Advisory Group MeetingAdvisory Group MeetingJanuary 29, 2010

WelcomeWelcome

Jerry Hirsch, Ph.DJerry Hirsch, Ph.D

Goals & ObjectivesGoals & Objectives

““The Long Island Center for Health Policy Studies is The Long Island Center for Health Policy Studies is dedicated to democratizing health planning dedicated to democratizing health planning

information so as to support a sustainable process of information so as to support a sustainable process of health policy development which directly results in health policy development which directly results in

improving the health of the residents and communities improving the health of the residents and communities of Long Island”of Long Island”

MissionMission

1. Provide professional expertise that advances the development of regional health planning

2. Advance the knowledge base of determinants of health and identification of community healthcare needs through the dissemination of valid and reliable healthcare data

3. Provide a venue for like-minded professionals dedicated to the improvement of the healthcare delivery system to share information and best practices of preventive healthcare

GoalsGoals

4. Study and disseminate information on how consumers make decisions that effect their health

5. Provide recommendations concerning the configuration of the health care delivery system and resource allocation to address local health care needs and improve quality in a sustainable and cost effective manner

GoalsGoals

Prevention Agenda Towards the Healthiest State 2008-2013

1. The aging population and cost effective care management methods

2. Health disparities in a suburban environment

3. Dissemination of healthy lifestyle best practices

Initial FocusInitial Focus

Needs Needs AssessmentAssessment

Initial Role Initial Role of LICHPSof LICHPS

Health Disparities in a Suburban Environment◦ Prevention Quality Indicators (PQIs)◦ Avoidable Emergency Room Visits◦ Primary Care Physician Workforce

Define and Measure the ProblemDefine and Measure the Problem

What are the Prevention Quality Indicators? Prevention Quality Indicators (PQIs) are a set of measures

created by the Agency for Health Research and Quality (AHRQ) that identify "ambulatory care sensitive conditions" (ACSCs) in adult populations, using hospital inpatient discharges.

ACSCs are conditions for which good outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications or more severe disease.

Prevention Quality Indicators Prevention Quality Indicators (PQIs)(PQIs)

What do these Indicators tell us? They can provide initial information about potential

problems in the community that may require further, more in-depth analysis.

Higher than anticipated rates may reflect ◦ poor access to care◦ barriers to timely care◦ barriers to adherence to medical advice◦ cultural influences that preclude seeking early treatment◦ higher prevalence of poor health behaviors

Prevention Quality Indicators Prevention Quality Indicators (PQIs)(PQIs)

Lowest and Highest PQI communities -2007-Lowest and Highest PQI communities -2007-

Prepared by North Shore-LIJ Health System Office of Strategic Planning

PQI GroupingPQI GroupingPQI GroupingPQI GroupingPQI GroupingPQI GroupingPQI GroupingPQI GroupingPQI GroupingWorst 20%All OtherBest 20%

Highest 20% All Other Lowest 20%

Diabetes PQIs: Change from 1997 to 2007Diabetes PQIs: Change from 1997 to 2007

Source: SPARCS ver11.28.08/jm; Thomson Reuters; Prepared by North Shore-LIJ Health System Office of Strategic Planning

Diabetes PQI Change1997 to 2007

>30% higher rateO to 30% higher rateNo changeO to 30% lower rate>30% lower rate

PQI Description 1997 2007 Δ

PQI 1 Diabetes with short term complication 562 1,550 988

PQI 3 Diabetes with long term complication 1,640 2,796 1,156

PQI 14 Uncontrolled Diabetes 867 787 -80

PQI 16 Lower extremity Amputation 547 586 39

Renee Pekmezaris, Ph.DRenee Pekmezaris, Ph.D

The Aging TsunamiThe Aging Tsunami

24

3540

70

1995 2000 2020 2030

Source: U.S. Census.

(millions)

Nearly 200% increase

People age 85 and older are fastest growing segment, from 4 to 20 million by 2050 (400% increase)

The Number of Older Americans The Number of Older Americans Age 65+: 1995-2030Age 65+: 1995-2030

Source: U.S. Census Bureau and Cornell Program on Applied Demographics

85% increase in Nassau

178% increase in Suffolk

1 out of

every 10

is of age

65 and

over

1 out o

f

every

5

will b

e

over t

he

age of 6

5

Long Island (including Queens County)Long Island (including Queens County)2000 Pct of Households with One or More Persons 65 & Over2000 Pct of Households with One or More Persons 65 & Over

YEAR LIFE EXPECTANCY

1776 35

1900 47

1950 68

1991 76

2005 77.8

2050 ????

Perspective: Perspective: We’re Living LongerWe’re Living Longer

More of Us Are Living More of Us Are Living Longer Healthier LivesLonger Healthier Lives

More of Us May Face More of Us May Face Dependency…Dependency…

Women Enjoy Greater Longevity than MenWomen Enjoy Greater Longevity than Men……At Age 65: Proportion of Women to MenAt Age 65: Proportion of Women to Men

Women Enjoy Greater Longevity than MenWomen Enjoy Greater Longevity than Men……At Age 85: Proportion of Women to MenAt Age 85: Proportion of Women to Men

Often Homebound and Alone, Often Homebound and Alone, Without a Spouse to Rely OnWithout a Spouse to Rely On

80% of Americans 65+ have at least 1 chronic condition; 50% have at least 2.1

Chronically ill patients, primarily comprised of older patients, in the US account for 78% of all medical costs nationally.2

30% decline in geriatricians since 1998.3

Most seniors want to stay in their own homes: AARP 2005 survey, shows that 89% polled reported they want to stay in current residence as long as possible.4

1) Center for Disease Control 2) Jan/Feb 2009 Health Affairs 3) Asso. of Dirs of Geriatric Academic Programs (ADGAP) 4) AARP 2005

Health Care Challenge of An Health Care Challenge of An Aging SocietyAging Society

The role of nursing facilities has changed: residential skilled nursing (rehab).

Many patients are homebound, and lack a primary physician (need to expand home visiting programs).

Many at home unsupervised, often not taking meds, deteriorating physically & mentally, often presenting in ER when in crisis.

Caregivers (many of whom are parents), are often overwhelmed by care issues.

Health Care Challenge of An Health Care Challenge of An Aging SocietyAging Society

What are the Needs of Seniors What are the Needs of Seniors Living On Long Island ?Living On Long Island ?

Senior Needs SurveySenior Needs Survey

To better understand issues of seniors, particularly the “older old” (85+) on Long Island.

To inform the Long Island community about senior issues/survey results

To make recommendations to policymakers with regard to improving community health: what can we do to improve quality of life for our seniors?

LICHPS Survey GoalsLICHPS Survey Goals

Health Care Challenges

Social Challenges

TransportationTransportation

NutritionNutrition

Community CharacteristicsCommunity Characteristics In-Home MaintenanceIn-Home Maintenance

Social SupportsSocial Supports

Chronic IllnessChronic Illness

Functional SupportFunctional Support

Health Care Information/UtilizationHealth Care Information/Utilization

Draft Survey Areas for LICHPS Draft Survey Areas for LICHPS Advisory Board ConsiderationAdvisory Board Consideration

Survey Design Survey Design SubcommitteeSubcommittee

Peter Clement, Ph.DPeter Clement, Ph.D

Potential Areas of StudyPotential Areas of Study

Contact LICHPS: Peter A. Clement, Ph.DDirector, LICHPSpclement@nshs.edu Tel (516) 465-8348Fax (516) 465-8179

DiscussionDiscussion