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Indiana Public Health

Indiana Public Health. Gregory N. Larkin, MD State Health Commissioner. The Mission Statement. The Indiana State Department of Health supports Indiana’s economic prosperity and quality of life by promoting, protecting and providing for the health of Hoosiers in their communities.

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Indiana Public Health

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  1. Indiana Public Health Gregory N. Larkin, MD State Health Commissioner

  2. The Mission Statement The Indiana State Department of Health supports Indiana’s economic prosperity and quality of life by promoting, protecting and providing for the health of Hoosiers in their communities

  3. The Health Impact Pyramid Increasing Population Impact Increasing Individual Effort Needed Counseling Education Clinical Interventions Long-lasting Protective interventions Changing context to make Healthy defaults Socioeconomic factors A Framework for Public Health Action

  4. A Picture of Indiana Public Health System • State public health funding/capita: 49/50 states • 60% of ISDH budget is grant dependent • 45 “Community Clinics” in under served areas • Home rule state – decentralized • Limited standardization • Equitable service delivery? • 92 counties with 93 LHDs • 2 city health departments (Gary, East Chicago) • 1 combined county health department (Fountain/Warren)

  5. The Environment • Indiana’s comparison state rank for key population health metrics is “unimpressive” • Smoking (slight improvement, but still bad) • Obesity (slight improvement but only because other states are getting worse) • Diabetes (nearly 10% of Hoosiers) • Perinatal morbidity and mortality

  6. Other Indiana Metrics

  7. Indiana Challenges Black Infant Mortality 2.3X White 32 states have a form of state- wide smoking bans

  8. Describing High YPLL Rate Areas 75% of Community Health Centers are located* in high YPLL area 39% of Indiana’s population resides in a high YPLL area 82% of Indiana’s Black population resides in a high YPLL area 57% of population in or near poverty resides in high YPLL area 16% of rural population resides in a high YPLL area – low percentage due to IDW ‘bulls eye’ effect • Potentially: Regression analysis or correlation with other variables

  9. Top Priorities, 2011 • Promotion of “Shared Services” of Local Health Departments • Integration and access to ISDH data repositories • Health Care Reform Act? • Strive for a change in the Hoosier culture of life style choices

  10. Shared Services What is it? LHDs share resources and obligations with other LHD within their State Preparedness District Barriers: Fear of loss of independence Fear of unfair resource sharing TRADITION

  11. Why work toward Shared Services? • Economy • LHD budget cuts • Expansion of services • Equitable delivery of the 10 Essential Public Health Services • Standardization • Funding/Grant opportunities • Accreditation

  12. 21st Century ISDH Data Center • Decades of hundreds of Grants • Creation of many individual grant related data silos • Dozens of different data capture/reporting software applications • Information technology rapidly expanding

  13. SharePoint Current ISDH Data Flows PHPER Portal ISDH Gateway • Challenges: • Multiple systems • Duplicated data collected • High maintenance costs • Limited data sharing ability INSTEP NBS SWIMSS TB LDF VPD STELLAR STD CHIRP HIV Lead IHIE/Regenstrief Hospitals Labs Local HDs Immunization PHESS / Essence CHIME LIMS Net ERC EBC ISDH Lab IHAN INEDRS Vital Records INEDSS ISDH Repository PHPER Immunizations Vital Records

  14. Indiana HIO Connectivity IHIE and HealthBridge are the First and Only HIOs connected In the Nation

  15. Health Care Reform Act/ISDH? • HCRA’s Two Key Public Health Components • Massive expansion of eligible residents for primary care services • Primary Care Provider Infrastructure? • Expansion of “Federally Qualified Health Centers” • Impact on current ISDH services?

  16. Access to Health Care • Indiana ranks 39th among the 50 states, with only 213 physicians per 100,000 residents • Access to physicians is unequally distributed across Indiana • Purdue Center for Regional Development analyzed access for each county using: • demand for the care facility at location • service capacity at provider location • distance between population point and provider location • total numbers of healthcare facilities location • total number of population locations • population size at certain points

  17. Access to Health Care

  18. Access to Health Care

  19. Access to Physician Care 2007 Darker shading indicates better access

  20. Better Choices? • Tobacco Usage- Three levers that work • Exercise- More opportunities • Obesity fighting grants • Healthier babies • Immunizations • INShape.com

  21. Indiana Trauma Care System • Executive Order- Trauma Care Task Force • Issues: • Indiana does not have an adequate Trauma Care network • Key elements: • Minimum initial trauma care training • Transportation protocols • Trauma centers presence and certification • Performance improvement processes

  22. Thank You

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