ype 2 diabetes was once considered a disease that only adults had diabetes is “mirroring the obesity epidemic,” notes Dr. Francine Diabetes …
The Pennsylvania Diabetes Action Plan 2007
Secretary of Health
May 2007 Dear Pennsylvanians: It is my pleasure to share with you Pennsylvanias first-ever Diabetes Action Plan
A MESSAGE FROM THE
The Pennsylvania Diabetes Action Plan 2007 is intended to be used as a blueprint by all who share the vision of coordinating efforts to improve diabetes prevention and control in the Commonwealth of Pennsylvania The goals and recommended actions in the Plan complement the Departments overall mission to promote healthy lifestyles, prevent injury and disease, and assure the safe delivery of quality healthcare services for all Commonwealth citizens Through cooperation and collaboration across the broad spectrum of community organizations and individuals, we can positively impact the lives of many people throughout the state I would like to thank those who served on the Diabetes Stakeholder Group and have contributed their time and talents to identify the components and goals identified in the Plan Their expertise and dedication are appreciated I encourage all Pennsylvanians to share the vision and enthusiasm and to work to implement the Diabetes Action Plan Together, we can make a
difference
Sincerely,
Calvin B Johnson, MD, MP H
The Pennsylvania Diabetes Action Plan
1
2
Contents
FROM THE SECRETARY 1 EXECUTIVE SUMMARY 5 SCOPE OF THE PROBLEM OF DIABETES 7 What is Diabetes? 7 What are the Risk Factors? 8 Disease Burden 8 ABOUT THE ACTION PLAN 15 The Purpose of the Diabetes Action Plan 15 The Framework for the Diabetes Action Plan 15 How was the Action Plan Created? 17 How will the Action Plan be Implemented? 17 THE GOALS OF THE PENNSYLVANIA DIABETES ACTION PLAN 20 Surveillance Component 21 Standards of Care Component 22 Health Policy Component 23 Evaluation Component 24 THE PROCESS OF EVALUATING THE PENNSYLVANIA DIABETES ACTION PLAN 27 CONCLUSION
28 Appendix A Diabetes Stakeholder Group Executive Steering Committee and Work Group Co-Chairs 29 Appendix B Diabetes Stakeholder Group Contributing Organizations 30 Appendix C Pennsylvania Diabetes Prevention and Control Program 32 Appendix D References 33 Appendix E Diabetes Resources 34 Appendix F Healthy People 2010 Cross Cutting Issues 35
TABLE OF
The Pennsylvania Diabetes Action Plan
3
4
Summary
T
he Pennsylvania Diabetes Action Plan represents the combined effort of more than 200 stakeholders, including federal, state, and local governmental agencies, voluntary health organizations, academic institutions, health systems, professional associations, foundations, consumers, corporations, and communities with an interest in diabetes prevention and control They have worked as partners through the Diabetes Stakeholder Group to create a common vision, the Diabetes Action Plan, which can be a catalyst for change The Plan provides the blueprint for how efforts, resources and interests can be combined to strengthen the collective capacity in Pennsylvania
to ultimately prevent diabetes whenever possible and to assist individuals with diabetes to live their best and healthiest lives To determine where the combined efforts of the stakeholders should be focused, the Department of Healths Diabetes Prevention and Control Program DPCP, in collaboration with the Diabetes Stakeholders Group, conducted a statewide diabetes public health system assessment and found four major areas in need of strengthening Those four areas became the four components of the Plan in which efforts and activities will be focused: Surveillance-to establish a solid base of knowledge about the populations at risk and to collect and to monitor data for diabetes trends in order to focus the use of diabetes resources and efforts Standards of Care-to identify and disseminate diabetes standards of care and increase awareness of the importance of early diagnosis, good management, and effective prevention strategies to ensure that all people with diabetes receive the same level of excellent care Health Policy-to work toward change and utilize Pennsylvania laws, regulations, standards, enforcement, authority, and funding in ways that improve diabetes care and decrease
health disparities Evaluation-to investigate and measure the impact of diabetes prevention and control activities and services to enable decision makers to identify effective programs With the intention to make sweeping changes in the way people think
EXECUTIVE
about and act in response to diabetes, the stakeholders identified six overarching themes that are embedded throughout the Plan and are fundamental to a public health approach to diabetes: Focus on prevention: take every opportunity to make the public and policy makers aware of the power of lifestyle changes to prevent diabetes–and to prevent complications in people who already have diabetes Eliminate health disparities: improve access to and availability of education and medical care to meet the needs of those disproportionately burdened by diabetes due to differences in gender, race or ethnicity, education or income, disability, geographic location or sexual orientation Ensure access to medical care: ensure all Pennsylvanians have access to quality diabetes care and treatment Use evidence-based research and best practices: use research to design prevention and treatment programs that incorporate best practices and
lead to more positive outcomes and sharing success stories Employ technology: use the internet and other technology to dispense and gather information; survey populations; share
The Pennsylvania Diabetes Action Plan
5
success stories; and provide guidance to patients, providers, and payers Coordinate efforts and create partnerships: share resources and responsibility to reduce the burden of diabetes on the people of Pennsylvania and establish metrics for tracking costs, performance measures, processes, and outcomes The Pennsylvania Diabetes Action Partnership PDAP, a newly formed structure that is replacing the Diabetes Stakeholder Group, is a diverse, multi-disciplinary partnership of agencies, organizations and individuals representative of the burden of diabetes in Pennsylvania, demographically and geographically The Plan contains a comprehensive list of goals and recommended action steps that are intended to guide the activities of the interacting entities In the months that follow the release of the Plan, the PDAP will meet to pri-
oritize Goals Once the Goals are prioritized, the PDAP will continue refining the Action Steps within each goal, completing the final details
needed to move into the implementation phase The PDAP will work in collaboration with and provide recommendations to the DPCP concerning the continued
development and implementation of the Plan and will facilitate statewide networking and resource sharing opportunities A visual representation of the composition of the PDAP appears in Figure 1-6
6
Problem of Diabetes
WHAT IS DIABETES?
