Health Commissioner’s Report |1 Date: March 26, 2019 To: Board of Health From: Melba R. Moore, MS, CPHA, Health Commissioner Subject: Health Commissioner’s Report, Reflects February 2019 Acronyms CHD- Cincinnati Health Department ODH- Ohio Department of Health CCPC- City of Cincinnati Primary Care Office of Communication and Governmental Relations Media Story Title / Topic Date Media Outlet Cliſton Market lender filed for foreclosure, but lawyer for owners hopes sale is approved February 1, 2019 Enquirer PX column: Big-money donor turns on Hamilton County GOP. What does $50K gift to Democrats mean? February 3, 2019 Enquirer 'My customers no longer have access to something that was really helping them.' Officials in Ohio raid CBD sellers, order products removed. February 4, 2019 Enquirer Cradle Cincinnati to host fatherhood event Feb. 13 February 4, 2019 WKRC CBD oil products pulled from store shelves amid state crackdown February 5, 2019 WKRC State cracks down on Cincinnati CBD retailers February 6, 2019 Cincinnati Business Courier CBD oil crackdown hits Findlay Market retailers February 7, 2019 WCPO More than 100 students call in sick at Roselawn Condon School February 13, 2019 WCPO CPS school working with health department aſter over 100 students call in sick February 14, 2019 WLWT
Transcript
Health Commissioner’s Report |1
Date: March 26, 2019
To: Board of Health
From: Melba R. Moore, MS, CPHA, Health Commissioner
Subject: Health Commissioner’s Report, Reflects February 2019
Acronyms CHD- Cincinnati Health Department ODH- Ohio Department of Health CCPC- City of Cincinnati Primary Care
Office of Communication and Governmental Relations
Media
Story Title / Topic Date Media Outlet
Clifton Market lender filed for foreclosure, but lawyer for owners hopes sale is
approved
February 1, 2019 Enquirer PX column: Big-money donor turns on Hamilton County GOP. What does $50K gift to Democrats mean?
February 3, 2019 Enquirer
'My customers no longer have access to something that was really helping
them.' Officials in Ohio raid CBD sellers, order products removed.
February 4, 2019 Enquirer Cradle Cincinnati to host fatherhood event Feb. 13
February 4, 2019 WKRC CBD oil products pulled from store shelves amid state crackdown
February 5, 2019 WKRC
State cracks down on Cincinnati CBD retailers
February 6, 2019 Cincinnati Business
Courier
CBD oil crackdown hits Findlay Market retailers
February 7, 2019 WCPO
More than 100 students call in sick at Roselawn Condon School
February 13, 2019 WCPO
CPS school working with health department after over 100 students call in sick
Health Promotion and Worksite Wellness Creating Healthy Communities Program
Health Promotion and Worksite Wellness Creating Healthy Communities and Evaluation Subcommittee Report Goals for 2019: Community Health Analysis aNd Group Evaluation (CHANGE) Tool Assessment
The Creating Healthy Communities Coalition held the first CHCC meeting of the year on February 13, 2019. Over 50 people attended the meeting to learn about diversity inclusion and equity.
Denisha Porter presented the CHCC’s Diversity and Disability and Inclusion Statement as the chair of the Evaluation Subcommittee. The Evaluation Subcommittee worked diligently to write the statement. The draft statement was sent to the speaker of the Coalition meeting who is also a diversity and inclusion expert, Mr. Alieu Nyassi, to review and finalize.
o Providing a healthy community is the responsibility of the entire community. The Creating Healthy Communities Coalition is an inclusive initiative that reflects the demographics of Cincinnati to improve the health of the entire population. In our plight to address social determinants of desired health outcomes, this multi-sector coalition creates community-driven policies and systems that advocates for socio and environmental changes to address health disparities and equity through engagement and inclusion. The Creating Healthy Communities Coalition echoes the vision, mission, and core values of the Cincinnati Health Department to improve community health by promoting innovative, high value quality practices and benchmarking within organizations and the diverse communities we serve.
