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New and Improved Chronic Disease Indicators

Posted By Sara Huston, Thursday, January 15, 2015
Untitled Document
CSTE, along with our partners CDC and National Association of Chronic Disease Directors (NACDD), is excited to share the release of two new important tools for chronic disease surveillance: 1) the MMWR Recommendations and Reports “Indicators for Chronic Disease Surveillance — United States, 2013” and 2) the redesigned CDC Chronic Disease Indicators website. These tools are products of a multi-year collaborative effort between CDC, CSTE, and NACDD to review and update the Chronic Disease Indicators (CDIs), which were first adopted in 1999.
The MMWR publication details the history of the CDIs and the process we went through in this most recent update. Did you know that the CDI work has been a successful collaboration between CSTE, CDC, and NACDD since way back in the mid-1990s? Many CSTE members dedicated their time and provided their expertise to help with this most recent CDI revision process – serving on or even chairing the content-specific working groups, or participating in the 2013 CSTE position statement process that officially adopted the newly revised CDIs. All the working group members are acknowledged in the MMWR. Thank you for your contributions!

The MMWR publication also highlights the major areas of change to the CDIs and provides detailed technical definitions – including numerator, denominator, and data sources – for each of the 124 indicators in 18 topic groups. The detailed definitions will enable epidemiologists to create estimates that are consistent with the data that CDC publishes on the CDI website, and may be especially helpful to local health departments in creating their own sub-state-level estimates.

CDC’s redesigned CDI website, just launched this week, provides data for each of the indicators at the state, territorial, and national level as well as for 40 large metropolitan areas. In addition to updating and adding data for all the CDIs, CDC worked hard to create a more user-friendly display, navigation, and data retrieval functionality for the website. Please take a few minutes to visit the site at www.cdc.gov/cdi, bookmark it and check it out!

If you haven’t taken a look at the CDIs since their last formal update in 2002, you’ll see many changes that reflect the growth in chronic disease programs in state and territorial health departments over the past decade and keep the CDIs relevant for present-day chronic disease surveillance. For example, the CDIs include 22 new indicators of systems and environmental change, reflecting the increased focus on environmental and systems change strategies in chronic disease program efforts. The updated CDIs also include five new topic areas – disability, mental health, older adults, reproductive health, and school health – reflecting the increased scope of work of many state and territorial chronic disease programs and increased collaboration with other program areas.

Here are just a few of the new CDIs you might find interesting:

  • Nutrition, physical activity, and weight status 8: Number of farmers markets per 100,000 residents (data source: USDA National Farmers’ Market Directory)
  • Asthma 5.1: Influenza vaccination among noninstitutionalized adults aged 18–64 years with asthma (data source: Behavioral Risk Factor Surveillance System)
  • Older adults 3.1: Proportion of older adults aged ≥65 years who are up to date on a core set of clinical preventive services (data source: Behavioral Risk Factor Surveillance System)
These newly revised Chronic Disease Indicators provide state and territorial health departments and other health agencies with a framework for chronic disease surveillance in the form of rigorously-defined consensus measures that are relevant to their programs. Our challenge going forward is to keep them relevant and to not let a whole decade pass before the next update! Please stay tuned for upcoming opportunities to learn more about the new CDIs and get involved in the next update process.
Sara L. Huston, Ph.D. is on the faculty of the University of Southern Maine’s Muskie School of Public Service and serves as the Lead Chronic Disease Epidemiologist for Maine. She is former chair of CSTE’s Chronic Disease/MCH/Oral Health Committee. For more information, please visit the CSTE page on CDIs and the 2013 CSTE position statement Revision to the National Chronic Disease Indicators.

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Tags:  cdi  chronic disease  chronic disease indicators 

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Synergy across chronic disease programs: An example from the Colorado Department of Public Health and Environment

Posted By Sara Ramey, Thursday, May 1, 2014
Untitled Document
Collaboration, integration, synergy, collective impact… whatever you call it, working with key public health partners can make efficient use of limited resources while increasing quality and reach of public health programs. Integration of chronic disease programs in public health departments has allowed for cross-cutting work on common risk factors and at-risk populations, including health care system changes, across programs that typically have worked in isolated silos.

The Colorado Department of Public Health and Environment’s (CDPHE) pathway to increased chronic disease integration started with organizational structure changes – centralization of epidemiology, evaluation, fiscal, and communication services. Soon thereafter, CDC selected Colorado and three other states to pilot combined chronic disease funding streams. CDPHE formed an integrated chronic disease leadership team, and the efforts of work units – newly organized along functional lines, including community-clinical linkages, health systems change, environmental approaches, and law and policy development – were increasingly evidence-based, executed at an enhanced level, and informed by science and data.
As part of the health systems change efforts, the Colorado Colorectal Cancer Control Program promoted colorectal cancer prevention and control efforts statewide by providing population-based strategies to increase screening rates and addressing the U.S. Preventive Services Task Force (USPSTF) recommended screening modalities through health systems change efforts. Through development of colorectal cancer screening policies, procedures, and protocols; client and provider-oriented reminder and recall systems; and staff training on USPSTF screening guidelines, this cancer program’s activities resulted in increased colorectal screening rates from 10 to 48 percent and from 16 to 29 percent in two Federally Qualified Health Centers (FQHCs).

