progress in
Preventing Childhood Obesity, Preventing
Childhood Obesity Health in Balance, Overview
and Next Steps
42
Appendix JObesity - Examples of Funding
Currently Florida receives funding for the
Florida Diabetes Prevention and Control Program
(DPCP) since 1996
43
Appendix KRecommendations Obesity Schools
  • Healthy Schools Physical Activity
  • Intramural and interscholastic sports programs
  • After school use of school facilities
  • Use of schools as community centers
  • Partnering with local community centers for after
    school and summer programs
  • Incorporate nutritional lessons into gym class
    lesson plans

Koplan, J and IOM Committee on Progress in
Preventing Childhood Obesity, Preventing
Childhood Obesity Health in Balance, Overview
and Next Steps
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