1. NCCHC Updates in Correctional Health Care April 24-27, 2010 Nashville, TN

2. Susan M. Tiona, M.D.,CCHP Kit Carson Correctional Facility PO Box 309 Burlington, CO 80807 719-346-9450care4cons@gmail.comwww.care4cons.com

3. Grounded in the notion that establishing objectives and providing benchmarks to track and monitor progress over time can motivate, guide, and focus action Aimed at improving the health of all Americans Three decades of providing a comprehensive set of national 10-year health promotion and disease prevention objectives

4. A society in which all people live long, healthy lives. A society in which all people live long, healthy lives.

5. Identify nationwide health improvement priorities Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress Provide measurable objectives and goals that are applicable at the national, state, and local levels Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge Identify critical research, evaluation and data collection needs

6. Attain high quality, longer lives free of preventable disease, disability, injury, and premature death Achieve health equity, eliminate disparities, and improve the health of all groups Create social and physical environments that promote good health for all Promote quality of life, healthy development and healthy behaviors across all life stages

7. Access to Health ServicesAdolescent HealthArthritis, Osteoporosis, and Chronic Back ConditionsBlood Disorders and Blood SafetyCancerChronic Kidney DiseaseDiabetesDisability and Secondary ConditionsEarly and Middle ChildhoodEducational and Community-Based Programs

8. Environmental HealthFamily PlanningFood SafetyGenomicsGlobal HealthHealth Communication and Health ITHealthcare-Associated InfectionsHearing and Other Sensory or Communication DisordersHeart Disease and StrokeHIV

9. Immunization and Infectious DiseasesInjury and Violence PreventionMaternal, Infant, and Child HealthMedical Product SafetyMental Health and Mental DisordersNutrition and Weight StatusOccupational Safety and HealthOlder AdultsOral HealthPhysical Activity and Fitness

10. Public Health InfrastructureQuality of Life and Well-beingRespiratory DiseasesSexually Transmitted DiseasesSocial Determinants of HealthSubstance AbuseTobacco UseVision

11. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS (National Center for Health Statistics); www.cdc.gov/nchs/nhanes.htm National Health Interview Survey (NHIS), CDC, NCHS; www.cdc.gov/nchs/nhis.htm National Ambulatory Medical Care Survey (NAMCS), CDC, NCHS; www.cdc.gov/nchs/ahcd.htm Medical Expenditure Panel Survey (MEPS), AHRQ (Agency for Healthcare Research and Quality); www.meps.ahrq.gov United States Renal Data System, NIH, NIDDK; (National Institute of Diabetes and Digestive and Kidney Diseases); www.usrds.org

12. Focus on some key objectives with correctional care applications…

13. Reduce the mean level of joint pain among adults with doctor-diagnosed arthritis Reduce the proportion of adults with doctor- diagnosed arthritis who experience a limitation in activity due to arthritis or joint symptoms Increase the proportion of adults with doctor- diagnosed arthritis who receive health care provider counseling For weight reduction among overweight and obese persons For physical activity or exercise

14. Increase the proportion of adults with chronic joint symptoms who have seen a health care provider for their symptoms Increase the proportion of adults with doctor- diagnosed arthritis who have had effective, evidence-based arthritis education as an integral part of the management of their condition Reduce activity limitation due to chronic back conditions

15. Increase the proportion of persons with diabetes and chronic kidney disease who receive recommended medical evaluation (serum creatinine, microalbumin, HgA1C, lipids, eye exams) Increase the proportion of persons with diabetes and CKD who receive recommended medical treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs).

16. Improve cardiovascular care in persons with chronic kidney disease Reduce the percentage of persons with CKD who have elevated blood pressure (Target <130/80) Reduce the percentage of persons with CKD who have elevated lipid levels Increase the percentage of persons with CKD who know that they have impaired renal function

17. Increase the proportion of persons with diagnosed diabetes who receive formal diabetes education Increase the proportion of adults with diabetes whose condition has been diagnosed Increase the proportion of persons with diabetes who obtain an annual urinary microalbumin measurement Increase the proportion of adults with diabetes who have a HgA1C measurement at least twice year

18. Increase the proportion of adults with diabetes who have an annual dilated eye exam, at least an annual foot exam, and at least an annual dental exam Improve glycemic control among the population with diagnosed diabetes Reduce the proportion with A1C value >9% Increase the proportion with A1C value <7% Increase the proportion of diabetics whose blood pressure is under control (Target < 130/80)

19. Improve lipid control among diabetics Increase the proportion of people with IFG, pre-diabetes, or multiple diabetes risk factors that are engaged in diabetes prevention behaviors Increase the proportion of the high-risk, overweight population reporting a physically active lifestyle Increase the proportion of the high-risk, overweight population who report intentionally losing weight in the previous year

20. Increase the proportion of persons who report that their health care providers have satisfactory communication skills Increase the proportion of persons who report that their health care provider always listens carefully to them Increase the proportion of persons who report that their health care provider always explains things so that they can understand them Increase the proportion of persons who report that their health care provider always shows respect for what they have to say Increase the proportion of persons who report that their health care provider always spends enough time with them

