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How to take local action to improve health at the local level is outlined at Frankfort conference

By Tara Kaprowy
Kentucky Health News

A recipe for how to improve health at the local level in Kentucky was the capstone of a day-long seminar in Frankfort Monday, with experts stressing that partnerships are key and funding will remain tight.

Communities must mobilize, prioritize, "effectivize" their actions, publicize and evaluate, measure and report performance, Trudi Matthews, director of policy and public relations at HealthBridge, summed up at the end of the Kentucky Health Quality Collaborative Conference.

The gathering was hosted by Kentucky Voices for Health in partnership with the Friedell Committee for Health System Transformation. "No single actor or set of stakeholders can solve what's wrong," Matthews said. "We really need to think across silos. We really have to collaborate."

When it comes to funding, governments "have made it very clear they will not increase the number of dollars that will be put into health care," said keynote speaker Dr. Robert Graham, national program director for Aligning Forces for Quality. "We're in a perfect storm," agreed Sue Thomas-Cox, branch manager for chronic disease prevention at the Kentucky Department for Public Health. "Federal, state and local governments don't have enough money . . . so we must work together."

Luckily, health care happens at the local level, Graham said, with hospitals and clinics unique to communities, health insurance agents locally based and consumers grounded in their communities. While there is "no particular model for how to get (change) started," Graham said, the first step is getting all stakeholders — purchasers, insurance agents, providers, consumers, faith-based organizations — around the same table. "You've got to make sure there is a balance of interests," he said. 

Also key are local boards of health and health departments, whose members and staff are charged with safeguarding the health of the people of a county, under state law, and have the advantage of being "relatively untainted by the illness-for-dollars disease," pointed out Dr. Forrest Calico, a rural health consultant and longtime worker in the field.

Health departments must ensure they don't spread themselves too thin, said Dr. Steve Davis, acting commissioner for the Department for Public Health. "One of the biggest reasons why we have not moved the health needle in Kentucky is we need to be an inch wide and a mile deep," he said. Communities need to "come up with five or six things and let's hammer, hammer, hammer it," he said. Of those priorities, Davis pointed out the importance of tackling chronic disease: "That's what's killing our brethren and eating our financial lunch." For adults, he would like to see an increase in breast, cervical, colon and lung cancer screening, as well an increase in immunization rates especially for flu and pneumonia.

For children, Davis has six priorities: reduce preterm and low-birthrate babies; improve injury-prevention programs; decrease tobacco use; reduce obesity; increase immunization rates; and improve oral health.

To get more accomplished, health departments need to team up with local organizations to avoid duplication of services, which Davis said accounts for $300 billion in unnecessary spending nationwide. He added the goal is to make "1 plus 1 equal 3," with health departments needing to adopt a "do or assure" philosophy.

But there are challenges in health departments, with some local health board members failing to "roll up their sleeves," Davis said. "You can go in with nothing in your head and leave with nothing in your head," agreed Henry Bertram, chair of the Pendleton County and Three Rivers District Board of Health.

A survey of health departments showed just 46 percent of local boards of health have a vision for the next three years to improve the health status of their community and just 44 percent say they are tracking compliance for the 10 essential services they are charged with providing. And the real numbers might be worse, because the survey was voluntary.

While about half of the state's health departments are committed to working toward achieving national accreditation, only three departments — Franklin, Northern Kentucky and Three Rivers District — have actually applied for it. 

Also crucial for communities is using data to identify priorities, take action and measure performance, whether using county-specific numbers at www.kentuckyhealthfacts.org or using national data.

"We don't want to get stuck in analysis paralysis," but communities can use the data as "a story you can use as leverage," said Jan O'Neill, community engagement specialist for County Health Rankings & Roadmaps. The County Health Rankings evaluate the morbidity and mortality rates for nearly every county in the country and rank them within a state.  The rankings can act as a motivator for counties interested in effecting health changes, but "We have to be aware of their limitations" given their margins of error, especially for small counties, pointed out Al Cross, director of the Institute for Rural Journalism and Community Issues. 

