PRESENTATION TO DSHS PUBLIC HEALTH IMPROVEMENT STAFF PRESENTATION TO DSHS PUBLIC HEALTH IMPROVEMENT...

PRESENTATION TOPRESENTATION TODSHS PUBLIC HEALTHDSHS PUBLIC HEALTHIMPROVEMENT STAFFIMPROVEMENT STAFF

November 9, 2010

Mike Gilliam, Jr., M.S.W., M.P.H.Mike Gilliam, Jr., M.S.W., M.P.H.Office of Priority Initiatives CoordinationOffice of Priority Initiatives Coordination

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ORGANIZATIONAL CHANGES:ORGANIZATIONAL CHANGES:

Mike Gilliam (Assessment & Benchmarking Specialist) Mike Gilliam (Assessment & Benchmarking Specialist) moved from Centers for Program Coordination, Policy & moved from Centers for Program Coordination, Policy & Innovation to the Office of Priority Initiatives Coordination Innovation to the Office of Priority Initiatives Coordination (OPIC).(OPIC).

Olga Rodriguez is Director of OPIC.Olga Rodriguez is Director of OPIC.

Assessment & Benchmarking Specialist will “conduct Assessment & Benchmarking Specialist will “conduct benchmarking activities, preventable hospitalization efforts benchmarking activities, preventable hospitalization efforts and activities associated with performance management, and activities associated with performance management, quality improvement and data analysis.”quality improvement and data analysis.”

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REQUESTING A COMMUNITY HEALTH ASSESSMENT REQUESTING A COMMUNITY HEALTH ASSESSMENT INVOLVING OPIC:INVOLVING OPIC:

1.1. County judge emails DSHS Regional Director (RD) County judge emails DSHS Regional Director (RD) requesting assistance in developing a community health requesting assistance in developing a community health assessment.assessment.

2.2. If RD approves county judge’s request, RD sends an email If RD approves county judge’s request, RD sends an email to Mike Gilliam requesting OPIC work with PHI in developing to Mike Gilliam requesting OPIC work with PHI in developing a Plan of Action for the community health assessment.a Plan of Action for the community health assessment.

3.3. Mike Gilliam sends Plan of Action to RD and OPIC Director Mike Gilliam sends Plan of Action to RD and OPIC Director for approval.for approval.

4.4. Project begins once RD and OPIC Director approve Plan of Project begins once RD and OPIC Director approve Plan of Action in writing (via email).Action in writing (via email).

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QUESTIONS TO ASK BEFORE REQUESTING ASSISSTANCE QUESTIONS TO ASK BEFORE REQUESTING ASSISSTANCE FROM OPIC IN DEVELOPING A COMMUNITY HEALTH FROM OPIC IN DEVELOPING A COMMUNITY HEALTH ASSESSMENT:ASSESSMENT:

• Why does the county want to develop a community health Why does the county want to develop a community health assessment?assessment?

• Do county leaders have a need to obtain community health Do county leaders have a need to obtain community health assessment data/information for a specific health-related assessment data/information for a specific health-related purpose?purpose?

• Who will the county judge appoint to work with DSHS in Who will the county judge appoint to work with DSHS in developing the community health assessment? Can this developing the community health assessment? Can this “appointed” person devote a significant amount of time to the “appointed” person devote a significant amount of time to the project?project?

• Are county leaders committed to post-assessment activities?Are county leaders committed to post-assessment activities?

• During the project period, can PHI staff devote at least 50% of During the project period, can PHI staff devote at least 50% of their time to the project?their time to the project?

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POSSIBLE PARTNERS IN PLANNING/IMPLEMENTING A POSSIBLE PARTNERS IN PLANNING/IMPLEMENTING A COMMUNITY HEALTH ASSESSMENT:COMMUNITY HEALTH ASSESSMENT:

• Non-profit HospitalsNon-profit Hospitals

• EMS/Trauma Regional Advisory CouncilsEMS/Trauma Regional Advisory Councils

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ONLINE DATA/INFORMATION COLLECTION (Question ONLINE DATA/INFORMATION COLLECTION (Question Pro):Pro):

DSHS has a corporate license to Question Pro (DSHS has a corporate license to Question Pro (www.questionpro.comwww.questionpro.com). Mike Gilliam is DSHS’ license ). Mike Gilliam is DSHS’ license administrator.administrator.

