Board of Health

Skokie Board of Health November 11th, 2016 Present Dr. Sood Excused Absent Mr. Abbasi Ms. Jones Thorne Dr. Gaynes Mr. Nidetz Dr. Dave Ms. Urbanus Dr. Polin Dr. Williams Dr. Drachler Dr. Usman Dr. Shim Ms. Nickisch Duggan Ms. Varma Dr. Topouzian Mr. Pandya Dr. Vernon Dr. Prince Dr. Werner Dr. Catherine A. Counard, Director of Health Bruce A. Jones, Staff Guest, Dr. Iryna Karetska, UIS MPH student Guest, Dr. Edward McCarron – Family Services Commission 1. Call to Order: The meeting was called to order at 7:02 p.m. by Dr. Drachler, Chairman. 2. Approval of Minutes: The minutes of the previous meeting were approved. 3. Presentations David Clough, MPA: Public Health Analyst, Skokie Health Department Skokie Mortality Data and Aggregate Hospital admissions Data for Skokie Residents (copies attached) Mr. Clough gave a very comprehensive and detailed presentation on Mortality Data & Aggregate Hospital admissions Data for Skokie Residents. Below is a summary of highlights from these reports a. Skokie Mortality Data All Skokie Residents Top Causes of Death from 2010-2014: Cancer (All Cause except Lung) (~18%) Ischemic Heart Disease (~16%) Other Cardiovascular/Heart (~10%) Alzheimer’s/Dementia (~9%) Lung Cancer (~6%) Cerebrovascular Diseases (~5%) Summary Skokie is doing slightly better than the U.S. averages for mortality measures. Top causes of death starting at age 35 are related to lifestyle factors like diet, exercise, and smoking. Men are dying earlier than women and may have more opportunities for interventions. While there is insufficient data to do any analysis by race or country of origin we will assume that disparities in Suburban Cook County apply in Skokie. Deaths by Age and by Race: Skokie 2010-2014 Note that average age of death for Black and Latino residents skew lower and total percentage of deaths for white skews higher. However, this fits with age and race data, i.e. older Whites, somewhat older Asians, younger Blacks, and younger Latinos. Asians includes South Asians, South East Asians, and East Asians rolled into one category. Assume that disparities for Blacks and Latinos in Cook County and the U.S. also apply to Skokie #506093  Foreign Born by Region Total Population vs Deaths - data showed 37% of deaths and 42% of the population over the same time frame. Higher deaths track with age in Eastern and Western European populations Other Considerations – Marital status, education and occupation Dr. Drachler asked if we could take a look at mortality vs. marital status, education, and occupation. It was not possible to analyze occupations as it related to age of death there were more than 500 categories. Interestingly, people live equally long lives in Skokie regardless of educational level. Most adult Skokie residents (82%) who died during this period were either married or widowed. Because men died at a much earlier age than women, most adult men (61%) were married at the time of death. Most adult women (60%) were widowed at the time of death. People who were never married died on average 10 years earlier than people who were married at the time of death. b. Hospital Discharge Data 2010 - 2014 Mr. Clough stressed that these data are numbers not reasons. Of note, the hospital discharge data are for number of discharges only and do not represent individual patients. For example, it could be five people admitted once or one person admitted five times. We think that we will eventually need to meet with representatives from area hospitals to get a better idea of what the data means. Overall Mr. Clough mentioned that the reason we are looking at the hospital discharge data for Skokie residents is to identify opportunities for prevention or intervention. Therefore, because the top reason for admission in the hospital is childbirth, it was removed for the analysis. There were 30,572 inpatient admissions and 186,742 outpatient admissions, not including childbirth. The most common hospitals overall for inpatient and outpatient care are Skokie Hospital followed by Evanston Hospital. The most common inpatient hospital for children under 18 is Lurie Children’s Hospital of Chicago followed by Lutheran General, for outpatient it is Skokie Hospital. Dr. Counard added that 80% of the outpatient visits for children at Skokie Hospital are ER visits. As you would expect, after age 65 more people have inpatient admissions, while prior to age 65most admissions are for outpatient purposes. Visits to the emergency room, outpatient surgery and imaging (x-ray, MRI, etc.) are considered “outpatient visits”. Insurance status Insurance status by race shows that the White Skokie residents admitted to the hospital are much more likely to have Medicare or Commercial insurance, while the Black residents are more likely to have Medicaid or be Self - Pay. This demonstrates that Black residents of Skokie are not immune to the disparities they face in the rest of Cook County and the U.S. Top inpatient diagnosis The top inpatient diagnosis over this time period was for mental illness (2,054 psychiatric admissions), followed by heart failure and shock. Mr. Clough again emphasized that the data is not for individual patients, so there could be a handful of people being admitted over and over vs. many people being admitted. Mental Illness Mr. Clough discussed the breakdown of psychiatric admissions, including by age. Of note, 47% of inpatient admissions for residents age 14 to 17 were psychiatric admissions. Dr. Counard mentioned that it will take some further research to determine if this is unusual or what might need to be done. #506093  Outpatient “admissions”: Emergency Room Visits, Outpatient Surgery and Outpatient Procedures Mr. Clough continued with a discussion of outpatient admissions. Not surprisingly, the top outpatient imaging procedure is mammography and the top outpatient surgery is colonoscopy. Race and Insurance Status Skokie residents who were Black, had Medicaid or were Self-Pay (did not have insurance), were more likely to use the Emergency room than have outpatient surgery or imaging studies. The number of mammograms and colonoscopies seemed lower than expected, but again, as this is not data for specific patients but rather aggregate data (e.g. one woman may have had 4 mammograms, while three others had none), it is a suggestion for further exploration with area hospitals. The number of mammograms for Asians was lower than for other racial groups. And, not surprisingly, people who were on Medicaid or Self-Pay were much less likely to have either a mammogram or colonoscopy. Dr. Drachler and Dr. Counard added that this data is made more