Active Living Subcommittee Report Goals for 2019 - 2020: Master Transit Plans IMPLEMENTATION GOAL: Bike/Pedestrian/Public Transit Master Plan
The Active Living Subcommittee met on February 13, 2019 to brainstorm how to create a Public Transit Master Plan. The Subcommittee identified ways that they can assist individuals who rely on public transit such as education on how to read a bus schedule and where to access the bus.
The Active Living Subcommittee also created a list of community members who could possibly help create plans for the priority communities. The Subcommittee chair will also educate the community on pedestrian safety and bike safety as well.
Tobacco Free Living Subcommittee Report Goals for 2019: Tobacco 21 IMPLEMENTATION GOAL: Tobacco 21 – Education and Promotion of Policy
The Tobacco Free Living Subcommittee met on February 13, 2019 to deliberate on the planned
meeting with City Council to discuss the T21 policy. At the Subcommittee Meeting, members reviewed
the draft list of Frequently Asked Questions (FAQs) that were likely to come up at the Council meeting,
and offered insights on how to answer the questions. The FAQs focused on defining the Tobacco Retail
License as well as describing how it will be implemented, clarifying the legal status of underage
smoking and the role of the Cincinnati Police Department in the T21 policy, and establishing the fines
and penalties for violating the ordinance. Based on feedback from the Subcommittee, the list of FAQs
is being finalized for use in the meeting with the Council.
Healthy Eating Subcommittee Report Goals for 2019: Farm to Institution IMPLEMENTATION GOAL: Farm to School Initiatives
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The Healthy Eating (HE) Subcommittee researched a list of childcare providers in our priority neighborhoods, and created a briefing sheet for HE Subcommittee members to take to potential partners for our Farm to School 2019 work (includes summary statement, goal, and public version of work plan).
The Healthy Eating Subcommittee started meeting with potential community partner organizations about the work they are currently doing to support Farm to School initiatives.
Worksite Wellness Health Promotion and Worksite Wellness: Monday Campaigns and more
Mentoring Meals Monday started on February 25, 2019. Mentoring Meals Monday is a fun way for Cincinnati Public School (CPS) staff to interact with students during the lunch period. CPS staff role model healthy eating behaviors and have “healthy conversation” with students discussing topics such as bullying, physical activity, depression, or any other issues that may plague a child throughout the school day. CPS staff who serve as mentors will receive worksite wellness incentives on their TriHealth Scorecard that they can use to pay for health and medical services.
Center for Public Health Preparedness Public Health Preparedness
Conducted two scheduled Hepatitis A vaccination sessions for target populations (36 vaccinations)
Participated in an Active Shooter Train-the-Trainer workshop to enhance future active shooter exercise activities.
Participated in City-Wide severe weather conference calls daily through the Ohio River flood events from February 11 through February 15.
Continued with the Renaissance Warehouse moving of equipment and materials. Communicable Disease Prevention and Control
Outbreak investigations o Began 10 new outbreak investigations and continued investigating 4 additional outbreaks.
Influenza in school settings was the largest category of outbreaks.
Case investigations o In February, completed investigations of 187 cases of probable and confirmed reportable
communicable diseases (see Monthly Communicable Disease Surveillance Report, February 2019).
This includes 5 confirmed cases of Hepatitis A.
Surveillance monitoring
Identified 12 outpatient visits meeting the definition of Influenza-Like Illness (ILI) at CHD’s three sentinel health centers, collected a single nasopharyngeal swab for testing at the Ohio Department of Health Laboratory and reported weekly to CDC.
Syndromic surveillance through EpiCenter triggered 31 anomalies in December, within the syndrome categories of
o Botulinic (1) o *Class A: Novel Influenza A (1) – misclassified (was merely influenza-associated
hospitalization) o Constitutional (6) o Cough (6) o Diarrhea, Not Watery/Bloody (1)
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o Drugs (1) o Edema (3) o Fever (8) o Respiratory (1) o Vision (3)
22 were found to need public health investigation, and none public health intervention by CHD. *Class A agents, including potential agents of bioterrorism, require immediate notification and investigation
Meetings and Events o Helped The Health Collaborative facilitate the Greater Cincinnati Collaborative Community
Health Improvement Plan kick off meeting on 2/26. Presented information concerning reportable diseases and communicable diseases of high incidence in Cincinnati (including Hepatitis A) to nursing students at Xavier University on 2/28. Division of Environmental Health Services
Environmental Events:
Food Inspection Program
The Food Inspection Program taught 1 ServeSafe and 1 PIC class Staff spoke with Findlay Market regarding Mobile Food Licensing Food Inspection Program worked with Ohio Dept of Agriculture regarding CBD Oil seltzer
water embargo Met with Law Dept & Communicable Disease regarding Hepatitis A cases concerning Food
Establishments
Healthy Homes Program
The Healthy Homes office assisted on a CDC Legionaries assessment with collaboration with communicable disease division and with guidance from ODH. This evaluation is still ongoing and is a great training and learning experience.