SCOPE OF THE
D
iabetes is a lifelong disease that occurs when a persons pancreas does not produce or stops producing insulin or is not producing enough insulin and/or the body cannot use it Insulin is needed to use the energy from food The body makes glucose from food that is eaten The glucose goes into the bloodstream and circulates around the body Insulin helps glucose enter the cells where it is used for energy, growth and repair When people have diabetes, glucose cannot get into the cells It builds up in the bloodstream until it reaches high levels, which are damaging to the body High blood glucose levels can be returned to normal with such treatments as meal planning, medication, and regular physical activity However, managing blood glucose levels requires daily, and sometimes hourly,
attention to the many things that can affect blood glucose, such as food, exercise, stress, illness, and hormone levels
There is no way to achieve perfect diabetes control, but awareness of the factors that influence glucose levels gives patients the ability to make adjustments and move on Research has shown that daily efforts to maintain nearly normal blood glucose pay great dividends in preventing long-term complications1 Although the causes of diabetes are not certain, genetics family history and lifestyle factors, such as obesity and lack of physical activity, are related to its development2 Diabetes is a chronic disease, but people with diabetes can live long and healthy lives The overarching goal of this Plan is to make this a reality for all people with diabetes There are several types of diabetes:
Type 1 is usually diagnosed in
children and young adults and results from the bodys failure to produce insulin This type accounts for five to ten percent of all diagnosed cases of diabetes1 Type 2 is the most common form of diabetes and can be diagnosed at any age It is most commonly seen in adults This type results when the body does
not produce enough insulin or the body
cannot use the insulin it produces Type 2 diabetes accounts for about 90 to 95 percent of all diagnosed cases of diabetes, or more than 18 million people in the United States1 Gestational diabetes appears during pregnancy in some women This form of diabetes usually disappears after the baby is born However, women who have had gestational diabetes have a higher risk 20 to 50 percent of developing diabetes in the next five to ten years1 Pre-diabetes is a condition that often precedes the development of type 2 diabetes In pre-diabetes, a persons blood glucose levels are higher than normal but not high enough to be considered diabetic Pre-diabetes does not always lead to the development of diabetes, because controlling weight and increasing physical activity can prevent or delay the onset of diabetes There are 41 million Americans who have pre-diabetes1
The Pennsylvania Diabetes Action Plan
7
WHAT ARE THE RISK FACTORS?
ccording to the National Diabetes Clearinghouse, people are at risk for diabetes if they have any of the following:3 Overweight BMI of 25 or more A waist measurement over 35 inches for women and 40 inches for men Over 45 years of age people over 65 have even
higher risks Inactive lifestyle little or no exercise each day Had a baby weighing more than 9 pounds at birth Had gestational diabetes during pregnancy Brother, sister, or parent with diabetes
High blood pressure 140/90
mg/dl or higher High cholesterol HDL [good] cholesterol is 35 or lower; triglyceride level is 250 or higher Member of a high-risk ethnic group African American, Hispanic/Latino, American Indian, Asian American, Pacific Islander
A
DISEASE BURDEN
grant from the Centers for Disease Control and Prevention CDC in all states, US territories, and the District of Columbia The BRFSS includes a Diabetes Module, which is the main source of information about the estimated prevalence, care, and control of diabetes in Pennsylvania4 This data assists the Department in tracking the progression of diabetes, planning for interventions, and targeting highrisk populations In 2005, the most recent year data is available, an estimated 764,000 adults 18 or eight percent of adults in the Commonwealth reported that they had ever been told that they had diabetes4 Pennsylvanias burden was higher than the 2005 national average of seven percent,1 and ranked sixteenth in the nation
for the percent of adults who had ever been told by a doctor that they had diabetes5 For a more comprehensive look at the burden of diabetes in Pennsylvania, please refer to The Burden of Diabetes in Pennsylvania 2007 report available on the Pennsylvania Department of Health Diabetes Prevention and Control Programs website at wwwhealthstatepaus/diabetes or check out the Pennsylvania Department of Healths EpiQMS system online at wwwhealthstatepaus/statistics The following table and graphs display the burden of diabetes in Pennsylvania Although the prevalence of diabetes is found in all racial, ethnic, socio economic
T
he Pennsylvania Department of Health Department conducts an annual telephone survey random sample of adults regarding various health risk behaviors The Behavioral Risk Factor Surveillance System BRFSS is implemented through a
8
groups and in both genders in Pennsylvania, some groups are disproportionately burdened by diabetes In this report, health disparities refers to differences in health status, the delivery of health services, or the use of health services that occur by gender, race and ethnicity, education and income, disability, and geographic
location6
Table 1 Estimated Diabetes Prevalence by Demographic, Pennsylvania Adults, 2003-2005
Demographic
Total Gender Male Female Age 18-44 45-64 65 Education High School High School Some College College Degree Income 15,000 14,000 to 24,999 25,000 to 49,999 50,000 to 74,999 75,000 Race/Ethnicity White, non-Hispanic Black, non-Hispanic Hispanic
Source: Pennsylvania BRFSS4
Percent
78
Confidence Interval
73-83
81 75
74-89 70-81
21 101 178
17-25 91-111 165-191
136 93 70 46
118-157 85-102 62-80 40-54
148 116 77 51 36
127-172 104-130 68-86 42-62 29-45
76 106 89
71-81 85-130 57-137
The Pennsylvania Diabetes Action Plan
9
AGE
Figure 1-1 Estimated Diabetes Prevalence by Age, Pennsylvania Adults, 2003-2005
250
For the 2003-2005 period, the rate of diabetes increases dramatically with age and becomes significantly higher for older adult groups 45 compared to their younger counterparts Those in the 65 age range were disparately affected and had the highest diabetes prevalence of all the age groups
