2016 TPHA Annual Meeting 61 poster submissions 33 posters - - PowerPoint PPT Presentation

Accelerating Our Culture of Health 2016 TPHA Annual Meeting

Accelerating Our Culture of Health

• 61 poster submissions
• 33 posters eliminated after 1st poster committee review
• 28 posters selected
• 5 posters selected after 2nd 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

(Poster #5)

Marie Bottomley Hartel I TDH I marie.b.hartel@tn.gov

Accelerating Our Culture of Health

Accelerating Our Culture of Health

• Zika virus infection during pregnancy can cause

microcephaly and other CNS birth defects

• Current surveillance approach: passive, retrospective

Image Source: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities

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 1 7 9 11 14 15 16 17 2 4 6 8 10 12 14 16 18

Number of Microcephaly Cases Reported

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

• ther 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

(Poster #7)

Shannon De Pont I TDH I shannon.depont@tn.gov

Accelerating Our Culture of Health

Accelerating Our Culture of Health

• 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 community-based HCV Testing Program among at- risk individuals.

Figure 1 displays the case rates of acute HCV from 2011-2015 with participating CBO locations.

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

33% 432 Ab (+) 1,101

49% 24% 22% 9% 8% 1% 0% 10% 20% 30% 40% 50% 60%

History of injection drug use History of tattoos or body piercing History of intranasal drug use Born 1945-1965 Sexual contact with a HCV (+) individual Known to be HIV (+)

Figure 3: Self-Reported Risk Factors

56% 44%

Male Females

84% 16%

White Non-White

Figure 2: Positivity Rate Figure 4: Demographics

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

(Poster #13)

Accelerating Our Culture of Health

Jennifer Jabson I University of Tennessee Knoxville I jjabson@utk.edu

Accelerating Our Culture of Health

• CRC is the 2nd leading cause of

cancer mortality nationally

• CRC mortality in Appalachian

Tennessee (17.7 per 100,000) is higher than the national average (15.5 per 100,000)

CRC Prevalence Patient Compliance

• Patient compliance may

contribute to higher CRC mortality rates

• There is evidence from other

forms of cancer that patients do not comply with treatment according to recommended guidelines

• 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

• Design: Retrospective
• Data Source: National Cancer

Database from the American College of Surgeons

• Cases were diagnosed 2000 to

2015

• 695,168 CRC patients

– 197,888 = Appalachian – 497,280 = non-Appalachian

• Outcome Variables:

surgery, radiation, chemotherapy

• Independent Variables:

days to treatment, age, gender, insurance status, income, education, race/ethnicity, urban/rural residence, stage at diagnosis, treatment facility

Jennifer Jabson I University of Tennessee Knoxville I jjabson@utk.edu

Accelerating Our Culture of Health

Surgery Radiation Chemotherapy 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)* Compliance OR (95%CI) †Linear regression adjusted for insurance status, income, education, rural/urban, stage at diagnosis, and treatment facility Multivariable associations between demographic and clinical characteristics and CRC treatment compliance among Appalachian CRC patients† Jennifer Jabson I University of Tennessee Knoxville I jjabson@utk.edu

Accelerating Our Culture of Health

• Appalachian CRC patients had greater odds for CRC treatment

compliance than non-Appalachian patients

• One-third of Appalachian CRC patients are still not getting

recommended treatment

• Our findings suggest the need for future public health

interventions that :

– Target men to improve compliance with radiation and chemotherapy – Engage provider and patient to improve chemotherapy compliance among patients over the age of 50 – Decrease the amount of days from diagnosis to recommended surgery treatment

Jennifer Jabson I University of Tennessee Knoxville I jjabson@utk.edu

(Poster #14)

Soghra Jarvandi I University of Tennessee Extension I sjarvand@utk.edu

Accelerating Our Culture of Health

Accelerating Our Culture of Health

• The built environment may influence the high rate of
• besity.
• CDC funded community-based obesity prevention grant:

– Community Coalitions for Change: Healthy living in Tennessee – In four rural counties in West Tennessee:

• Haywood, Humphreys, Lake, and Lauderdale

Accelerating Our Culture of Health

• To assess physical activity environment, and to explore

the barriers related to physical activity in low socioeconomic rural communities in West Tennessee.