Healthy Homes had a meeting with Children Hospital to enhance the CLEAR Program (Collaborating to Lessen Environmental Asthma Risks) and the role of this office in that improvement.
Technical Environmental Services (TES)
Technical Environmental applied for the Ohio Environmental Protection Agency's 2019 Mosquito Control Grant and submitted 2018 animal bite/rabies exposure data to the Ohio Department of Health for its annual report.
Coordinated with CHD's Communicable Disease unit and Healthy Homes office to conduct a Legionella assessment in response to a local outbreak.
Lead Program Report Total open cases 143
PHLI’s conducted (10ug/dL & above) 7
PHLI’s conducted (5 ug/dL & above) 5
No of cases filed 0
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Environmental Waste Unit
The Environmental Waste Unit licensed a Temporary Body Art Event – Over the Rhine Participated in the Hamilton County Crimes Task Force Meeting
Food Safety Program Feb 2019 Total
Healthy Homes Program Feb 2019 Total
FSO School Food Inspections 0 0
Inspections 228 508 RFE/FSO - Class 1 0 0
Reinspections 21 62 RFE/FSO - Class 2 0 0
CCP Inspections 98 246 RFE/FSO - Class 3 0 0
Monthly Total 347 816 RFE/FSO - Class 4 0 0
RFE/FSO - CCP 0 0
RFE RFE/FSO - Mobile 0 0
RFE Inspections 55 112 * Month Total * 0 0
RFE Reinspections 8 20
RFE Process Review 2 16 FSO/RFE Plans Received 0 0
Body Art Plans Received 0 1 Complaint Investigation 5 6
Body Art Plans Approved 1 1 Complaint Re-investigation 1 4
Body Art Licenses Issued (New) 1 1
Body Art Temp License Issued 1 2 Vectorborne Disease
Body Art Complaints 0 0 Complaint Investigation 1 2
Complaint Re-investigation 3 3
Cincinnati Vital Records and Statistics Program
Monthly Dashboard February 2019
Kiosk Birth Certificates Sales 1872
Kiosk Death Certificates Sales 88
Web Birth Certificates Sales 952
Web Death Certificates Sales 1216
Kiosk total payment Amount $43,686.00
Web Total Payment Amount $54,205.00
*Monthly dashboard is not an account of dollars paid thru the fiscal department and does not reflect refunds, mail, vouchers payments and Vital Chek payments.
Program goals and program dashboard Goal 2: Quality improvement activities related to identified gaps The program has a very low response rate (4.8%) for customers completing surveys who use the kiosk and we implemented several measures to increase the response rate.
• Paper surveys being completed onsite after service is rendered
• Customer service survey emailed to funeral homes 01/18/2019 reviewing responses
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• We also created a QR code that allows a customer or funeral home to complete the survey on their
mobile device
Division of Family Health Dear Family Health Colleagues, This is the final Director’s Report for the Family Health Division. Over the past several years, we’ve worked to collaborate, break down silos, and better integrate our learnings in our division. We have shared resources and ideas that help to promote the wellbeing of Cincinnati families. We began as the Maternal and Infant Health Division, but I think we quickly realized that we were much bigger in scope that just mothers and babies. We grew to include young children, adolescents, young men, fathers, the LGBTQ community, and those affected by substance use disorder. It has been a pleasure to work in this division and watch it grow. We led the performance management efforts for our department and now have tools to help guide our work. Although we are no longer a division, we should look at this as an opportunity to share our wealth of knowledge and capabilities with the rest of the department. I look forward to continuing our innovative work together in the future, just in different ways. It has been a pleasure to work alongside each of you. Sincerely, Jennifer L. Mooney, PhD, MS Division Director
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Family Health Division Managers - Taken in 2017
Reproductive Health and Wellness Program (RHWP)
We received funding for another year, and received a notice of award last week. The grant year will start
April 1st.