1.1. Program emails Mike hard copy of survey.Program emails Mike hard copy of survey.

2.2. Mike puts the survey online in a draft format.Mike puts the survey online in a draft format.

3.3. Program reviews/tests/approves draft online survey.Program reviews/tests/approves draft online survey.

4.4. Mike provides program with web-link of final online survey Mike provides program with web-link of final online survey to send via email to target audience.to send via email to target audience.

5.5. Mike provides program with real-time web-link to monitor Mike provides program with real-time web-link to monitor survey results.survey results.

6.6. Program requests Excel file of survey data/information Program requests Excel file of survey data/information when survey closes. when survey closes.

http://www.questionpro.com/

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ADULT POTENTIALLY PREVENTABLE ADULT POTENTIALLY PREVENTABLE HOSPITALIZATIONS:HOSPITALIZATIONS:

• Exceptional Item (2011/12)Exceptional Item (2011/12)

• MHSA Co-morbidityMHSA Co-morbidity

• Presentations (e.g., TMA, TACHC, EMS/Trauma RAC) Presentations (e.g., TMA, TACHC, EMS/Trauma RAC)

• HHSCHHSC

• 2009 Data2009 Data

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The purpose of this information is to assist in The purpose of this information is to assist in improving health care and reducing health care costs in improving health care and reducing health care costs in Texas.Texas.

This information is not an evaluation of hospitals or This information is not an evaluation of hospitals or other health care providers.other health care providers.

The preventable hospitalization conditions were selected by the The preventable hospitalization conditions were selected by the Agency for Healthcare Research and Quality (AHRQ). AHRQ (Agency for Healthcare Research and Quality (AHRQ). AHRQ (www.ahrq.govwww.ahrq.gov) is the lead federal agency responsible for research ) is the lead federal agency responsible for research on health care quality, costs, outcomes and patient safety.on health care quality, costs, outcomes and patient safety.

The data comes from the Texas Health Care Information The data comes from the Texas Health Care Information Collection in the Center for Health Statistics at the Texas Collection in the Center for Health Statistics at the Texas Department of State Health Services (Department of State Health Services (www.dshs.state.tx.us/thcicwww.dshs.state.tx.us/thcic ).).

Adult Potentially Preventable Hospitalizations in TexasAdult Potentially Preventable Hospitalizations in Texas

http://www.ahrq.gov/

http://www.dshs.state.tx.us/thcic/

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Hospitalizations for the following ten conditions are Hospitalizations for the following ten conditions are called “called “potentially preventablepotentially preventable,” ,” because if the because if the individual had access to individual had access to andand cooperated with cooperated with outpatient health care, the hospitalization would outpatient health care, the hospitalization would likely not have happened:likely not have happened:

o Bacterial Pneumonia;Bacterial Pneumonia;o Dehydration;Dehydration;o Urinary Tract Infection;Urinary Tract Infection;o Angina (without Procedures);Angina (without Procedures);o Congestive Heart Failure;Congestive Heart Failure;o Hypertension (High Blood Pressure);Hypertension (High Blood Pressure);o Asthma;Asthma;o Chronic Obstructive Pulmonary Disease;Chronic Obstructive Pulmonary Disease;o Diabetes Short-Term Complications; andDiabetes Short-Term Complications; ando Diabetes Long-Term Complications.Diabetes Long-Term Complications.


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From 2005-2008, adult residents (18+) of Texas received From 2005-2008, adult residents (18+) of Texas received $24.9 billion$24.9 billion in hospital charges for the ten conditions. in hospital charges for the ten conditions. This amount equals This amount equals $1,418$1,418 for every adult Texan. for every adult Texan.

Bacterial Pneumonia and Congestive Heart Failure Bacterial Pneumonia and Congestive Heart Failure comprise 52% of these hospital charges.comprise 52% of these hospital charges.

Hospital Charges Billed:Hospital Charges Billed:MedicareMedicare $16.0 $16.0 billionbillion (64%)(64%)Private Health InsurancePrivate Health Insurance $ 4.4 $ 4.4 billionbillion (18%)(18%)UninsuredUninsured $ 2.2 $ 2.2 billionbillion (09%)(09%)MedicaidMedicaid $ 1.7 $ 1.7 billionbillion (07%)(07%)OtherOther $ 600 million$ 600 million

(02%)(02%)

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Adult Potentially Preventable Hospitalizations in Texas (2005-2008)