200 Percent 150 100 50 00 Percent
Total 78 18-44 21 45-64 101 65 178
Age Group
Source: Pennsylvania BRFSS4 Note: symbol marks lower and upper 95 confidence interval
CI
GENDER
Figure 1-2 Estimated Diabetes Prevalence by Gender, Pennsylvania Adults, 2003-2005
100 90 80 70 60 50 40 30 20 10 00 Percent
There are no significant gender differences in diabetes prevalence rates
Percent
Total 78
Male 81
Female 75
Gender
Source: Pennsylvania BRFSS4 Note: symbol marks lower and upper 95 confidence interval CI
10
RACE/ETHNICITY
In 2003-2005, Black, non-Hispanic Pennsylvania adults had significantly higher diabetes prevalence compared to White, non-Hispanic Pennsylvania adults No other significant racial/ethnic disparities exist in diabetes prevalence for the 2003-2005 period In 2001-2003, Black, non-Hispanic Pennsylvania adults had significantly higher diabetes prevalence 122, CI 99148 compared to White, non-Hispanic 70, CI 66-75 and Hispanic 51, CI 30-85 Pennsylvania adults Figure 1-3 Estimated Diabetes Prevalence by Race/Ethnicity, Pennsylvania Adults, 2003-2005
160 140 120 Percent 100 80 60 40 20 00
Note: In general, Pennsylvania BRFSS sample sizes are too small to provide reliable data for some racial/ethnic groups in the state eg, Asians, Native Americans, and Pacific Islanders However sample sizes are usually large enough to provide
reliable data for the three largest racial/ethnic groups in Pennsylvania: non-Hispanic Whites, non-Hispanic African Americans, and Hispanics
Total 78
Percent
White, non- Black, nonHispanic Hispanic 106 76
Hispanic 89
Race Ethnicity
Source: Pennsylvania BRFSS4 Note: symbol marks lower and upper 95 confidence interval CI
The Pennsylvania Diabetes Action Plan
11
SOCIOECONOMIC STATUS
Education Estimated diabetes prevalence decreases with increases in education level In 2003-2005, each education level had a significantly lower diabetes prevalence compared to each lesser education level Income
Education Income
the 75,000 income group In 2002-2004, estimated diabetes prevalence for the 15,00024,999 in the 25,000-49,999 income ranges were significantly higher than the 50,000 income group
two time periods, diabetes prevalence for the 15,00024,999 income range was significantly higher than all income groups 25,000 Also, in 2001-2003, the diabetes prevalence for 25,000-49,999 and 50,000-74,999 income ranges were significantly higher than
In 2003-2005, Pennsylvania
adults with annual income levels 25,000 had significantly higher diabetes prevalence compared to all other income
groups The diabetes prevalence for the 25,000-49,999 income range was significantly higher than the 50,000 income group
Figure 1-4 Estimated Diabetes Prevalence by Education, Pennsylvania Adults, 2003-2005
180 160 140 120 Percent 100 80 60 40 20 00 Percent
Total 78 High School High School 93 Some College 70 College Degree 36
The trend of decreasing diabetes
prevalence with increasing income has remained fairly consistent over time In 2001-2003 and 2002-2004, Pennsylvania adults with annual income levels 15,000 had significantly higher diabetes prevalence compared to all other income groups In addition, during these
136
Education
Source: Pennsylvania BRFSS4 Note: symbol marks lower and upper 95 confidence interval CI
12
Table 2 Estimated Diabetes Prevalence by Income, Pennsylvania Adults, 2001-2003, 2002-2004, and 2003-2005
Income 15,000 15,000 to 24,999 25,000 to 49,999 50,000 to 74,999 75,000
2001-2003 Percent CI 160 137-185 98 86-112 61 54-70 56 46-69 29 21-38
2002-2004 Percent CI 149 130-170 113 101-126 72 65-81 49 41-59 35 29-44
2003-2005 Percent CI 148 127-172 116 104-130 77 68-86 51 42-62 36 29-45
Figure 1-5 Estimated Diabetes Prevalence by Income, Pennsylvania
Adults, 2003-2005
200 180 160 140 120 Percent 100 80 60 40 20 00 Percent
Total 78 15,000 15,000 to 25,000 to 50,000 to 75,000 49,999 74,999 24,999 46 51 77 116 148
Income
Source: Pennsylvania BRFSS4 Note: symbol marks lower and upper 95 confidence interval CI
The Pennsylvania Diabetes Action Plan
13
HOSPITALIZATIONS AND ECONOMIC IMPACT
Adding to the burden of diabetes are the complications often experienced by individuals as a result of the disease The complications of diabetes can be disabling and life threatening Diabetes is a primary cause of blindness, heart disease and stroke, and lower-extremity amputations Many people who have Type 2 diabetes do not realize they have the disease until they see a health care professional for one of its complications Earlier diagnosis and proper treatment could have prevented or postponed the development of complications1 In Pennsylvania, the Pennsylvania Health Care Cost Containment Council PHC4 is the independent agency responsible for addressing the problem of escalating health care costs and ensuring the quality of health care and increasing access for all citizens, regardless of ability to pay Of primary interest to the diabetes
community is the production of the Diabetes Hospitalization Report by PHC4 Excerpts from the report are presented below The full report can be found at wwwphc4org7
In 2004 alone, the hospitalizations where diabetes was the principal diagnosis accounted for over 131,800 hospital days and incurred over 673 million in hospital charges
tions for end-stage renal disease
Medicare was the primary payor
for 49 percent of the hospitalizations for diabetes as a principal diagnosis Private insurers had the next highest percentage at 253 percent
While the number and rate of
hospitalizations for type 1 diabetes have decreased from 2000 to 2004, the number and rate of hospitalizations for type 2 diabetes have increased steadily during this period
Multiple hospitalizations for diabetes are common and costly Some 154 percent of patients with diabetes were hospitalized two or more times in 2004 Certain populations, including Medicaid and Medicare recipients were more likely to have recurrent hospitalizations The data makes clear the serious challenges that diabetes poses for the Pennsylvania health care systems–not to mention the damage done to individuals and their quality of life
Between 2000 and 2004, hospitalization rates for diabetes increased with age The most pronounced increase was in the 20 to 39 age group where admission rates jumped 260 percent
The number of hospitalizations
where diabetes was the principal diagnosis rose by almost 86 percent between 2000 and 2004growing from 21,842 to 23,725 hospitalizations