We are on track to exceed our projected patient numbers for the current grant year, ensuring we will
receive the full grant amount for the year.
RHWP epidemiologist Anthony Nixon was selected to participate in this year’s Community Leadership
Institute. This is an eight week course that uses development of leadership skills to enhance or create
health programs. Anthony will receive a small grant to implement a project upon completion.
Congratulations Anthony! Figure 1. Visits by Gender and month
FY18/19 Visits with Men: 1,080 FY18/19 Visits with Women: 4,010 FY18/19 Visits Combined: 5,090 FY18/19 Control Visits: 3,498 FY18/19 Visits as % of Control Total: 114.64%
633
705
602
681725
664
191 189 189 177 189145
824
894
791858
914
809
0
100
200
300
400
500
600
700
800
900
1000
2018_09 2018_10 2018_11 2018_12 2019_01 2019_02
Visit by Gender and Month
Female Male
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Figure 2. Long-acting reversible contraception provision by month.
Table 1. Selected Demographic Characteristics of Unduplicated Patients
Female % in col. Male % in col. Total % in col.
Race
AI/AN 1 0.20% 1 0.78% 2 0.32%
Asian 5 0.99% 1 0.78% 6 0.95%
Black 396 78.42% 107 83.59% 503 79.46%
PI/HN 3 0.59% 0.00% 3 0.47%
Unknown 9 1.78% 1 0.78% 10 1.58%
White 91 18.02% 18 14.06% 109 17.22%
Ethnicity
Hispanic 119 19.07% 119 15.82%
Non-Hispanic 505 80.93% 128 100.00% 633 84.18%
Income
<=100% FPL 471 75.48% 98 76.56% 569 75.66%
101-249% FPL 153 24.52% 30 23.44% 183 24.34%
Insurance Private 51 8.17% 9 7.03% 60 7.98%
Public 308 49.36% 28 21.88% 336 44.68%
Uninsured 265 42.47% 91 71.09% 356 47.34%
Age
>=17 29 4.65% 29 3.86%
18 to 44 529 84.78% 100 78.13% 629 83.64%
44< 66 10.58% 28 21.88% 94 12.50%
Limited English
147 23.56% 2 1.56% 149 19.81%
Total 624 100.00% 128 100.00% 752 100.00%
1
5
1 1
7
3
2 23
7
3
2 4 2
2
0
2
4
6
8
10
12
14
16
2018_09 2018_10 2018_11 2018_12 2019_01 2019_02
LARCs by Month (IUD)
Private Public
2 2 13
52
2 3 2
6
9
6 9 8 9
0
5
10
15
20
2018_09 2018_10 2018_11 2018_12 2019_01 2019_02
LARCs by Month (Implants)
Private
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Cribs for Kids Program
Children with Medical Handicaps (CMH) The Ohio Department of Health conducted the CMH program’s annual chart review at the Bobbie Sterne Health Center evaluating the period of July 1, 2017 – June 30, 2018. Eighteen charts were evaluated for the program. The amount of income earned for the program through the documentation process was $61,890 greater than the previous year. The goal of CMH is that children with special health care needs and their families obtain comprehensive care and services that are family centered, community based and culturally sensitive. It is also very beneficial for the families to receive assistance from a CMH PHN. The nurses are instrumental in guiding and assisting families through what most likely is a difficult time for their child and their family. The program reviewer, Jennifer Combs, RN, BSN was “very pleased with the progress that has been made over the past two years. Thank you for what you are doing for the children and families in Cincinnati City. You are greatly appreciated!” Men’s Health Men’s Health Education Modules
City Gospel Mission February 15th - 29th 4 - 5 Module – Reached 48 men
1 – 5 Modules Total men reached 133 Medical Home Referral – 3 appointments confirmed (Walnut Center)
Dohn Community High School February 7th , 21st & 28th 4 - 6 Modules – Reached 45 males/females
4 – 6 Modules Total males/females 71
Learning to Love Fatherhood Community – Villages February 13th Community Collaboration with Talbert House, Cradle Cincinnati, Community Action Agency,
and Fatherhood Collaborative Topics: Relationship Building, Positive Communication, Managing Emotions, Challenges of
Fatherhood, and Available Resources Reached 15 Men
1714
11
19 20
2 4 3 3
