Preventing and Managing Chronic Conditions in Children Presentation Overview
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Presentation Overview Preventing and Managing Chronic Conditions in Children Introduction to the Problem Approaches to address the Problem February 7, 2006 Nemours Community-Based Approach Debbie I. Chang, MPH Executive Director and Senior Vice President Nemours Health and Prevention Services 1 2 Chronic Diseases Healthcare Environment Increasing Prevalence of Chronic Diseases in Children Estimated $1.6 trillion spent on health care in 2003 Moderate to Severe Chronic 70-80% of national health expenditures related to chronic conditions Mild Chronic Children consumed about 12% or $200 billion Well and Acute Care Expenditures Influence 10% 20% 70% 70% The 10% of the sickest children consumed 69%; the top 20% accounted for 81% 20% 10% Source: McGinnis, Health Affairs, 2002 & CDC, Wennberg 3 2002 4 Chronic Diseases Chronic conditions affect 3X as many children now compared to 1960’s Asthma:160% increase in rate over past 15 years for children <5 yr Overweight: prevalence in children and youth (ages 6-19) has more than tripled over the last 35 years to over 15% Many chronic diseases previously associated with adulthood are quickly becoming childhood concerns – 60% of overweight children aged 5-10 already have a risk factor for heart disease such as high blood pressure or elevated insulin levels 5 6 1 Health Promotion: Opportunities to address chronic conditions Approaches to Children’s Health Of the $1.6 trillion spent on health care annually – 95% on direct medical care services – 5% on prevention/health promotion Behavior and environment account for over 70% of avoidable mortality Comprehensive health promotion involves: – The medical model – The lifestyle or behavioral approach – The social-environmental model SocioEnvironmental Model Lifestyle or behavioral approach Traditional Medical Model Expanded Approach Rigid adherence to biomedical view of health Incorporate a multifaceted view of health Focused primarily on acute episodic illness Chronic disease prevention and management Focus on individuals Focus on communities Cure as uncompromised goal Prevention as a primary goal Focus on disease Focus on health Medical Model 7 8 4 Promising Approaches 1. Debbie Chang – Nemours community-based health promotion to address overweight in children 2. Tricia Leddy– Rhode Island’s systematic approach to understanding the problem with data, developing innovative solutions and evaluating results (case studies from lead paint and CSHCN in child care) 3. Charlie Homer – A medical home/chronic care model and practice improvements through learning collaboratives 4. Peggy McManus– Promising approaches to improving the interface between primary and specialty care in pediatrics First Approach: Nemours Community-Based Health Promotion for Children 9 10 NHPS Background Nemours Overview 2003 Nemours redefined its approach: health as well as health care Operating Foundation that provides pediatric primary and specialty health care throughout DE, northern Florida, and also parts of southeastern PA, and southern NJ. Nemours Health and Prevention Services (NHPS) was created and focuses on child health promotion & disease prevention to address root causes of health problems At these various operating sites, Nemours cares for more than 225,000 children annually through 870,000 patient visits. Complements and expands the reach of clinicians with a broader, community-based perspective In DE, Nemours cares for almost 55,000 children (1/4 of the state’s population of 0-17 year olds). Traditional Medical Care 11 Nemours Communitybased health promotion 12 2 NHPS Philosophy Vision for Healthy Children requires a Cultural Shift Health promotion must extend beyond the clinical setting to the whole child in his/her family & community We are a catalyst, a change agent Long-term commitment; impact takes years to realize Cultivate an environment that supports both behavior change and systems change for child health promotion – Behavior change means children choosing healthier lifestyles – Systems change means the greater DE community supporting these choices Focus on broad health determinants; not medical care Build on community strengths; do not duplicate existing efforts nor supplant existing resources Collaborate with the community to leverage resources and maximize the reach and impact of our efforts Only this combination can result in lasting improvements in child health 13 14 The new social norm? Our First Focus Area: Childhood Obesity Prevention Why must we move beyond the primary care office? 15 Our children’s food environment 16 Drive-thru makes it easy 17 18 3 Our Aspiration Even in hospitals and museums! To see a cultural change in which people place a high value on health, wellness and prevention. Where: – Children choose fruit instead of fries – Child care providers offer nutritious snacks and physical activity – Families spend less time in front of a screen – Insurers pay for health promotion and prevention services 19 Our Plan 20 Targets and Outcomes NHPS catalyzes and supports changes in policy, programs and practices across the state Content Areas 1) Healthy Eating & Physical Activity Unique role includes 3 core components: – Coalition Building and Strategic Partnerships – Dissemination of Knowledge and Best Practices – Social Marketing 2) Emotional/ Behavioral Health 3) Community Capacity Target Sectors 1) Childcare 2) Primary Care 3) Schools 4) Community Outcomes Impact on Delaware Children and Communities Strategically chosen to impact the most children in the shortest time 21 Child Health Outcomes for 2015: Obesity Prevention 22 NHPS Mission To be a leading catalyst for improving children’s health in Delaware. To engage communities and work with partners to find, develop, implement, evaluate and promote successful strategies to help children and their families live healthier lives. Improved child health behaviors NHPS Vision Optimal health and development for all children Policy changes and additional environmental/system supports in place to promote healthy eating and physical activity Summary We work with families and communities to help children grow up healthy. Debbie I. Chang, MPH Senior Vice President and Executive Director Nemours Health and Prevention Services 252 Chapman Road, Christiana Bldg, Suite 200 Newark, DE 19702 dchang@nemours.org (302) 444-9100 (Office) (302) 444-9200 (Fax) Reduction in overall trajectory of overweight for children Specific measures will be tracked over time in each area 23 24 4 All the flowers of all the tomorrows are in the seeds of today. - Anonymous 5