African Americans continued to
have the highest rates of hospitalization for diabetes, as well as the highest rates of lower extremity amputations and hospitaliza-
14
Action Plan
THE PURPOSE OF THE PLAN
ABOUT THE
T T
he Pennsylvania Diabetes Action Plan provides a blueprint for focusing statewide efforts in a collaborative way As a result of the efforts, Pennsylvanias
ability to address the prevention of diabetes and diabetes related issues will be strengthened The ultimate success of the Plan will be the prevention of diabetes and the reduction of its impact
Healthy People 2010 Health Status Objectives for the Nation guides public health initiatives The objectives have 28 focus areas containing 15 diabetes-related indicators6 The Pennsylvania Department of Health monitors seven of those indicators and uses the data to guide
decision making The Diabetes Action Plan seeks to meet Healthy People 2010 Goals for diabetes and other chronic diseases
Another influence is the CDCs Division of Diabetes Translation DDT This is the federal agency responsible for guiding diabetes prevention-and-control activities and for achieving the diabetes related Healthy People 2010 objectives The Division supports public health diabetes prevention-andcontrol programs and translates diabetes research findings into widespread clinical and public health practice The Action Plan has the support from the DDT through the efforts of the state level Diabetes Prevention and Control Program to create change throughout the systems that interact with those individuals who have diabetes
THE FRAMEWORK OF THE PLAN
he framework in the Diabetes Action Plan, like other Pennsylvania Department of Health chronic disease plans Cardiovascular Health, Obesity, Arthritis, and Osteoporosis, is grounded in the perspective of Pennsylvanias State Health Improvement Plan-SHIP 2006-20108 A model for health planning in Pennsylvania, SHIP 2006-2010, raises a broad awareness of public health issues and stimulates increased involvement of all sectors in the
community health care providers, businesses, community-based organizations, educational institutions, faith-based organizations, all levels of government, and families It is a step toward a common agenda for health The State Health Improvement Plans goals are:
To empower communities to
identify, plan for and address local health needs;
To link community-based health
plans with the allocation of Commonwealth resources to the degree possible;
To establish partnerships among
local government, state, and local partners that are committed to sharing the risk, responsibility, and resources needed to coordinate health improvement along the spectrum of prevention, acute care, and long-term care; and
To shift the mode of community
health planning from a prescriptive model to a shared responsibility model
The Pennsylvania Diabetes Action Plan
15
As displayed in Table 3, Pennsylvanias progress toward reaching seven of the national Healthy People 2010 diabetes indicators has been positive in some areas and has room for growth in other areas Additionally, Healthy People 2010 Diabetes Crosscutting Indicators and Pennsylvania Profiles indicators related to diabetes risk factors and
complications are listed in Appendix E of this document
Table 3 Key Diabetes Healthy People 2010 Indicators in Pennsylvania6 INDICATOR
1 Objective 05-01 Increase the proportion of persons with diabetes who receive formal diabetes education 2 Objective 05-03 Reduce the overall rate of diabetes that is clinically diagnosed 3 Objective 05-05 Reduce the diabetes death rate 4 Objective 05-12 Increase the proportion of adults with diabetes who have an A1C measurement at least once a year 5 Objective 05-13 Increase the proportion of adults with diabetes who have annual dilated eye examination 6 Objective 05-14 Increase the proportion of adults with diabetes who have at least an annual foot examination 7 Objective 05-17 Increase the proportion of adults with diabetes who perform blood glucose monitoring 60 507a
NATIONAL HP 2010 GOAL
PA PROFILE 2005 unless noted
25 cases per 1,000 population 45 deaths per 100,000 population
746b
807c
50
914a
75
776a
75
776a
60
627a
a BRFSS estimates age-adjusted to 2000 std population and including 95 confidence interval b BRFSS age-adjusted rate per 1000 ages 18 and including 95 confidence interval c 2004 rate age-adjusted to 2000 std
population for deaths as underlying or contributing cause
Data Source: Bureau of Health Statistics and Research, Pennsylvania Department of Health
16
HOW WAS THE ACTION PLAN CREATED?
n 2004, the Pennsylvania Department of Healths Diabetes Prevention and Control Program DPCP in collaboration with the members of the Diabetes Stakeholder Group DSG conducted a statewide diabetes public health system assessment The statewide diabetes public health system in Pennsylvania is a network of individuals and organizations that share the responsibility to guarantee quality diabetes care and prevention in Pennsylvania The assessment conducted was based on CDCs ten recommended Essential Public Health Services The Essential Public Health Services provide a
I
working definition of public health and a guiding framework for the responsibilities of local public health systems Among the ten services are monitoring the health status to identify and solve community health problems; diagnosing and investigating health problems and health hazards in the community; and informing, educating and empowering people about health issues More information about the Essential Public Health Services can be found
at http://wwwcdcgov/od/ocphp/nphpsp/EssentialPHServiceshtm The results of the survey were used to guide the group in the first steps of developing the Action Plan
The group was convened again in November 2005 for the first Diabetes Summit facilitated by the Department and hosted by the University of Pittsburgh The group brainstormed goals and activities to be incorporated into a Diabetes Action Plan and created four functioning work groups: Surveillance, Evaluation, Standards of Care, and Health Policy Throughout the next year, stakeholders worked on components, goals, and activities via phone, e-mail, and face-to-face meetings The draft Plan was presented at the October 2006 Diabetes Stakeholder Group meeting Work Groups assigned to each of the four components continue to work on implementing strategies in the Plan
HOW WILL THE ACTION PLAN BE IMPLEMENTED?