21. Increase the proportion of adults with high blood pressure whose blood pressure is under control Increase the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high Reduced the mean total blood cholesterol levels among adults Reduce the proportion of adults with high total blood cholesterol levels Increase the proportion of adults who have had their blood cholesterol checked within the preceding 5 years

22. Increase the proportion of adults with pre- hypertension who meet the recommended guidelines for: Body mass index Saturated fat consumption Sodium intake Physical activity Moderate alcohol consumption

23. Increase the proportion of adults with hypertension who meet the recommended guidelines for: Body mass index Saturated fat consumption Sodium intake Physical activity Moderate alcohol consumption Increase the proportion of persons with coronary artery disease who have their LDL cholesterol level at or below recommended levels

24. Increase the proportion of adults with elevated LDL cholesterol who have been advised by a health care provider to: Eat fewer foods high in saturated fat or high in cholesterol Control weight or lose weight Increase physical activity or exercise Take recommended medication Increase the proportion of adults with elevated LDL cholesterol who meet the recommended guidelines for: Healthy weight Cholesterol-lowering diet Physical activity

25. Increase the proportion of adults who are at a healthy weight Reduce the proportion of adults who are obese Reduce iron deficiency among females aged 12 to 49 years Reduce iron deficiency among pregnant females Reduce consumption of saturated fat and sodium in the population aged 2 and older Increase the consumption of calcium in the population aged 2 and older

26. Increase the proportion of physician office visits that include counseling or education related to nutrition or weight Increase the proportion of primary care physicians who regularly measure the body mass index of their patients Reduce consumption of calories from solid fats and added sugars in the population aged 2 years and older

27. Reduce the proportion of adults who have moderate to severe functional limitations Increase the proportion of older adults with one or more chronic health problems who report confidence in managing their conditions Increase the proportion of older adults with reduced physical or cognitive function who engage in light, moderate, or vigorous leisure- time physical activities

28. Reduce the proportion of adults who engage in no leisure-time physical activity Increase the proportion of physician office visits for chronic health diseases or conditions that include counseling or education related to exercise

29. Increase the proportion of adults that meet current Federal physical activity guidelines for aerobic physical activity and for muscle strength training Increase the proportion of adults who engage in aerobic physical activity of at least moderate intensity for at least 150 minutes/week or 75 minutes/week of vigorous intensity, or an equivalent combination Increase the proportion of adults who perform muscle-strengthening activities on 2 or more days of the week

30. Reduce hospitalizations for asthma Reduce hospital emergency department visits for asthma Reduce activity limitations among persons with current asthma Reduce the proportion of adults whose activity is limited due to chronic lung and breathing problems

31. Increase the proportion of persons with current asthma who receive appropriate asthma care according to National Asthma Education and Prevention Program (NAEPP) guidelines. Persons with current asthma who receive written asthma management plans from their health care provider Persons with current asthma with prescribed inhalers who receive instruction on their use Persons with current asthma who receive education about appropriate response to an asthma episode, including recognizing early signs and symptoms or monitoring peak flow results Increase the proportion of persons with current asthma who do not use more than one canister of short-acting inhaled beta agonist per month

32. Healthy Inmates 2020 ??? How do we make it work?

33. A correctional system in which all inmates have the opportunity for healthy living A correctional system in which all inmates have the opportunity for healthy living

34. Identify health improvement priorities for correctional health care Increase awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress Provide measurable health objectives and goals that are applicable across a wide range of correctional settings Engage correctional health professionals to take action to strengthen policies and improve practices that are driven by the best available evidence and knowledge Identify critical research, evaluation and data collection needs for correctional health care

35. Eliminate preventable disease, disability, injury, and premature death Achieve health equity, remove disparities, and improve health status across all ethnic groups Cultivate correctional environments that promote good health for all Promote healthy behaviors for all incarcerated individuals

36. Access to Health ServicesArthritis, Joint Pain, and Chronic Back ConditionsChronic Kidney DiseaseDiabetesHealth Communication

37. Heart Disease and StrokeNutrition, Weight Status and ExerciseOlder AdultsRespiratory DiseaseSpecial Groups: Adolescent and Womens Health

38. Increase the proportion of inmates who report having little or no problem accessing routine health care services Increase the proportion of inmates who report having little or no problem accessing specialty health care services Increase the proportion of inmates who report overall satisfaction with their health care

39. Reduce the mean level of joint pain among adult inmates with doctor- diagnosed arthritis Reduce the proportion of adult inmates with arthritis who experience a limitation in activity due to arthritis or joint symptoms Increase the proportion of adult inmates with arthritis who receive health care provider counseling For weight reduction among overweight and obese persons For physical activity or exercise Reduce activity limitation of adult inmates due to chronic back conditions

40. Increase the percentage of inmates with CKD who know they have impaired renal function Improve cardiovascular care in inmates with chronic kidney disease Increase the proportion of inmates with diabetes and CKD who receive recommended medical treatment with ACEIs or ARBs. Reduce the percentage of inmates with CKD who have elevated blood pressure (Target <130/80) Reduce the percentage of inmates with CKD who have elevated lipid levels