Condition Number of Hospitalizations

Average Hospital Charge

Total Hospital Charges

Average $ Impact for All Adult

Texas Residents

Bacterial Pneumonia 216,727 (*6 days) $27,277 $5,911,741,178 $336

Dehydration 60,225 (*4 days) $16,512 $994,426,460 $57

Urinary Tract Infection 123,228 (*5 days) $18,843 $2,322,012,868 $132

Angina (without procedures) 14,319 (*2 days) $16,319 $233,676,275 $13

Congestive Heart Failure 254,611 (*5 days) $27,998 $7,128,562,258 $405

Hypertension 38,054 (*3 days) $18,380 $699,414,834 $40

Asthma 61,306 (*4 days) $20,545 $1,259,543,126 $72

Chronic Obstructive Pulmonary Disease 109,581 (*5 days) $25,203 $2,761,769,189 $157

Diabetes Short-term Complications 33,341 (*4 days) $21,151 $705,191,762 $40

Diabetes Long-term Complications 84,631 (*7 days) $34,506 $2,920,646,232 $166

TOTAL 996,023 (*5 days) $25,036 $24,936,584,181 $1,418* Average Length of Hospital Stay

Source: Center for Health Statistics, Texas Department of State Health Services

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Adult Potentially Preventable Hospitalizations in Texas (2005-2008)EXPECTED SOURCE OF FIRST PAYMENT

Source of Payment Number of Hospitalizations

Percent HospitalCharges

Medicare – Part A 594,654 60% $14,887,757,544

Medicaid 67,399 07% $1,687,401,364

Self-Pay 57,352 06% $1,435,864,672

Preferred Provider Organization 51,754 05% $1,295,713,144

HMO – Medicare Risk 41,408 04% $1,036,690,688

Commercial Insurance 38,819 04% $971,872,484

HMO 36,713 04% $919,146,668

Blue Cross/Blue Shield 36,527 04% $914,489,972

Self Pay/Charity/Indigent/Unknown (2005) 22,133 02% $554,121,788

Other Non-Federal Program 10,697 01% $267,810,092

Charity, Indigent or Unknown 10,008 01% $250,560,288

Other 28,559 03% $715,003,124

ALL 996,023 100% $24,936,584,181

1313Source: Center for Health Statistics, Texas Department of State Health Services

Adult Potentially Preventable Hospitalizations in Texas (2005-2008)EXPECTED SOURCE OF FIRST PAYMENT

Condition TOTAL Medicare Private Health Insurance

Uninsured Medicaid Other

Bacterial Pneumonia 216,727 147,155 (68%)

39,964(18%)

15,471(07%)

11,252(05%)

2,885(01%)

Dehydration 60,225 38,880(65%)

14,698(24%)

2,952(05%)

3,055(05%)

640(01%)

Urinary Tract Infection

123,228 81,668(66%)

20,961(17%)

10,802(09%)

7,851(06%)

1,946(02%)

Angina (without procedures)

14,319 6,097(43%)

4,918(34%)

1,951(14%)

909(06%)

444(03%)

Congestive Heart Failure

254,611 189,542 (74%)

29,105(11%)

17,460(07%)

14,831(06%)

3,673(01%)

Hypertension 38,054 17,255(45%)

10,575(28%)

6,441(17%)

2,662(07%)

1,121(03%)

Asthma 61,306 26,737(44%)

18,030(29%)

8,533(14%)

6,507(11%)

1,499(02%)

Chronic Obstructive Pulmonary Disease

109,581 80,367(73%)

14,718(13%)

5,969(05%)

7,081(06%)

1,446(01%)

Diabetes Short-term Complications

33,341 6,316(19%)

10,542(32%)

10,319(31%)

4,777(14%)

1,387(04%)

Diabetes Long-term Complications

84,631 46,989(56%)

17,207(20%)

9,595(11%)

8,474(10%)

2,366(03%)

ALL 996,023 641,006 (64%)

180,718(18%)

89,843(09%)

67,399(07%)

17,407(02%)

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Average Age

Female Male

Bacterial Pneumonia 216,727 67 Years 56% 43%

Dehydration 60,225 64 Years 64% 36%

Urinary Tract Infection 123,228 65 Years 74% 26%

Angina (without procedures) 14,319 59 Years 57% 43%

Congestive Heart Failure 254,611 69 Years 54% 46%

Hypertension 38,054 58 Years 64% 36%

Asthma 61,306 54 Years 75% 25%

Chronic Obstructive Pulmonary Disease 109,581 68 Years 56% 44%

Diabetes Short-term Complications 33,341 39 Years 52% 48%

Diabetes Long-term Complications 84,631 57 Years 49% 51%

ALL 996,023 64 Years 59% 41%

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White AA/Black Other Hispanic