lthough this Plan has been created to be used and implemented by all the organizations and individuals in Pennsylvania that have an interest in diabetes related issues, the three major forces that will implement it are the Pennsylvania Diabetes Action Partnership PDAP, the Pennsylvania Department of Health Diabetes Prevention
and Control Program DPCP, and Action Plan Champions, all described as follows
A
Pennsylvania Diabetes Action
Partnership PDAP The Pennsylvania Diabetes Action Partnership PDAP, a newly formed structure replacing the Diabetes Stakeholder Group, is a diverse, multi-disciplinary partnership of agencies, organizations and individuals in the Commonwealth interested in addressing diabetes in a coordinated approach based upon the Pennsylvania Diabetes Action Plan Anyone or any organization is wel-
come and encouraged to participate with key partners being recruited for membership The composition of the PDAP will be representative of the burden of diabetes in Pennsylvania, demographically and geographically In addition to working towards the completion of the goals of the Action Plan, the PDAP will facilitate state-wide networking and resource sharing The group will be organized to provide guidance and recommendations to the Department concerning the implementation
The Pennsylvania Diabetes Action Plan
17
and continued development of the Pennsylvania Diabetes Action Plan See Figure 1-6
Pennsylvania Department of
Health Diabetes Prevention and Control Program DPCP The program
strives to reduce the burden of diabetes in Pennsylvania and improve the quality of life of those Pennsylvanians having diabetes by preventing and controlling its complications Staff from the program, both in regional and statewide roles, will coordinate events that support the completion of the goals of the Plan The DPCP will also support the efforts of surveillance, data collection, and analysis
The Plan contains a comprehensive list of goals and recommended action steps that are intended to guide the activities of the interacting entities In the months that follow the release of the Plan, the PDAP will meet to prioritize the Goals of the Action Plan Once the
Goals are prioritized, the PDAP will continue refining the Action Steps within each goal, completing the final details needed to move into the implementation phase ie key roles, responsibilities, and evaluation plans
Action Plan Champions
It is understood that there will be individuals, organizations and entities which do not wish to be a part of the formal Diabetes Action Partnership, but will be contributing factors to the success of the Action Plan The creation of the category of Plan Champions will provide an
opportunity for those individuals, organizations and entities to work towards the completion of the goals of the plan by sharing intervention strategies and results that are in line with the Plan
18
Figure 1 
-6 The Pennsylvania Diabetes Action Partnership
PDAP Core Team
PDAP Executive Leadership Team Pennsylvania Diabetes Action Partnership PDAP Members Surveillance Work Groups Standards of Care Evaluation
PDAP Evaluation Team
Health Policy
PDAP Core Team
consists of Department Staff and Chair and Vice Chair of the Executive
Leadership Team
provides leadership, direction and guidance iemeetings agendas,
sensitive items, etc to the PDAP Executive Leadership Team PDAP Executive Leadership Team
consists of members from key diabetes partners in Pennsylvania,
work group chairs and Department staff provides leadership to PDAP makes recommendations to the DPCP plans PDAP meetings and activities
PDAP Work Groups
Surveillance, Standards of Care, Health Policy, and Evaluation consist of general members of the PDAP implement the Plans component goals and action steps provide recommendations to the PDAP Executive Leadership Team via chairs of the work groups and general
members of the PDAP with expertise in evaluation
PDAP Evaluation Team
consists of Department staff, key executive leadership team members, evaluates progress and outcomes of the Diabetes Action Plan issues regular reports with the intention of updating and improving
marketing and implementation of the Plan
The Pennsylvania Diabetes Action Plan
19
Diabetes Action Plan
THE GOALS OF THE
T
he primary goal of the Diabetes Action Plan is to focus individual, organization and agency energy and efforts towards reducing the burden of diabetes in Pennsylvania The components or focus areas in the Action Plan were created based on the results of a statewide assessment of CDCs ten recommended Essential Public Health Services The four major areas include:
funding in ways that improve diabetes care and decrease health disparities Evaluation-to investigate and measure the impact of diabetes prevention and control activities and services to enable decision makers to identify effective programs Throughout each of these components, the Diabetes Stakeholder Group chose six overarching themes to be addressed in completion of the goals Focus on prevention: take every opportunity to make the
public and policy makers aware of the power of lifestyle changes to prevent diabetes–and to prevent complications in people who already have diabetes Eliminate health disparities: improve access to and availability of education and medical care to meet the needs of those disproportionately burdened by diabetes due to differences in gender, race or ethnicity, education or income, disability, geographic location or sexual orientation
Ensure access to medical care: ensure all Pennsylvanians have access to quality diabetes care and treatment Use evidence-based research and best practices: use research to design prevention and treatment programs that incorporate best practices and lead to more positive outcomes and sharing success stories Employ technology: use the internet and other technology to dispense and gather information; survey populations; share success stories; and provide guidance to patients, providers, and payers Coordinate efforts and create partnerships: share resources and responsibility to reduce the burden of diabetes on the people of Pennsylvania and establish metrics for tracking costs, performance measures, processes, and outcomes
Surveillance-to establish
a solid
base of knowledge about the populations at risk and to collect and monitor data for diabetes trends in order to focus the use of diabetes resources and efforts
Standards of Care-to identify
and disseminate diabetes standards of care and increase awareness of the importance of early diagnosis, good management, and effective prevention strategies to ensure that all people with diabetes receive the same level of excellent care Health Policy-to work toward change and utilize Pennsylvania laws, regulations, standards, enforcement, authority, and
20
1 Surveillance Component
Objective 11: Develop a more comprehensive statewide surveillance system for diabetes in Pennsylvania that allows new sources of data to be continually identified, and develop a systematic process to integrate multiple data sources to provide an accurate picture of diabetes as a chronic disease as well as its risk factors and self management
Action Steps 1 Assess diabetes data currently available 2 Research, acquire, and assess diabetes data not routinely utilized by PA DOH or other Diabetes Action Plan members in the Commonwealth 3 Expand diabetes surveillance to provide a more comprehensive picture of
