Accelerating Our Culture of Health 2016 TPHA Annual Meeting
61 poster submissions • 33 posters eliminated after 1 st poster committee review • 28 posters selected • 5 posters selected after 2 nd poster committee review • Top Outstanding Poster to be announced during Award • Luncheon Posters were graded based a scoring rubric of: • Originality, Science, Implications for program, policy and/or • practice, Clarity, Presentation Accelerating Our Culture of Health
• Design and Implementation of a Real-time Microcephaly Surveillance System • TDH’s Community Based Organization HCV Testing Pilot • Non-Compliance to Recommended Cancer Treatment among Appalachian Colorectal Cancer Patients • Assessing the built environment for physical activity in four counties in West Tennessee • Tennessee Stroke Registry Report, 2015 Accelerating Our Culture of Health
(Poster #5) Accelerating Our Culture of Health Marie Bottomley Hartel I TDH I marie.b.hartel@tn.gov
• Zika virus infection during pregnancy can cause microcephaly and other CNS birth defects Image Source: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities • Current surveillance approach: passive, retrospective Marie Bottomley Hartel I TDH I marie.b.hartel@tn.gov Accelerating Our Culture of Health
• To design and implement a real-time microcephaly surveillance system based on provider report of infants diagnosed with congenital microcephaly • To identify all infants in the population diagnosed with congenital microcephaly that is present at birth/delivery • To estimate the baseline prevalence of congenital microcephaly in Tennessee • To monitor the frequency of congenital microcephaly to detect increases that might reflect Zika virus infection during pregnancy Marie Bottomley Hartel I TDH I marie.b.hartel@tn.gov Accelerating Our Culture of Health
• Included Microcephaly as reportable condition • Team Crosswalk of data elements – Focus on reducing data entry burden for providers – Wherever possible, data obtained from secondary, matched data sources • Broadcast to providers via TNHAN alert • Compare line list to all pregnant women authorized for Zika virus testing at the State Lab Marie Bottomley Hartel I TDH I marie.b.hartel@tn.gov Accelerating Our Culture of Health
Number of Microcephaly Cases Reported 17 18 16 15 16 14 14 11 12 9 10 7 8 6 4 1 2 0 Marie Bottomley Hartel I TDH I marie.b.hartel@tn.gov Accelerating Our Culture of Health
Real-time surveillance allows TDH to detect changes in • incidence of congenital microcephaly TDH Division of Family Health and Wellness was awarded a • cooperative agreement with the Centers for Disease Control and Prevention to expand real-time birth defects surveillance to capture cases of hydrocephaly, arthrogryposis, and the other CNS anomalies Enhanced birth defects surveillance should include referral and • follow-up TDH will monitor and facilitate referrals when needed to • medical specialists, the TEIS Program, and the Title V Maternal and the CSS Program Marie Bottomley Hartel I TDH I marie.b.hartel@tn.gov Accelerating Our Culture of Health
(Poster #7) Accelerating Our Culture of Health Shannon De Pont I TDH I shannon.depont@tn.gov
Increase in acute Hepatitis C • (HCV) case rates in Appalachia (Kentucky, Virginia, West Virginia and Tennessee) among young, white, non-urban dwelling individuals. Tennessee Department of • Health (TDH) partnered with Community Based Organizations (CBOs), predominately in Eastern TN, to develop a Figure 1 displays the case rates of acute community-based HCV HCV from 2011-2015 with participating Testing Program among at- CBO locations. risk individuals. Shannon De Pont I TDH I shannon.depont@tn.gov Accelerating Our Culture of Health
Reach individuals with a high risk of acquiring HCV that • are infrequently identified in clinical settings Increase screening efficiency by targeting high risk • groups within CBO settings Provide post-test counseling to all individuals tested • – Recommend confirmatory screening (if antibody positive) – Recommend repeat screening (if risk behavior is ongoing) – Recommend HCV follow-up with primary care provider to discussion care and treatment options Shannon De Pont I TDH I shannon.depont@tn.gov Accelerating Our Culture of Health
