accelerating our culture of health 2016 tpha annual meeting€¦ · · 2016-10-26• posters were...

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


• 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 [email protected] 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 [email protected]


• 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



• 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



1

7

9

11

14 15

16 17

0

2

4

6

8

10

12

14

16

18

Number of Microcephaly Cases Reported



• 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


(Poster #7)

Shannon De Pont I TDH I [email protected] 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 [email protected]


• 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



• 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).



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



• 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


(Poster #13)

Accelerating Our Culture of Health Jennifer Jabson I University of Tennessee Knoxville I [email protected]


• 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 [email protected]


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.



• 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



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†



• 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


(Poster #14)

Soghra Jarvandi I University of Tennessee Extension I [email protected] Accelerating Our Culture of Health


• The built environment may influence the high rate of obesity.

• 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


• To assess physical activity environment, and to explore the barriers related to physical activity in low socioeconomic rural communities in West Tennessee.


• 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


Number of Resources

Type of 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.”


• 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 [email protected] 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


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


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


Results


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 2016 tpha annual meeting€¦ · · 2016-10-26• posters were...

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