difficult to interpret because of conflicting recommendations within the medical community regarding the number, frequency and age of screening for both mammograms and colonoscopy. Mr. Clough ended his presentation and Dr. Counard reminded everyone that we will continue to reflect on and explore this data as we develop the 2017 Community Health Plan, focusing on areas where we can prevent illness or early death. Discussion: Dr. Drachler commented that the main causes of cancer death (lung cancer and colon rectal cancer) are still preventable (don’t smoke and get colon cancer screening). Also, we are getting better concerning breast cancer which is being diagnosed earlier. Dr. McCarron asked about the high number of septicemia diagnoses and wondered if they were related to surgical procedures? Mr. Clough thought that was a very good question but did not know if there is a way to tease that out of this data set. He would look into it. Dr. Drachler asked about the data on the young age group (14-17) for psychiatric admissions and if any outpatient data indicated a reach out for help prior to admission. Mr. Clough and Dr. Counard said no, but possibly the hospitals could answer this question. Dr. Werner asked if there had been a drop in Emergency Room (ER) visits under the Affordable Care Act (ACA). Dr. Counard replied that would be hard to assess from this data. We would need to also obtain data prior to ACA, and then determine if the ER visits could have been prevented by better access to care prior to ACA and after ACA was implemented. Certainly that would be an excellent point to bring to the discussion with area hospitals. Ms. Jones Thorne asked if we had any data from similar communities for a comparison. Mr. Clough explained that Skokie is unique to have community-level data, because we have our own health department. Other health departments report county-level data, so he is unable to compare Skokie to other surrounding communities. Dr. Werner asked about substance abuse or opioid addiction, because that is such a major issue in the nation but did not show up in Skokie’s data. Dr. Counard responded that was true, Skokie Battalion Chief Gabe Millard spoke at our IPLAN meeting and this is not an issue in Skokie. Drug overdoses have been very consistent over the years, with the exception of a spike during the worst of the economic downturn, when #506093 more people in their 20s and 30s were overdosing on illicit drugs in the Village. That has tapered off, so that over the past five years the number of people overdosing on opiates has declined to a few each year, perhaps once per month, primarily involving people who are trying to commit suicide using prescription drugs. Mr. Clough added that he had searched the hospital data for evidence of opioid overdoses and found none. 4. Chair’s Report: Dr. Drachler commented that he had run into Mayor Van Dusen who complimented the Board on all the marvelous work that has been done by Dr. Counard. 5. Director’s Report: October Monthly Report highlights – a copy is attached: New State restrictions for Vaccines for Children Program On October 1 the Illinois Department of Public Health began requiring that every child receiving vaccines through the VFC program must have their Medicaid status checked at every visit, to determine if their insurance is through the Illinois Comprehensive Health Insurance Plan (CHIP). If the child is insured through CHIP, they are not eligible to receive VFC vaccines. The process for verifying CHIP status is labor-intensive, and is requiring many hours of staff time to complete each day. During October, Department nurses vaccinated 40 children through the VFC program and were not able to vaccinate 23 others. Those children were referred to either Asian Human Services or Erie Family Health Center clinics for vaccination. State to adopt FDA Model Food Safety Code By July 2018, the Illinois Department of Public Health will begin implementing the 2013 FDA Model Food Safety Code. This is an important step to achieve one national standard for food safety. Health Department staff are working to understand the new code and ensure we are prepared to implement. Community flu shot clinics conclude The community flu shot program concluded successfully on October 31. This year we added a well- received second evening clinic responding to resident requests. Additionally, the Skokie Medical Reserve Corps (MRC) personnel volunteered to administer the shots, which was possible after the State approved liability protection for MRC members under the Good Samaritan Act last year. Each year the Department vaccinates 3,000 people against influenza. Discussion During the report a very enthusiastic conversation began concerning the VFC vaccine new requirements, how it has placed barriers on administering vaccines, how it affects how children will be vaccinated and how it impacts all Health Departments and health care providers in Illinois. Dr. Werner mentioned that the medical societies had sent a letter of concern to IDPH. Dr. Counard said she would send the Board all the documents that we have received from the State on this issue, as well as the letter from the medical societies. Dr. Vernon asked about the age groups served at our community flu shot clinics. Dr. Counard explained all age groups are served but the majority are adults over the age of 50 years. We do bill Medicare which covers all costs of the program except for staff time. Dr. Vernon asked Dr. Drachler for his support in his initiative to make flu vaccinations mandatory for all NorthShore University HealthSystem hospital staff as he is working on the policy now. All other hospital systems in our area require staff to have flu shots, but North Shore does not. As a result, North Shore flu shot compliance rates are below the national average. Dr. Drachler said he would support this effort. #506093 Dr. McCarron asked if while inspecting long term care facilities (LTCF) we could check to see if most staff are receiving flu vaccinations. Dr. Counard responded that she would need to follow up on this issue since we do not regulate LTCFs and this is not a State requirement. She believes that Health Dept nurses will have that information. Trustee Bromberg added that since LTCF are regulated by the State there would need to be a change in state law to mandate LTCF staff have an annual flu shot. 6. Old/New Business Dr. Drachler asked about the topic of changing stations and breast feeding locations. Dr. Counard will follow up with the Managers office staff person assigned to address this issue. Adjournment The meeting adjourned at 8:34 p.m. #506093