Bacterial Pneumonia 216,727 73% 11% 17% 19%

Dehydration 60,225 72% 11% 16% 18%

Urinary Tract Infection 123,228 70% 11% 19% 23%

Angina (without procedures) 14,319 67% 14% 19% 23%

Congestive Heart Failure 254,611 64% 19% 17% 22%

Hypertension 38,054 52% 31% 17% 21%

Asthma 61,306 62% 21% 17% 20%


109,581 81% 09% 10% 11%

Diabetes Short-term Complications 33,341 55% 26% 19% 26%

Diabetes Long-term Complications 84,631 54% 20% 26% 36%

ALL 996,023 67% 16% 17% 21%

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Adult Potentially Preventable Hospitalizations in Texas (2005-2008)DISCHARGED TO


Home/Self-Care

SkilledNursingFacility

Home Health

Other

Bacterial Pneumonia 216,727 62% 12% 10% 16%

Dehydration 60,225 65% 12% 09% 14%

Urinary Tract Infection 123,228 57% 18% 10% 15%

Angina (without procedures) 14,319 75% 02% 02% 21%

Congestive Heart Failure 254,611 61% 10% 13% 16%

Hypertension 38,054 86% 03% 06% 06%

Asthma 61,306 86% 03% 06% 05%


109,581 68% 08% 12% 13%

Diabetes Short-term Complications 33,341 86% 02% 04% 07%

Diabetes Long-term Complications 84,631 60% 09% 16% 15%

ALL 996,023 65% 10% 11% 14%

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Demographics ALL996,023

Medicaid67,399

Uninsured89,843

Average Age 64 50 45

Female 59% 66% 56%

Male 41% 34% 44%

White 67% 51% 54%

African American/Black 16% 26% 24%

Other (Race) 17% 21% 20%

Hispanic 21% 34% 31%

Discharged to Home/Self Care 65% 79% 89%

Discharged to Skilled Nursing Facility 10% 03% 01%

Discharged to Home Health Services 11% 07% 03%

Discharged to Other 14% 10% 07%

1818


Sixty-three (63) Sixty-three (63) high impact countieshigh impact counties whose adult residents whose adult residents had a rate had a rate more than 50% highermore than 50% higher than the state than the state rate/average for adult potentially preventable hospitalizations rate/average for adult potentially preventable hospitalizations for 2005, 2006, 2007 for 2005, 2006, 2007 andand 2008. 2008.

……Angelina, Atascosa, Brooks, Brown, Burleson, Caldwell, Angelina, Atascosa, Brooks, Brown, Burleson, Caldwell, Camp, Coke, Collingsworth, Comanche, Crosby, Delta, Camp, Coke, Collingsworth, Comanche, Crosby, Delta, Dickens, Duval, Fannin, Franklin, Freestone, Gray, Grayson, Dickens, Duval, Fannin, Franklin, Freestone, Gray, Grayson, Gregg, Grimes, Henderson, Hill, Hockley, Houston, Howard, Gregg, Grimes, Henderson, Hill, Hockley, Houston, Howard, Hunt, Jasper, Jefferson, Jim Hogg, Jim Wells, Johnson, Kleberg, Hunt, Jasper, Jefferson, Jim Hogg, Jim Wells, Johnson, Kleberg, Lamar, Lampasas, Leon, Liberty, Limestone, Maverick, Moore, Lamar, Lampasas, Leon, Liberty, Limestone, Maverick, Moore, Morris, Nacogdoches, Navarro, Orange, Palo Pinto, Panola, Morris, Nacogdoches, Navarro, Orange, Palo Pinto, Panola, Polk, Red River, Robertson, Runnels, Sabine, San Augustine, Polk, Red River, Robertson, Runnels, Sabine, San Augustine, San Jacinto, Shelby, Sutton, Terry, Tom Green, Trinity, San Jacinto, Shelby, Sutton, Terry, Tom Green, Trinity, Upshur, Victoria, Willacy, Wood and Zapata County.Upshur, Victoria, Willacy, Wood and Zapata County.