Accelerating Our Culture of Health

• THE PHYSICAL ACTIVITY RESOURCE ASSESSMENT

(PARA)

– The PARA focused on:

• Resource type
• Count of available features (13 features)

– e.g., Baseball fields; Basketball court

• Count of available amenities (12 amenities)

– e.g., Access points; Bathrooms; Benches

• Quality of features and amenities

– Rated as: 3 =‘good’, 2 = ‘mediocre’, and 1=‘poor’

• FOCUS GROUPS

– A total of thirteen focus groups were conducted with the counties’ residents

Accelerating Our Culture of Health

Number of Resources Type

• f

Resources

Features Amenities

Mean N. Mean Quality Mean N. Mean Quality

Lake 4 Sport facility, Park, Senior center 4 2.8 9.3 2.9 Humphreys 8 Trail, Sport facility, Park 3.1 2.8 6.8 2.7 Haywood 11 Pool, Community center, Trail, Sport facility, Park, School 1.8 2.9 6.6 2.7 Lauderdale 12 Community center, Trail, Sport facility, Park, Fitness club 2.4 2.2 4.4 2.5

Focus groups: barriers to physical activity

• Affordability

– Gym membership, and transportation costs

• Limited access to recreation

– Lack of indoor facilities for physical activities

Summary of PARA Results

“We have no place to go here to even walk out of the heat.” “Well not everybody can go to [the gym] because [the gym] is very expensive.”

Accelerating Our Culture of Health

• The results help to develop community-based physical

activity programs to improve built environment

• Possible strategies to improve physical activity will

include:

– Outreach programs to encourage residents to take advantage of the available resources – Identifying funding to repair, update and expand physical activities

Tennessee Stroke Registry Report, 2015 (Poster #18)

2016 TPHA Annual Meeting

Casey Morrell I East Tennessee State University I strokeregistry@etsu.edu

Accelerating Our Culture of Health

Accelerating Our Culture of Health

Background

Stroke is the 5th leading cause of death in Tennessee1 The Tennessee Stroke Registry (TSR) Act2 of 2008 established a statewide stroke database with annual reports produced by East Tennessee State University’s College of Public Health The TSR is a partnership between East Tennessee State University’s College of Public Health, American Heart/American Stroke Association (AHA), and the Tennessee Department of Health The TSR report is generated from data which are voluntarily input by hospitals in Tennessee who participate in the AHA- supported quality improvement program, Get with the Guidelines-Stroke

Accelerating Our Culture of Health

Objectives

To provide information about stroke in Tennessee to residents, health care professionals, and policy makers To highlight key findings of the 2015 Tennessee Stroke Registry Report To produce an updated map of the locations of certified stroke centers in Tennessee and a choropleth of stroke mortality rates across the state To identify areas of stroke disparities in Tennessee as reflected by various stroke mortality rates across the state and locations

• f certified stroke centers

To identify distributions of stroke risk factors (gender, age, etc.) across stroke types

Accelerating Our Culture of Health

Methods

ArcMap 10.3.1 was used to map 2014 stroke mortality data, location of stroke centers, and 30-, 60-, and 90-minute service areas of stroke centers Primary and Comprehensive Stroke Centers were identified through The Joint Commission quality check search engine; addresses were obtained from hospital websites then geocoded into a point shapefile in QGIS using the Google geocoder Aggregate data were abstracted from Quintiles, the online software used by GWTG-Stroke participating hospitals to input data Microsoft Excel was used to generate charts and graphs to illustrate the data collected by the TSR

Accelerating Our Culture of Health

Results

Accelerating Our Culture of Health

Conclusion

• In 2015, stroke types (i.e. hemorrhagic and ischemic) exhibited

different characteristics than strokes overall and geographic disparities were highlighted through the descriptive mapping

• Regions with clusters of certified stroke center (i.e. the

Nashville area) tend to have lower rates of stroke mortality. Clusters of stroke centers appear to have a greater association with lower stroke mortality rates than does the presence of a single stroke center

• Identifying and understanding these differences and

disparities in stroke mortality can help in addressing ways to improve stroke care and outcomes in Tennessee

Accelerating Our Culture of Health