Building upon its pilot integration and health systems change efforts, CDPHE is now using funding from CDC’s new collaborative chronic disease grant, “State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity, and Associated Risk Factors and Promote School Health” (a.k.a. “1305,” a nickname based on the RFA number) to increase the institutionalization and monitoring of aggregated/standardized quality measures at the provider and systems level. Part of CDPHE’s approach to this strategy is to combine efforts and resources across four grant programs: the Colorado Colorectal Cancer Control Program (CO CRCCP), the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program, and “1305.” Synergy!

To leverage promotion of screening for chronic diseases and related risk factors, CDPHE staff across these previously siloed programs revised the baseline assessment methodology to align measures with National Qualify Forum (NQF) standards and statistically validated the methods for establishing baseline cancer, cardiovascular, diabetes and tobacco screening rates among patient populations. In the near future, staff will establish comprehensive baseline screening rates in selected pilot FQHCs and will then conduct clinic site visits to:

  • Review the comprehensive baseline screening rates (cancer, cardiovascular, diabetes, and tobacco)
  • Determine concordance between chart audit findings and existing electronic health record reports
  • Evaluate existing clinic policies, procedures, and protocols
  • Collaborate with clinic staff to develop action plans for quality improvement measures to increase preventive screening rates. These health system change efforts are based on The Guide to Community Preventive Services (The Community Guide) and How to Increase CRC Screening Rates in Practice: A Primary Care Clinicians’ Evidence-Based Toolbox and Guide
By working collaboratively and combining chronic disease grant funding, we will maximize our efforts in the promotion of health system change to institutionalize and monitor aggregated/standardized quality measures and increase screening rates for chronic diseases such as cancer, cardiovascular disease, and diabetes in Federally Qualified Health Centers in Colorado. CDPHE staff have been able to determine the best way to integrate chronic disease programs and which strategies to implement and how based on data, evidence, and target populations. All states benefit from hearing what colleagues in other states are doing and what initiatives are making a difference. We welcome continued related discussion and sharing of experiences, challenges, and successes.
Renee Calanan
Chronic Disease and Oral Health Epidemiologist
Colorado Department of Public Health and Environment

Tags:  chronic disease  collaboration  member spotlight 

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Navigating Cancer Clusters

Posted By Sara Ramey, Wednesday, February 19, 2014
Updated: Wednesday, February 19, 2014
Untitled Document
In most states, public health professionals struggle with response to citizen calls reporting a suspected cancer cluster. Calls of this nature are not uncommon and often involve high levels of anxiety, mistrust of the public health agency and a sense of urgency on the part of the citizen. When environmental contaminant concerns are thrown into the mix the response becomes even more complex and media attention and lawsuits often follow.

The recently published MMWR “Investigating Suspected Cancer Clusters and Responding to Community Concerns” (MMWR1993;62(No.RR-8) presents new guidelines developed by a joint CDC and CSTE workgroup tasked with updating the 1990 MMWR guidelines for investigating clustering of health events. Things have changed in public health since 1990: all states have a cancer registry and access to record level data on cancer patients, statistical tools have expanded including geospatial analysis, and geocoding of data has become a norm. These new tools are discussed in the guidelines.
Public expectations have changed since 1990 as well; the internet is accessible to most and search of public websites and blogs are one new way citizens communicate and gather information during a cluster inquiry. Communication with the public has always been a key component of these investigations and this aspect was highlighted in the new guidelines. Emphasizing the importance of community communication, the guidelines recommend earlier partnership with all community partners in these situations. In addition, the CDC also collaborated with the National Public Health Information Coalition (NPHIC) to develop a document “Cancer Clusters” A Toolkit for Communicators” Both of these documents are on the CSTE website for membership use. Both documents recognize that ineffective communication can rapidly spin these situations out of control and put the public health agency in an adversarial light.
We only need to look toward recent news articles to understand the national picture on cancer clusters. In December 2013, ATSDR found that mothers at Camp Lejeune Marine Base in North Carolina with first trimester exposures to PCE, vinyl chloride, or DCE were more likely to have a child with leukemia or non-Hodgkin lymphoma compared with unexposed mothers although higher exposures did not increase the likelihood that the child would have these cancers. In May 2013, an 11-year study of the incidence of brain cancer associated with the Pratt & Whitney jet engine plant in Connecticut ended with university researchers saying they found no statistically significant elevations in the rate of cancer among workers related to exposures to contaminants. In January 2014, the Minnesota Department of Health found normal cancer rates for the Como neighborhood near the General Mills plant in Minneapolis despite concerns about elevated levels of solvent vapors detected in the soil. And in Clyde Ohio, the Ohio Department of Health has been investigating contamination concerns and cancer rates in the areas surrounding a Whirlpool facility for a number of years without resolution. My home state, Florida, has had some high profile investigations in recent years as well.
Please take some time to read these documents and share the links . Having a state specific protocol and guidelines in place in your own state before an event of this nature happens may be the key to successful resolution of cancer cluster calls and inquiries.
Sharon Watkins, PhD
Florida Department of Health

Tags:  cancer  chronic disease  member spotlight  surveillance 

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