105
107
41
47
14
14 2 2
71 1
771 3 3
7
55
34
4136
48
00000000
10
20
30
40
50
60
Oct-18 Nov-18 Dec-18 Jan-19 Feb-19
Crib Distribution SFY18-19
Cribs for Kids HH:BBB Home HealthFirst Step Home ECS Santa MariaCrossroad Hlth Ctr HM&B Su CasaThe Community Builders Total
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Men’s Health Navigation- KNOW YOUR Numbers – Planning Phase Ongoing
Your Inspiration Health Host - Radio 1050 Inspiration (Mercy Health) until April 2019 Substance Use/Addiction Presentations/Talks Dr. Jennifer Mooney provided educational seminar to Community Practicum students in the Nursing program at Xavier University. Medication Assisted Treatment: New Health Counselor slated to start March 25, 2019 at the CHD. Onboarding will begin immediately as well as planning site, timeline, and scope of MAT services. Safe Places Cincy: Planning “Safe Places Cincy” project for the CHD health centers.
Training date for CHD staff was February 5, 2019 for approximately 100 staff members. It was successful and we believe staff are well informed of the process. Goal for implementation is mid-March.
Conducted “round robin” meetings at each health center’s all staff meeting to answer any lingering questions, provide Narcan training and kits to interested staff, and to discuss the folder created on the shared network drive for all staff.
Scheduled and conducted “dry runs” at each health center using a fictitious patient as our trial. Uncovered glitches in the system both on the treatment side as well as the health center side. Worked out issues pertaining to Uber Health as well.
Syringe Exchange Program:
Working with partners to expand syringe exchange services to Over the Rhine (OTR) in Cincinnati. The goal is to have that site ready by summer 2019.
Worked with the Hamilton County Health Department to address issues with two sites. We will need to find other locations for these sites.
February 2019 Syringe Exchange Program Totals
TOTALS (YTD), January 1, 2019 – February 28, 2019
*Take-home pregnancy test provided ‘Other referral’ defined as social services or mental health services Totals include Hamilton and Clermont Counties and Middletown
1. Provided services to approximately 4,881 participants out of 14,505 in the month of February. 2. Provided education for “high weight gain during pregnancy” to 142 or 70% of postpartum participants
in February. 3. Caseload in February was 14,505. The caseload continues to decrease. We have begun to send out WIC
Facebook posts on CHD Facebook. Division of School Health
*statistics impacted by students transferring into and out of the District
Data Reflects February 1 – February 28, 2019
School Based Health Centers
Total Medical Visits School Based Health Centers 3221
Vaccines Administered 355
Medicaid Rate % 67.4%
Private Insurance Rate 4.9%
Uninsured Rate 27.3%
Schools with CHD Nursing Staff on Site
Medical Vision Dental Hearing Total
Health Office Visits/ 911 8549/1
Screenings 569 566 672 1807
Routine Exams 122 137
Referrals 189 256 226 22 693
Referrals Completed 97 115 138 1 351
Referrals Incomplete 92 141 88 21 342
Referrals In-process 0
Referrals % Complete 51.32 44.92 61.06 4.54 50.64
Referrals % Serviced 61.06
Asthma Control Test (ACT) Scores Reported in Last 365 Days
This month marked the retirement of Marilyn Crumpton MD, who was serving as Medical Director for the Division of School and Adolescent Health. To fill that role, Grant Mussman, MD, MHSA began serving as Associate Medical Director, School Health and School Based Health beginning March 1, 2019. Division of Primary Care Patients seen from 02/01/2019 to 02/28/2019
Health Center January Health Center January AIKEN SBHC 204 NORTHSIDE DENTAL 250
AMBROSE CLEMENT 551 OYLER DENTAL 285
AWL SBHC 191 OYLER SBHC 227
BRAXTON CANN 637 OYLER VISION CTR 648
CHILDREN'S HOME 174 PRICE HILL 1,370
