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Telling the Stories Behind the Data

Posted By Robert Harrison and Laura Styles, Thursday, July 31, 2014
Untitled Document
As epidemiologists, we view and interpret a lot of data. It's our responsibility to take action on the surveillance we conduct. Public health professionals understand that each case, each dot on a map, each block on an epi curve represents an ill patient, a person who has died, or a worker who has been injured. To us, charts and tables and summary reports tell an important story, but for others, we have to make it more personal to make an impact.
The Fatality Assessment and Control Evaluation (FACE) program is a case-based investigation program for the prevention of work-related injuries and illnesses. When workplace fatalities for landscape services increased in California and nationally from 2010 to 2012, we wanted to look closer. Data from the Census of Fatal Occupational Injuries (CFOI) confirmed that tree trimmers' fatality rate is twice the national average for worker fatalities. There is also a high incidence of workplace injury in this industry, although not all workers report these injuries or receive medical treatment.
At the California Department of Public Health, Occupational Health Branch, we have created videos about worker safety and health issues in addition to fact sheets, fatality alerts and investigation reports. These videos are a new strategy in the California FACE program’s prevention effort – written findings and prevention recommendations are brought to life with video re-creations, photos from the investigation, interviews with co-workers and family members, and clear explanations of how these tragedies can be prevented.
One such video, "Preventing Palm Tree Trimmer Fatalities," tells the story of Roberto, a 35-year-old tree trimmer, who died of suffocation when the palm fronds he was cutting fell on him. The video also explains proper equipment and climbing techniques that prevent this type of hazard. We see these workers every day around our neighborhoods, and they perform one of the most dangerous jobs in the U.S. They often don't have adequate training, and several deaths due to falls, suffocation, and other causes have occurred in California and elsewhere.
Click here to view the video, Preventing Palm Tree Trimmer Fatalities.
The California FACE video uses digital storytelling techniques to create a different kind of narrative to communicate public health data and messages. The key messages for the video are conveyed through real people and a real story; the video shows the devastating impact of not using proper palm trimming equipment or climbing techniques on the job. We listened to those affected by this issue so we could tell their story respectfully. This approach makes occupational health personal and local for viewers and the public, in order to encourage safety and prevent deaths.
A lot of planning went in to creating the video itself. We created a storyboard as a roadmap for the video with planned narration, video, and photos. Production partners included the Los Angeles County Fire Department, and tree climbing and safety professionals. We sought to balance the emotional and the factual, the problem and the solution, and to create a compelling video that could be used in trainings and would tell Roberto’s story.
We have found this and our other workplace safety videos on YouTube to be an effective medium to reach our target audiences and make our surveillance data come alive for maximum public health impact. We hope you can use our experience to weave together data and narrative to tell an important story for your program.
Laura Styles is the California FACE Program Manager, and Robert Harrison is the Chief of the Occupational Health Surveillance and Evaluation Program at the California Department of Public Health, Occupational Health Branch.

Tags:  collaboration  data  member spotlight  occupational health 

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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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