diabetes in children infant to 18 years and disparate populations 4 Define key issues, needs, and requirements of an ideal Commonwealth-wide diabetes surveillance system 5 Add questions to the Diabetes Module BRFSS to address crosscutting issues and access to care 6 Engage the legislative Diabetes Caucus or other related body to discuss possible ways to improve the diabetes surveillance system in Pennsylvania 7 Work with the Health Policy Work Group to determine the advantages, disadvantages, feasibility, and cost to make diabetes a reportable disease Indicators of Success Surveillance System is recognized by CDC as a best practice Number of diabetes programs and services throughout the state that are data driven and evidence based Expansion and Surveillance system includes more sources of data in 2008 than are available in 2007, more in 2009 than in 2008, and so forth
Objective 12: Create an efficient and effective way to communicate diabetes surveillance data to people in Pennsylvania
Action Steps 1 Update and expand the Pennsylvania Diabetes Burden Report, a comprehensive report with diabetes statistics 2 Partner with organizations with a stake in better diabetes care to
distribute and promote the use of Pennsylvania diabetes surveillance data Indicators of Success The number of organizations and agencies that incorporate diabetes surveillance data into their planning Organizations in search of diabetes data are able to access data as needed Responsibility for Surveillance Component: The PDAP the DPCP Administrator of Planning and , Development, and the epidemiologist assigned to the DPCP in the PA DOH are responsible for assessing and implementing recommendations included in the Surveillance Component
The Pennsylvania Diabetes Action Plan
21
2 Standards of Care Component
Objective 21: Adopt a single set of standards for the care of diabetes and communicate these standards to a wide variety of audiences
Action Steps 1 Assess current outpatient diabetes standards of care guidelines and adopt the most comprehensive, data-driven set of standards to promote and use in Pennsylvania 2 Establish partnerships with key stakeholders who will use the standards of care 3 Develop a communication strategy for all media–TV, radio, internet, scientific literature–to include the diabetes standards of care as part of their message 4 Identify specific inpatient
standards Indicators of Success Number of providers and insurers that use the recommended diabetes standards of care for reimbursement purposes Progress toward meeting Healthy People 2010 diabetes objectives
Objective 22: Establish collaborations/partnerships with other agencies, organizations, insurers, employers, and groups on the prevention of diabetes, the prevention of diabetes complications, and the development of wellness programs
Action Steps 1 Educate health professionals and other groups to focus on risk factors for diabetes and provide referral and resource information 2 Develop and utilize a widespread primary diabetes prevention media campaign 3 Encourage the implementation of school and workplace wellness programs 4 Provide staff and community diabetes and wellness education for schools, businesses, community based organizations and health and human service organizations Indicators of Success The number of businesses and schools across the state that have wellness programs that include diabetes risk and diabetes management information and appropriate activities Reports of activities and successes from community programs focusing on physical activity, better
nutrition, and weight loss Progress toward meeting the Healthy People 2010 Diabetes Objective 05-03: Decrease the rate of people diagnosed with diabetes to 25 per 100,000 people and Objective 05-05: Decrease the diabetes death rate to 45 per 100,000 people Responsibility for Standards of Care Component: The PDAP and the PA DOH DPCP with assistance , , from other committed partners in the state, are responsible for coordinating recommendations listed in this component
22
3 Health Policy Component
Goal 31: Create an effective diabetes management incentive program across all health care program providers within the entire Pennsylvania Medicaid program
Action Steps 1 Build on the success of Access Plus, PAs Fee for Service Medicaid program, that currently offers incentives to providers for their quality of care 2 Evaluate current economic incentives programs with the goal of establishing a uniform set of incentives for all stakeholders 3 Investigate disease-related incentive programs in other states 4 Refocus to include outcome incentives 5 Provide incentives to encourage physicians, health care providers, hospitals, insurers, and consumers to access and use the diabetes standards
of care 6 Explore ways to disseminate effective incentive medical models to others Indicators of Success Number of Medicaid providers that use the diabetes standards of care Number of Medicaid patients that receive formal diabetes education Decrease in the number of lower-extremity amputations and cases of serious diabetic eye disease in Medicaid patients
Goal 32: Develop policies to promote the adoption of best practices in diabetes care
Action Steps 1 Promote health information exchange and information technology use to enhance patient care 2 Establish criteria for centers that demonstrate excellence in providing innovative diabetes care 3 Assess health care workforce in the state Promote models of care that address workforce limitations and resources, for example in small or rural communities 4 Promote use of multidisciplinary teams 5 Identify and include best practices for inspiring individual responsibility and behavior change 6 Advocate for alternative delivery methods and coverage 7 Evaluate environmental influences that affect access to care Indicators of Success Number of organizations that report using best practices of diabetes care Progress toward meeting all
Healthy People 2010 diabetes objectives
Goal 33: Ensure that individuals with diabetes are not treated unfavorably and that violations are remedied
Action Steps 1 Identify current legislation that addresses the unfavorable treatment of individuals with diabetes 2 Identify gaps within the legislation
The Pennsylvania Diabetes Action Plan
23
3 Promote legislation/policies to address unequal treatment 4 Ensure that the legislation provides for enforcement of the law Indicators of Success Number of school children, employees, and members of the general public who have diabetes that report that they participate fully in educational, professional, social, and other activities Responsibility for Health Policy Component: The PDAP and community-based coalitions are responsible for carrying out actions in the Health Policy section The role of the DOH DPCP is limited to promoting awareness and education about policy issues and procedures
4 Evaluation Component
Objective 41: Develop a systematic way of evaluating diabetes services and outcomes in Pennsylvania that can be adapted in organizations and programs throughout the state
Action Steps 1 Inventory diabetes programs across the state
that currently have evaluation components 2 Develop an evaluation component for each goal accomplished under the Diabetes Action Plan and track the implementation of the Plan 3 Develop a process to evaluate ongoing diabetes programs and services 4 Evaluate adherence to standards of care Indicators of Success The number of organizations that report they use data to make decisions that lead to improvement in the quality of diabetes programs Results of various evaluations are used to plan for additional training or other interventions to increase the number of providers using the standards of care