CITYLINK DENTAL 39 PRICE HILL DENTAL 762
CITYLINK VISION 46 RIVERVIEW EAST 144
CREST SMILE 330 ROLL HILL ACADEMY 139
ELM ST DENTAL 509 RP ACADEMY SBHC 296
ELM ST. 952 TAFT HIGH SCHOOL 185
ETHEL TAYLOR SBHC 93 WALNUT ST CLINIC 22
MILLVALE 19 WESTERN HILLS DEN 473
MILLVALE DENTAL 565 WESTERNHILLS SBHC 324
MT AIRY SBHC 176 WITHROW DENTAL 273
NORTHSIDE 194 WITHROW HIGH SBHC 295
GRAND TOTAL 10,391
PHAB Accreditation Update The PHAB Accreditation Committee meets on March 21, 2019 for their final decision on the health department’s accreditation status. It may take a week or two to receive notification from PHAB but hopefully we will know the decision by the end of the month. Since PHAB’s focus is continuous quality improvement, no matter what their decision is, CHD will have to develop a plan to improve performance in areas identified by the committee. At the last Board of Health Meeting on February 26, 2019, the Community Health Improvement Plan (CHIP) process was reviewed. This is one project that Cincinnati Health Department (CHD) staff have been focused on improving from the previous CHIP. CHD staff did a wonderful job of leading a community meeting on March 19th, 2019 to kick-off the Cincinnati CHIP process. Over 50 participants, from multiple community organizations and sectors, came together to partake in this process. At the meeting, Cincinnati health data was presented and preliminary focus areas were discussed. The next meeting for the CHIP process will be held in early May. Participants will finalize the focus areas and begin to form action teams to develop strategies in each focus area. Thank you to all those that helped plan and participate in this kick-off effort. We are excited to see what is accomplished through the Cincinnati CHIP.
Epidemiology and Evaluation
Infant Vitality Surveillance:
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As of March 5, 2019, 49 infant deaths in the City of Cincinnati have been provisionally reported for 2018. Of which, 41 infants are African American, 7 are Caucasian and 1 with an Other racial designation.
As of March 5, 2019, 2 infant death in the City of Cincinnati has been provisionally reported for 2019. Of which, 2 infants are African American, 0 are Caucasian and 0 are Other.
PermitStat:
For Building Permit Health review, the total number of applications screened are below.
2.10.2019 -3.9.2019
Received 37
Approved 22
Denied 6
Pending* 22
Avg Days 5.9
* Note: The pending category may include applications that were forwarded to Health, but that do not require actual Health review. Therefore, the number of pending will not exactly match the number received minus (the number approved + number denied).
2019 Community Health Needs Assessment (CHNA): The Cincinnati Health Department (CHD) released the Collaborative 2019 CHNA on March 5, 2019. The CHD worked with The Health Collaborative, Greater Dayton Area Hospital Association, regional hospitals and regional health departments to identify health priorities for our region. The next step will be to develop a Cincinnati Community Health Improvement Plan (CHIP) with the determined priorities. For the Cincinnati profile of the CHA, please visit https://www.cincinnati-oh.gov/health/assets/File/2019%20CHNA%20Report%20Cincy%20Profile(1).pdf. For the full CHNA report, please visit, http://bit.ly/2019_CHNA. Epidemiology Data Brief: Our first Epidemiology Data Brief is being released for the Cincinnati Health Department with Hepatitis A as the topic of focus. The Hepatitis A Epidemiology Data Brief was written by Alexander Evans, MBA, MPH, Public Health Associate appointed by the CDC to the Cincinnati Health Department working in Emergency Preparedness. Data for the brief was provided by Sharon Hutchins, PhD, MPH, Supervising Epidemiologist, Communicable Disease Unit and John Dunham, MS, Emergency Preparedness.
