Building Community Partnerships for Health
June Simmons Partners in Care Foundation
The shift to health – from health care The new demographics of health The Chronic Care Model
Nationwide Statistics:Opportunity for Impact
50% of Americans have a chronic condition◦ 25% have multiple chronic conditions.
7 of 10 deaths in US each year due to chronic disease 7% of Medicaid population but 54% of costs 80% of health care costs go to 20% of patients -- those with
chronic diseases
Chronic Illness in California Largest and most diverse state:
◦ 38 million residents◦ 3.9 million residents ages 65+ (10%)1
62% of all older people report having 2+ chronic conditions2,3
58% of older Californians have some type of arthritis4
14.8% of CA seniors suffer from diabetes5
30% of the state’s elderly minorities are diabetic5 Heart disease accounts for 29% of the state’s deaths6
1 CDC. Population Estimate 2006.2Yen I, Trupin L, Yelin E. The relationship between health and employment. San Francisco, CA: Institute for Health Policy Studies; 2001.3 Partnership for Solutions. Chronic conditions: Making the case for ongoing care. Baltimore, MD: Johns Hopkins University; 2002.4 Lund LE. Prevalence of Arthritis in California Counties, 2001: Center for Health Statistics; December 2003.5 Lund LE. Prevalence of Diabetes in California Counties: 2003 Update: Center for Health Statistics; February 2005. 6 CDC. Chronic diseases: The leading causes of death California. CDC. Available at: http://www.cdc.gov/nccd php/publications/factsheet/chronicDisease/California.ntml. Accessed 8/1, 2006.
Californians Age 65 and OverAge
% 65 years old and over 10.7%
Ethnic Background
% White persons, not Hispanic 44.5%
% Persons Hispanic or Latino 34.7%
% Asian persons 12.1%
% Black persons 6.8%
% Other 1.9%
Socio-economic Characteristics
% Of Medi-Cal beneficiaries 20.5%
% Below Poverty 8.1%
% Near Poor (0-199% of Poverty) 28.6%
% Limited English Proficient 16.9%
Health/Functional Status
Fair or Poor Health 29.6%
Have any disability 42.2%
Sedentary Lifestyle 37.2%
Arthritis/Moderately or highly limited in daily activities 57.7%
Diabetes—Ever Diagnosed 14.8%
Hypertension—Ever Diagnosed 53.5%
Heart Disease—Ever Diagnosed 23.7%
Impaired Activities Due to Emotional Problems Last Month 11.5%
Development of New Evidence-Based Health Promotion Models
Transformation of the Aging Network What is Evidence-Based
Available Programs
A New Vision is Being Crafted◦ Health Care Providers do not have to solve the
problem of chronic disease alone◦ There are powerful, proven programs available
New strategies are being developed and tested to take these new programs to scale
Peer-led, 2-hour sessions for 6 weeks Any chronic disease Focus on goals and action plans Techniques to deal with problems such as
frustration, fatigue, pain and isolation Appropriate exercise for maintaining and
improving strength, flexibility, and endurance Appropriate use of medications Communicating effectively with family, friends,
and health professionals Nutrition How to evaluate new treatments.
After 12 months, significant improvement in:◦ Amount of exercise (ROM & aerobic), ◦ Cognitive symptom management◦ Communication with physicians◦ Self-efficacy – Confidence in coping◦ Health status (fatigue, shortness of breath, pain, role
function, depression, health distress) ◦ Utilization:
Emergency department (ED) visits Physician visits Hospital days
Spanish version available; Effective among minorities
Arkansas Arizona California Colorado Connecticut Florida Hawaii Idaho Illinois Indiana Iowa Maine Maryland
Massachusetts Michigan Minnesota New Jersey New York North Carolina Ohio Oklahoma Oregon Rhode Island South Carolina Texas Washington Wisconsin
Health care cost savings in programs that improve quality of life
CMS working with AoA at national level – Move senior centers from recreation to wellness
Aging Departments working with Public Health at state level – Fall prevention, flu, etc.
Locally, health care and aging/disability service providers pursuing goal of individual responsibility and empowerment in self-care
Many Strategies Being Many Strategies Being Developed and Tested Developed and Tested
How can we reach real scale
Tobacco is a good example of the model of change
How do we engage people in this change?
Physicians are proven most powerful referral source
California as an example 3.9 million older adults Chronic disease summary Strategies to reach evolving Want to build a “distribution system” that is
scalable and sustainable
Parks and Rec.
Senior Centers
Mental Health Sector
Faith-Based Orgs
Community
Colleges
Physician Groups
Health Plans
Hospitals
Senior
Housing
Sites
Public Health Sector
Evidence-Based ProjectOffice
Target Sectors For ADOPTION/ENGAGEMENT
Physicians & Older Adult Education Programs New Partnerships to identify and engage
older adults Physician practices a location where many
elders are seen Physicians can identify those with chronic
conditions Physician referral is the most powerful tool
Emphasize patient responsibility
Empower the patient – You CAN do it!
Know the resources Write the prescription – for
all chronic conditions Follow-up encouragement What changes did you
make?Physician is the most powerful influence in patients signing up for and completing the 6-week program
Sustainable Sources of Support Community Colleges and K-12 offer free
non-credit education to older adults Paid for attendance Can add new curricula Have marketing in place Teach in community settings
Promoting Health and Preventing Decline – the New Imperative Quality of life is at stake The health dollar is at stake With new knowledge and methods, we must
transform community understanding Mobilize the population to rise to the
challenge Take on the leadership
Top Related