Objective 42: Identify and evaluate the effectiveness of incentives on the quality of diabetes care
Action Steps 1 Select incentives to be targeted for evaluation monetary, educational, etc 2 Identify and explore incentive programs in this state and others, rural health, Medicare, insurers, etc See goal 5 3 Establish goals, performance measures, and outcomes to identify and evaluate the effectiveness of incentives on the quality of diabetes care Indicators of Success The number of instances in which effective incentives are utilized to improve the quality of diabetes care in
Pennsylvania
24
Objective 43: Assess diabetes knowledge in disparate populations
Action Steps 1 Identify current BRFSS data questions on diabetes 2 Identify gaps in list of questions 3 Formulate and propose additional questions to the BRFSS 4 Propose targeted population surveys to assess diabetes knowledge 5 Work with the DOH Office of Health Equity and partner with Centers for Health Equity at colleges and universities to administer surveys Indicators of Success Increase in the level of diabetes knowledge found in disparate populations
Objective 44: Identify process to evaluate legislative impact on diabetes-related policies and issues
Action Steps 1 Obtain the list of diabetes-related policies and issues 2 Identify legislative policy timelines to determine impact on diabetes outcomes eg, when a policy becomes effective, how long before the impact of the policy can be measured 3 Monitor the process and current status of legislative initiatives under consideration 4 Examine the level of compliance by insurers for legislatively mandated benefits Indicators of Success Process for evaluating legislative impact is in place
Objective 45: Evaluate the effectiveness of third-party
reimbursement strategies on the quality of diabetes care
Action Steps 1 Acquire data 2 Determine a business case for the return on investment reimbursement 3 Identify the range of reimbursements for diabetes care 4 Evaluate the effect of third-party disease management programs on care see Goal 8 Indicators of Success Number of insurers using reimbursement strategies targeted at improving diabetes care Data indicates reimbursement has increased quality of care
The Pennsylvania Diabetes Action Plan
25
Objective 46: Assess, evaluate and monitor the availability of resources for all stakeholders
Action Steps 1 Define resource and create a list of resources to monitor 2 Identify covariates that affect access to resources for example, geographic access, cultural appropriateness 3 Use geomapping to identify resources for stakeholders and for public use 4 Research other tools available to evaluate socioecological influences that affect access to care Indicators of Success Number of gaps in the applicability ie, culturally appropriate, reading level and availability of resources are identified
Objective 47: Measure the economic burden of diabetes every two years
Action Steps 1 Define
the parameters of economic burden 2 Identify sources of cost data 3 Determine validity of cost data 4 Establish a baseline 5 Evaluate the associated costs of diabetes eg, disability, lost work days, savings due to prevention services, etc 6 Use cost data in evaluating the effectiveness of interventions and strategies Indicators of Success Completion and release of a document that highlights the economic burden of diabetes in Pennsylvania Responsibility for Evaluation Component: The PDAP others who helped develop the Plan, , and community-based coalitions, in concert with the PA DOH, DPCP
26
The Pennsylvania Diabetes Action Plan
valuating the Pennsylvania Diabetes Action Plan will determine the progress towards completion of the Plans goals The evaluation results will be useful not only in assessing the current progress, but will also be used for future strategic planning in the prevention and control of diabetes in Pennsylvania The Plan evaluation will assess: Use of Plan by stakeholders Implementation of action steps Progress in achieving Plan goals The evaluation of both individual pieces of the Plan, as well as, the Plan in its entirety will be evaluated by using the CDCs
six step framework for evaluation The steps of the framework and a brief description are listed below: Engage Stakeholders-include those involved in the Plan operations eg staff, administrators, partners, sponsors; those served or affected by the program eg clients, family members, community organizations, schools; and primary users of the evaluation results eg persons in a position to make decisions about the Plan
THE PROCESS OF EVALUATING
E
Describe the Program-define the resources eg staff time, money, and technology needed to implement the Plan; the specific activities eg steps, actions that need to be conducted; and the changes that are expected to happen as a result Focus the Evaluation Design-decide who are the specific persons that will use the results of the evaluation; what does each person hope to learn from the evaluation; what questions should the evaluation answer Gather Credible Evidence-decide on the specific pieces of information needed to answer questions; translating general information about the program into specific indicators that can be measured and interpreted is needed, as well as, what are the sources of information
Justify Conclusions-give reasons for
the answers generated Ensure use and share lessons learned-share the conclusions and recommendations with stakeholders The PDAP Evaluation Team, comprised of staff from the Pennsylvania Department of Health Diabetes Prevention and Control Program, key executive leadership team members and general members of the PDAP with expertise in evaluation is the primary entity involved in evaluation of the Diabetes Action Plan and will plan and execute evaluation of the progress and outcomes The Team will gather information on the progress of reaching the Plans goals and issue regular reports with the intention of updating and improving marketing and implementation of the Plan
The Pennsylvania Diabetes Action Plan
27
Conclusion
THE
T
he Pennsylvania Diabetes Action Plan is an important tool to mobilize and guide the efforts of many to lessen the burden of diabetes Its success will take the efforts and commitment of a diverse group of stakeholders
including PDAP DPCP and Plan , , Champions The goals and action steps will produce measurable outcomes that will help Pennsylvania exceed its Healthy People 2010 goals Evaluation of the Plan will improve future planning and further
implementation to ensure that
resources are used effectively and without disparity Together, with the plan in action, we will reduce the burden of diabetes in Pennsylvania and improve the quality of life for those living with the disease
Diabetes Action Plan
28
Appendix A: Diabetes Stakeholder Group Executive Steering Committee and Work Group Co-Chairs
Diabetes Stakeholder Group Steering Committee
Michael Dunn, MD Windber Medical Center Neil Freedman, MD Wellspan Health/South Central Preferred Robert Gabbay, MD, PhD Penn State College of Medicine Milton S Hershey Medical Center Ingrid Libman, MD, PhD Childrens Hospital of Pittsburgh Gerri Weiss University of Pittsburgh Diabetes Institute Don Wilson, MD Quality Insights of Pennsylvania Janice Zgibor, RPH, PhD University of Pittsburgh Diabetes Institute Jan Miller, MA Pennsylvania Department of Health, Diabetes Prevention and Control Program Amy Schweitzer, MPA Pennsylvania Department of Health, Diabetes Prevention and Control Program Robert Goodman, PhD University of Pittsburg Graduate School of Public Health Terri Lipman, PhD, CRNP FAAN , Associate Professor of Nursing of Children University of Pennsylvania School of Nursing
