NORC Health Indicators: Shifting from Reactive to Strategic Practice by Using Data to Improve the Health Status of Seniors

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NORC Health Indicators Shifting from Reactive
to Strategic Practice by Using Data to Improve
the Health Status of Seniors

• November 12, 2008

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Presenters

• Fredda Vladeck, Director, Aging In Place
  Initiative,
• United Hospital Fund
• fvladeck_at_uhfnyc.org
• Rebecca Segel, Program Manager,
• United Hospital Fund
• rsegel_at_uhfnyc.org
• Stephanie Pinder, Executive Director
• Lincoln Square Neighborhood Center, Inc.
• stpinder_lcsn_at_yahoo.com
• Mia Oberlink, Senior Research Associate
• Center for Home Care Policy Research
• mia.oberlink_at_vnsny.org

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United Hospital Fund

• New York City public charity, policy, and
  research center
• Long history of fostering models and strategies
  to integrate health care and community-based
  social services
• Established the Aging in Place Initiative in 1999
  
• Works with multiple partners
• Programs
• Funders public and private
• Researchers

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To Advance Aging in Place

• Maximize the health and well-being of all older
  adults
• Foster connections within the community
• Empower older adults to assume new roles in the
  community

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Shifting from Reactive to Systematic Practice

• Identify the issues
• Quantify the problem
• Set goals
• Utilize believable, valid interventions
• Measure the results

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NORCs and NORC Programs

• NORC Naturally Occurring Retirement Community
• A multi-age community with a large
  concentration of older adults
• NORC Supportive Service Programs
• Community change model
• Public-private partnerships of
• Housing/neighborhood organizations
• Senior residents
• Health and social service providers
• Community stakeholders
• Government agencies

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Community Health Chronic Care Model

• Environment
• Resources
• Support

Community Care
Self Care
NORC PROGRAM

• Empowerment
• Self-Advocacy
• Lifestyle Choices

Medical Care

• Diagnosis
• Treatment
• Disease Management

United Hospital Fund 2008
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Health Indicators Initiative

• Goal
• To help NORC programs use evidence-based practice
  to maximize the health and well-being of
  seniors.
• Three domains
• Access to Care
• Prevention, Promotion, and Wellness
• Management of Chronic Conditions

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Health Indicators Initiative

• Three Steps
• Baseline data collection to identify key health
  issues in the community
• Implementation and measurement of targeted
  interventions
• Resurvey and assessment of progress towards
  improving health status

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New York State-funded NORC Programs

• 20 State-funded NORC Programs
• Located in three regions
• NYC- 9 Long Island- 4 Upstate- 7
• Administered 1,264 surveys

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Demographic Characteristics of the 20
State-funded NORC programs
Characteristic Characteristic New York City 9 Programs Long Island 4 Programs Upstate 7 Programs
Sample total Sample total N695 N282 N287
Gender Male 26 20 20
Gender Female 74 80 80
Age 60-64 12 4 7
Age 65-74 35 17 26
Age 75-84 39 46 42
Age 85 13 33 24
Race/ Ethnicity White (Non-Hispanic) 49 96 92
Race/ Ethnicity Black (Non-Hispanic) 17 lt1 3
Race/ Ethnicity Asian 20 1 lt1
Race/ Ethnicity Hispanic 14 1 3
Note Percentages may not add up to 100 due to
rounding and/or missing information.
Source UHF-NYS Health Indicators in NORC
Programs Project, 2007
Prepared by
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Fair/Poor Health Status(Indicators Data compared
to City, State, National Data)
Indicators
New York City
USA
New York State
Percentages are rounded to the nearest whole
number. Source NYC www.nyc.gov NYS
http//www.cdc.gov US http//www.cdc.gov
Source UHF Health Indicators in NORC Programs
Initiative, 2007-2008
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Health Status by Region
Aggregate
(N1,264)
Long Island Programs
(N282)
New York City Programs
(N695)
Upstate Programs
(N287)
Note Percentages may not add up to 100 due to
rounding and/or missing information.
People aged 60 in 20 NYS NORC-SSPs were
asked, Would you say that in general your health
is excellent, very good, good, fair, or poor?
Responses of excellent, very good, and good
were combined into one category. Responses of
fair and poor were combined into another
category.
Source UHF-NYS Health Indicators in NORC
Programs Project, 2007
Prepared by
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Chronic Conditions In NORC Programs, by Region