41. Improve glycemic control among the incarcerated population with diagnosed diabetes Reduce the proportion of inmates with diabetes whose A1C value is >9% Increase the proportion of inmates with diabetes whose A1C value is <7% Increase the proportion of inmates with IFG, pre- diabetes, or multiple diabetes risk factors that are engaged in diabetes prevention behaviors Report having a physically active lifestyle Report intentionally losing weight in the previous year

42. Increase the proportion of inmates with diabetes who are being treated according to the Standards of Medical Care in Diabetes2010 ADA guidelines Receive formal diabetes education Annual urinary micro- albumin HgA1C checked at least twice a year Annual dilated eye exam, foot exam, and dental exam Blood pressure less than 130/80 LDL at or below target guidelines (100 w/o CAD; 70 w/ CAD)

43. Increase the proportion of inmates who report that their health care providers have satisfactory communication skills Their health care provider listens carefully to them Their health care provider explains things so that they can understand them Their health care provider shows respect for what they have to say Their health care provider spends enough time with them

44. Increase the proportion of inmates with high blood pressure (on treatment) whose blood pressure is under control Increase the proportion of inmates who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high Reduced the mean total cholesterol levels among inmates Reduce the proportion of inmates with high total cholesterol levels Increase the proportion of inmates who have had their blood cholesterol checked within the preceding 5 years

45. Increase the proportion of inmates with pre-hypertension who meet the recommended guidelines for: Body mass index Saturated fat consumption Sodium intake Physical activity Increase the proportion of inmates with hypertension who meet the recommended guidelines for: Body mass index Saturated fat consumption Sodium intake Physical activity

46. Increase the proportion of inmates with elevated LDL cholesterol who have been advised by a health care provider to: Eat fewer foods high in saturated fat or high in cholesterol Control weight or lose weight Increase physical activity or exercise Take recommended medication Increase the proportion of inmates with elevated LDL cholesterol who meet the recommended guidelines for: Healthy weight Cholesterol-lowering diet Physical activity Increase the proportion of persons with coronary artery disease who have their LDL cholesterol level at or below recommended levels

47. Reduce consumption of saturated fat and sodium Increase the consumption of calcium Reduce consumption of calories from solid fats and added sugars

48. Increase the proportion of patient encounters that include counseling or education related to nutrition, weight, or exercise Increase the proportion of providers who regularly measure the body mass index of their patients Increase the proportion of inmates who are at a healthy weight Reduce the proportion of inmates who are obese

49. Increase the proportion of inmates that meet current Federal physical activity guidelines for aerobic physical activity and for muscle strength training Increase the proportion of inmates who engage in aerobic physical activity of at least moderate intensity for at least 150 minutes/week or 75 minutes/week of vigorous intensity, or an equivalent combination Increase the proportion of inmates who perform muscle-strengthening activities on 2 or more days of the week

50. Reduce the proportion of older inmates who have moderate to severe functional limitations Increase the proportion of older inmates with one or more chronic health problems who report confidence in managing their conditions Increase the proportion of older inmates with reduced physical or cognitive function who engage in light, moderate, or vigorous leisure-time physical activities

51. Increase the proportion of inmates with current asthma who receive appropriate asthma care according to National Asthma Education and Prevention Program (NAEPP) guidelines. Receive written asthma management plans from their health care provider Receive instruction on use of prescribed inhalers Receive education about appropriate response to an asthma episode, including recognizing early signs and symptoms or monitoring peak flow results Do not use more than one canister of short-acting inhaled beta agonist per month

52. ???

53. PHASE 1: Choose the focus areas and objectives that will define the Healthy Inmates project. PHASE 2: Develop data collection tools that will unify the information gathering process PHASE 3: Collect data from as many correctional practices as possible in order to identify trends and baselines for each objective PHASE 4: Encourage correctional practices to implement one or more project objectives PHASE 5: Periodically repeat the information and data gathering process to evaluate the progress being made

54. Inmate Pain Survey (Available at www.care4cons.com) Arthritis, Joint Pain, and Chronic Back Conditions Inmate General Health Survey (Available at www.care4cons.com) Access to Health Services Health Communication Older Inmates Health Survey (Under Development) Older Inmates Healthcare Delivery Audits (Under Development) Chronic Kidney Disease Diabetes Heart Disease and Stroke Nutrition, Weight and Exercise Respiratory Disease

55. Asthma NIH Guidelines ATP III Cholesterol Guidelines Diabetes Care Standards Diabetes Care in Corrections JNC 7 (Hypertension) Guidelines Obesity Guidelines (1998) Physical Activity Guidelines USRDS Report (All links available at www.care4cons.com)

56. Share your tools, audits, strategies, implementation ideas, etc. Collect (and share) your data Adopt one or more Healthy Inmates 2020 objectives Evaluate (and share) your progress over time

57. For the most up-to-date version of this presentation, for Healthy Inmates 2020 implementation tools, and for links to other useful public health resources, visitwww.care4cons.com