O'Neill spoke of San Bernadino County in California, which used its low ranking to spur change. The county focused on its built environment, pressing hard for Walk or Wheel to School programs, community gardens and a kids community health center. O'Neill pointed out the changes are about more than infrastructure. "It's the relationships," she said. "It's the human capital ... It's many not all doing it all, but bringing what you do best. That's what mobilizing looks like."

Jodi Mitchell, executive director for Kentucky Voices for Health, said she is "starting to see a tide of change" already in Kentucky. What's important is to keep momentum building and, equally vital, ensure people are willing to participate. "If you're not at the table," she said, "you're on the menu."

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

531 deficiencies found in 80 Kentucky nursing homes in first quarter of 2012; worst one had 29; five had none

State inspectors found 531 deficiencies in 80 Kentucky nursing homes in the first quarter of this year, with one facility accounting for 29 of them alone: Life Care Center of Morehead. In five nursing homes, no deficiencies were found.

The information was released by Kentuckians for Nursing Home Reform, a nonprofit organization that advocates for nursing home residents and obtains the data regularly through open-records requests to the Cabinet for Health and Family Services and distributes it statewide. The information is posted as part of Medicare's nursing-home comparison data.

According to the Centers for Medicare and Medicaid Services, the average number of deficiencies for a nursing home inspected in the U.S. is eight and the average in Kentucky is seven. Inspections assess a facility on the care of residents and how that care is administered; on how staff and residents interact; and on its environment. Certified nursing homes must meet more than 180 regulatory standards. The state Office of Inspector General website has more data, such as the results of inspections and the ownership of each facility.

Nursing homes with 10 or more deficiencies in the first quarter were:
• Life Care Center of Morehead (29 deficiencies)
• Kindred Transitional Care & Rehab-Fountain Circle in Winchester (24)
• Signature Health of Pikeville (19)
• Hearthstone Place in Elkton (15)
• Martin County Health Care Facility in Inez (14)
• Wesley Manor Nursing Center in Louisville (13)
• Pembroke Nursing & Rehabilitation Center in Pembroke (13)
• Highlands Nursing & Rehabilitation Center in Louisville (11)
• Mountain Manor of Paintsville (11)
• Cumberland Valley Manor in Burkesville (10)
• Klondike Care and Rehabilitation Center in Louisville (10)

The five nursing homes with no deficiencies were:
• Clark Regional Medical Center in Winchester
• Nazareth Home in Louisville
• Essex Nursing and Rehabilitation Center in Louisville
• Barren County Health Care Center in Glasgow
• Cardinal Hill Rehabilitation Center in Lexington (initial inspection; under new ownership)

For more information about Kentuckians for Nursing Home Reform, click here.

Newspaper reporting contest for rural health coverage; deadline June 24

Journalists who have reported about rural health in the past year should start sifting through their clippings. The Kentucky Rural Health Association is awarding four writers $100 each for their efforts.

Entries will be judged on their relevance to rural health; the quality of the reporting; impact on health-care policy; and new insights that might have been generated by the reporting.

The contest features two divisions, daily and non-daily, with two categories in each division: series and single story. The contest period ranges from July 1, 2011 to June 15, 2012. Entries must be received by June 24. Winners will be announced during KRHA's annual conference in Aug. 16-17 in Bowling Green.

Entries can be submitted to David A. Gross, 222 Medical Circle, Morehead KY 40351. For more information, contract Gross at 606-783-6468 or e-mail at dagross@st-claire.org. (Read more)

Tobacco virus may be used to combat Parkinson's disease

A tobacco crop affected by drought. Courier-Journal photo
by David R. Lutman.

University of Louisville researchers say a virus that attacks tobacco plants may be used to develop a vaccine for Parkinson's disease.

The answer lies with the tobacco mosaic virus, which causes antibodies that "may be protective against Parkinson's," said Dr. Robert Friedland, a clinical and research neurologist at U of L.

Friedland's findings come after more than 60 studies have shown that smokers seem to have a reduced risk for developing Parkinson's, a motor system disorder that can cause tremors, stiffness and impaired balance. 

But Friedland and Dr. Honglei Chen, an investigator with the National Institute of Environmental Health Sciences, part of the National Institutes of Health, warn the findings should not be considered an excuse to smoke. Friedland's research is partly funded by the NIH, but not by any tobacco companies, reports Laura Ungar for The Courier-Journal. (Read more)