People aged 60 in 20 NYS NORC-SSPs were
asked Has a doctor ever told you that you
have diabetes? are overweight or obese? have
heart disease? have high blood pressure? The
percentages of people who said yes to each
question are shown for the Group 2 Aggregate, and
for three geographic groupings.
Source UHF-NYS Health Indicators in NORC
Programs Project, 2007
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10 or More Medications, by Region
Aggregate
(N1,264)
Long Island Programs
(N282)
New York City Programs
(N695)
Upstate Programs
(N287)
People aged 60 in 20 NORC-SSPs were asked,
How many prescription and non-prescription
medications are you currently taking?
Source UHF-NYS Health Indicators in NORC
Programs Project, 2007
Prepared by
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Physical Activity by Region
Aggregate
(N1,264)
Long Island Programs
(N282)
New York City Programs
(N695)
Upstate Programs
(N287)
Note Percentages may not add up to 100 due to
rounding and/or missing information.
People aged 60 in 20 NORC-SSPs were asked two
questions in order to estimate their level of
physical activity. Level of physical activity
Recommended level of activity is defined as 1)
light or moderate activity that causes light
sweating or a light to moderate increase in
breathing or heart rate and occurs five or more
times per week for at least 30 minutes each time,
and/or 2) vigorous activity that causes heavy
sweating or large increases in breathing or heart
rate and occurs three or more times per week for
at least 20 minutes each time. People who engage
in other combinations of the two types of
physical activities described above are included
in the category some activity. Those who do not
engage in physical activity are included in the
category no activity.
Source UHF-NYS Health Indicators in NORC
Programs Project, 2007
Prepared by
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Flu Shot and Pneumonia Shot
Percentages are rounded to the nearest whole
number. Source State of Aging and Health in
America(2002) http//www.cdc.gov/aging/pdf/State_o
f_Aging_and_Health_in_America_2004.pdf
Source UHF Health Indicators in NORC Programs
Initiative, 2007-2008
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Falls
Characteristic Characteristic People who fell People who did not fall Aggregate
N346 N917 N1,264
Age 60-64 60-64 9 9 9
Age 65-74 65-74 23 31 29
Age 75-84 75-84 42 41 41
Age 85 85 25 18 20
Medication Use 5 Meds 5 Meds 67 54 58
Assistive Devices Cane Cane 45 27 32
Assistive Devices Walker Walker 30 14 18
Assistive Devices Wheelchair Wheelchair 10 5 7
Assistive Devices Shopping Cart Shopping Cart 30 22 24
Note Percentages may not add up to 100 due to
rounding and/or missing information.
Source UHF-NYS Health Indicators in NORC
Programs Project, 2007
Prepared by
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Lincoln Square Neighborhood NORC

• Home to 804 seniors
• 500 seniors connected to the program
• 253 seniors completed the survey
• 20 White non-Hispanic
• 33 Black non-Hispanic
• 43 Hispanic
• 51 rate their health fair/poor

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Diabetes Prevalence
and ControlN253
Source UHF Health Indicators Initiative 2008
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Health IndicatorsDiabetes Selected Indicators
Source UHF Health Indicators Initiative 2008
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Health IndicatorsDiabetes Selected Indicators
Source UHF Health Indicators Initiative 2008
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Using Data to Inform Practice

• Understand community health risks
• Introduce standards of practice to advance more
  strategic and targeted practice
• Share findings with community to develop new
  partnerships and strengthen existing ones

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Design Considerations

• Utility of the information
• Easy to administer and enter data
• Confidentiality maintained at the program
• Quality assurance built in
• Technical assistance provided in real time
• Analysis and reports accessible and
  understandable