1919Source: Center for Health Statistics, Texas Department of State Health Services


63 High Impact Counties63 High Impact Counties

2020


Potentially Preventable Hospitalizations (2005-2008)

Hospitalizations forAdult Residents of Travis County

Number of Hospitalizati

ons




County Residents

Bacterial Pneumonia 4,726 $24,782 $117,120,977 $164

Dehydration 970 $16,516 $16,020,347 $22

Urinary Tract Infection 3,329 $17,363 $57,802,570 $81

Angina (without procedures) 228 $16,104 $3,671,690 $5

Congestive Heart Failure 5,942 $24,905 $147,986,462 $207

Hypertension (High Blood Pressure) 851 $17,040 $14,501,152 $20

Asthma 1,951 $17,931 $34,983,318 $49

Chronic Obstructive Pulmonary Disease 2,075 $24,393 $50,615,186 $71

Diabetes Short-term Complications 972 $18,743 $18,218,527 $26

Diabetes Long-term Complications 2,337 $32,090 $74,995,296 $105

TOTAL 23,381 $22,921 $535,915,525 $751


2121


Potentially Preventable Hospitalizations (2005-2008)

Hospitalizations forAdult Residents of Liberty County

Number of Hospitalizations




County Residents

Bacterial Pneumonia 1,474 $35,013 $51,609,738 $889

Dehydration 419 $18,279 $7,658,779 $132

Urinary Tract Infection 983 $24,751 $24,329,914 $419

Angina (without procedures) 64 $21,035 $1,346,230 $23

Congestive Heart Failure 1,445 $40,714 $58,831,545 $1,013

Hypertension (High Blood Pressure) 215 $22,546 $4,847,396 $83

Asthma 433 $30,164 $13,061,015 $225

Chronic Obstructive Pulmonary Disease 1,255 $29,945 $37,580,633 $647

Diabetes Short-term Complications 124 $33,980 $4,213,509 $73

Diabetes Long-term Complications 379 $43,169 $16,361,162 $282

TOTAL 6,791 $32,372 $219,839,921 $3,787


2222

Results of Community Interventions:Results of Community Interventions:

Under the leadership of the county judge, community health Under the leadership of the county judge, community health coalitions in Freestone and Red River County used the coalitions in Freestone and Red River County used the potentially preventable hospitalization data to implement potentially preventable hospitalization data to implement community interventions (e.g., vaccine outreach campaign) community interventions (e.g., vaccine outreach campaign) to reduce hospitalizations for Bacterial Pneumonia.to reduce hospitalizations for Bacterial Pneumonia.

Freestone County:Freestone County: 32% decrease in hospitalizations for 32% decrease in hospitalizations for Bacterial Pneumonia for 2008 as compared to 2007 Bacterial Pneumonia for 2008 as compared to 2007 ($1,055,448 in hospital charges were avoided).($1,055,448 in hospital charges were avoided).

Red River County:Red River County: 29% decrease in hospitalizations for 29% decrease in hospitalizations for Bacterial Pneumonia for 1Bacterial Pneumonia for 1stst Quarter 2008 as compared to 1 Quarter 2008 as compared to 1stst Quarter 2009 ($317,658 in hospital charges were avoided).Quarter 2009 ($317,658 in hospital charges were avoided).


2323

Upcoming Community Interventions :Upcoming Community Interventions :

Community interventions to reduce hospitalizations for Community interventions to reduce hospitalizations for Bacterial Pneumonia are currently being planned for the Bacterial Pneumonia are currently being planned for the following counties:following counties: Fannin CountyFannin County (Health Service Region 2/3) (Health Service Region 2/3) Montague CountyMontague County (Health Service Region 2/3) (Health Service Region 2/3) Runnels CountyRunnels County (Health Service Region 2/3) (Health Service Region 2/3) Stonewall CountyStonewall County (Health Service Region 2/3) (Health Service Region 2/3) Liberty CountyLiberty County (Health Service Region 6/5S) (Health Service Region 6/5S) Waller CountyWaller County (Health Service Region 6/5S) (Health Service Region 6/5S)


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WebsiteWebsite ( (www.dshs.state.tx.uswww.dshs.state.tx.us/ph/ph):):• Profiles on all 254 counties in Texas;Profiles on all 254 counties in Texas;• Clinical Interventions; andClinical Interventions; and• Maps illustrating the impact of the ten Maps illustrating the impact of the ten

adult potentially preventable adult potentially preventable hospitalization conditions.hospitalization conditions.

Contact:Contact:Mike Gilliam, Jr., M.S.W., M.P.H.Mike Gilliam, Jr., M.S.W., M.P.H.Texas Department of State Health ServicesTexas Department of State Health [email protected]@dshs.state.tx.us (512)458-7111 (Ext. 2708) (512)458-7111 (Ext. 2708)

http://www.dshs.state.tx.us/ph

http://www.dshs.state.tx.us/ph

mailto:[email protected]

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