TDH identified several CBO partners through existing CBO • relationships with HIV prevention as testing sites. The CBOs were vetted to: • – 1) confirm the populations they serve and – 2) fulfill the requirements for testing (internal quality assurance, training programs, and proper storage and documentation). The validated CBOs then received HCV rapid antibody (Ab) test kits in • exchange for standardized documentation that collected risk factor information and provided risk reduction messaging for both Ab positive and Ab negative individuals. The OraQuick HCV Rapid Antibody Test is a point-of-care test • approved by the U.S. Food and Drug Administration (FDA waived under the Clinical Laboratory Improvement Amendment regulations (CLIA). Shannon De Pont I TDH I shannon.depont@tn.gov Accelerating Our Culture of Health
Figure 2: Positivity Rate Figure 4: Demographics Male Females 432 Ab 1,101 33% (+) 44% Figure 3: Self-Reported Risk Factors 56% 60% 49% 50% 40% 30% 24% White Non-White 22% 20% 9% 8% 10% 16% 1% 0% History of History of History of Born Sexual Known to injection tattoos or intranasal 1945-1965 contact be HIV (+) drug use body drug use with a HCV 84% piercing (+) individual Shannon De Pont I TDH I shannon.depont@tn.gov Accelerating Our Culture of Health
• Results of the HCV Testing Program demonstrates the need for increased targeted HCV screening in both CBO settings and the feasibility of implementing a formal CBO HCV testing program • Viral Hepatitis Program staff are currently developing a training program in order to provide standardized guidance to the CBOs, which consists of HCV education and technical capacity to administer tests • Full integration of the onboarding program is forthcoming and interested CBOs are encouraged to inquire as this pilot is ongoing Shannon De Pont I TDH I shannon.depont@tn.gov Accelerating Our Culture of Health
(Poster #13) Accelerating Our Culture of Health Jennifer Jabson I University of Tennessee Knoxville I jjabson@utk.edu
Patient Compliance CRC Prevalence • Patient compliance may • CRC is the 2nd leading cause of contribute to higher CRC cancer mortality nationally mortality rates • There is evidence from other • CRC mortality in Appalachian forms of cancer that patients Tennessee (17.7 per 100,000) is do not comply with treatment higher than the national average according to recommended guidelines (15.5 per 100,000) • We do not know the rate of compliance or the factors that influence treatment compliance in CRC patients in Appalachia Jennifer Jabson I University of Tennessee Knoxville I jjabson@utk.edu Accelerating Our Culture of Health
1. To describe compliance rates for recommended CRC treatment including surgery, radiation, and chemotherapy among CRC patients in Appalachia. 2. To identify demographic and clinical factors associated with compliance with surgery, radiation, and chemotherapy among CRC patients in Appalachia. Jennifer Jabson I University of Tennessee Knoxville I jjabson@utk.edu Accelerating Our Culture of Health
• Outcome Variables: • Design: Retrospective surgery, radiation, chemotherapy • Data Source: National Cancer Database from the American • Independent Variables: College of Surgeons days to treatment, age, gender, insurance status, • Cases were diagnosed 2000 to income, education, 2015 race/ethnicity, urban/rural • 695,168 CRC patients residence, stage at – 197,888 = Appalachian diagnosis, treatment – 497,280 = non-Appalachian facility Jennifer Jabson I University of Tennessee Knoxville I jjabson@utk.edu Accelerating Our Culture of Health
Multivariable associations between demographic and clinical characteristics and CRC treatment compliance among Appalachian CRC patients † Compliance Surgery Radiation Chemotherapy OR (95%CI) Age 41-50 ref ref ref 51-60 1.46 (.39, 5.46) .79 (.47, 1.32) .63 (.55, .73)** 61-70 .65 (.20, 2.18) .69 (.41, 1.16) .49 (.43, .57)** 70+ .31 (.09, 1.08) .33 (.20, .57)** .17 (.14, .19)** Male .91 (.53, 1.54) .75 (.31, .94)* .89 (.84, .94)** Race/Ethnicity Caucasian ref ref ref African American/Black .43 (2.4, .76)* 1.08 (.80, 1.46) .97 (.90, 1.05) Other -- .79 (.39, 1.60) 1.23 (.98, 1.54) Days to Treatment less than 7 .68 (.23, 2.05) 1.43 (.98, 2.08) 1.18 (1.08, 1.30)** 8-14 ref ref ref 15-28 .23 (.11, .48)** 1.43 (1.05, 1.96)* 1.18 (1.09, 1.28)** more than 28 .15 (.08, .30)** 1.42 (1.05, 1.92)* 1.10 (1.01, 1.19)* †Linear regression adjusted for insurance status, income, education, rural/urban, stage at diagnosis, and treatment facility Jennifer Jabson I University of Tennessee Knoxville I jjabson@utk.edu Accelerating Our Culture of Health
Recommend
More recommend