Gretchen Piatt, MD University of Pittsburgh Diabetes Institute Phillip Benditt, MD United Health care Linda Siminerio, RN, PhD, CDE University of Pittsburgh Diabetes Institute Jeremy Nobel, MD Harvard School of Public Health Janet Tomcavage Director, Clinical Medicare Programs Geisinger Health Plan
Diabetes Stakeholders Work Group Co-Chairs
Health Policy Michael Dunn, MD Neal Freedman, MD Surveillance Ingrid Libman, MD, PhD Terri Lipman, PhD, CRNP FAAN , Evaluation Janice Zgibor, RPH, PhD Don Wilson, MD Standards of Care Phillip Benditt, MD Janet Tomcavage Carla Miller, PhD, RD former chair
The Pennsylvania Diabetes Action Plan
29
Appendix B: Diabetes Stakeholder Group Contributing Organizations
AARP Adagio Health Council AETNA Albert Einstein Health care Network Allegheny County Health Department American Diabetes Association Central-East PA/SNJ Central PA Office Beaver County Cancer and HeartAssociation BodyMedia, Inc Capital Blue Cross Centers for Healthy Hearts and Souls Childrens Hospital of Philadelphia Van Scoyoc Associates Pediatric Endocrine Fellowship Program Weight Management and WellnessCenter CIBER, Inc Community Health Collaborative Conemaugh Diabetes Institute
Conemaugh Valley Memorial Hospital Cumberland Valley Endocrinology Center Cumberland Valley Obstetrics and Gynecology DDI Delphi Health Systems Diasense, Inc Drexel University School of Public Health Department of Epidemiology and Biostatistics Duquesne University, Mylan School of Pharmacy Erie County Department of Health Erie Retinal Surgery First Health at PACE Gateway Health Plan Geisinger Health Plan General Clinical Research Center Giant Eagle, Inc GlaxoSmithKline Greenlee Partners, LLC HJ Heinz Company World Headquarters Harrisburg Area Community College Harvard School of Public Health Hatch Engineering Health America Health Dialog Health Promotion Council of SE, PA Inc HealthAmerica of PA Healthy Adams County Helwig Diabetes Center, Health Center at Trexlertown Highmark iMetrikus Independence Blue Cross Indiana Regional Medical Center Jefferson Medical College, Department of Health Policy Jewish Health care Foundation Joslin Diabetes Center Juvenile Diabetes Research Foundation, Philadelphia Chapter Keystone Rural Health Center L Robert Kimball Associates Lankenau Hospital Latino Health Projects Latrobe Area Hospital, Diabetes Learning Center Learning Institute Lions
Diabetes Center McKeesport Hospital Foundation Mercy Hospital Mercy Parish Nurse Program HHMC - SJV Parish Center Monongahela Valley Hospital, Center for Diabetes Endocrinology Nesbitt Medical Arts Building Nicole Johnson, Inc Novo Nordisk PA Academy of Family Physicians PA House of Representatives PA Pharmacists Association PENN Rodebaugh Diabetes Center, Division of Endocrinology, Diabetes Metabolism Penn State University College of Health and Human Development Department of Biobehavioral Health Department of Nutritional Sciences
30
Milton S Hershey Medical Center College of Medicine Pennsylvania Association for the Blind Pennsylvania Department of Health Diabetes Prevention and Control Program Northwest District Southcentral District Southeast District Southwest District Bureau of Health Promotion and Risk Reduction Division of School Health Northcentral District Northeast District Office Secretarys Office Pennsylvania Department of Public Welfare Office of Medical Assistance Program Pennsylvania Dietetic Association Pennsylvania Medical Society Pennsylvania Pharmacists Association Pinnacle Health Systems Pittsburgh Business Group on Health Pittsburgh Regional Health
Initiative PPG Industries, Inc PSD/CMI Quality Insights of Pennsylvania Renal Solutions, Inc Retina Oculoplastic Consultants Rodebaugh Diabetes Center Hospital of the University of Pennsylvania RX Council Safeway, Inc Saint Francis University/CERMUSA Sanofi-Aventis Sherrard, German Kelly, PC Slippery Rock University, Dept of Health and Safety SMC Business Councils St Clair Hospital Steps to a Healthier PA-Luzerne County Temple School of Podiatric Medicine The InforMedx Group Thomas Jefferson University Hospital Three Rivers Health Plan
Treatment Management Uniontown Hospital Unison Administrative Services United Health care United States Air Force United States Steel Corporation University of Pennsylvania Hospital School of Nursing University of Pittsburgh Center for Rural Health Practice Graduate School of Public Health Department of Behavioral and Community Health Sciences Department of Epidemiology School of Nursing School of Pharmacy STEP UP Montefiore University Hospital Department of Medicine Center for Minority Health Health Policy Institute University of Pittsburgh Diabetes Institute University of Pittsburgh Medical Center Braddock Government Relations Health Plan
Wilford Hall Medical Center Urban League of Pittsburgh US Steel, LLC USS and Carnegie Pension Fund Washington Hospital Diabetes Program WellSpan Health South Central Preferred PPO West Penn Allegheny Health System West Penn Hospital Western PA Health Disparities Collaborative Westmoreland Regional Hospital Out Patient Clinics, Excela Health Windber Medical Center and Windber Research Institute WPSO Endocrine-Metabolic Consultants York City Health Bureau
The Pennsylvania Diabetes Action Plan
31
Appendix C: Pennsylvania Diabetes Prevention and Control Program
The Pennsylvania Diabetes Prevention Control Program DPCP is an integral part of the Pennsylvania Department of Health The DPCP strives to reduce the burden of diabetes in Pennsylvania and improve the quality of life of those Pennsylvanians having diabetes by preventing and controlling its complications through limited federal and state funding Program activities include:
creating partnerships with communities, providers, health care systems, worksites, and schools working with stakeholders to develop and implement plans for statewide actions to address the challenges of diabetes and diabetes related issues;
promoting
culturally appropriate strategies to target disproportionately affected populations for interventions; convening stakeholders from across the state to encourage cooperation and collaboration towards the mutual
goals of lessening the burden of diabetes; and
collecting and communicating diabetes surveillance data in Pennsylvania
32
Appendix D: References
1 Centers for Disease Control and Prevention 2005 National Diabetes Fact Sheet 2005 [Electronic version] Retrieved January 19, 2007, from http://wwwcdcgov/diabetes 2 National Diabetes Education Program 2007 About Diabetes and Prediabetes [Electronic version] Retrieved January 19, 2007, from http://wwwndepnihgov 3 National Institute of Diabetes and Digestive and Kidney Diseases 2007 National Diabetes Statistics fact sheet:
general information and national estimates on diabetes in the United States, 2005 [Electronic version] Retrieved January 19, 2007, from http://wwwdiabetesniddknihgov/dm/pubs/riskfortype2/indexhtm
4 Pennsylvania Department of Health 2007, Bureau of Health Statistics and Research Homepage, [Electronic version] Retrieved January 19, 2007, from http://wwwhealthstatepaus/stats 5 National Center for Chronic Disease
Prevention and Health Promotion Behavioral Risk Factor Surveillance System Prevalence Data, Diabetes, 2004 and 2005 6 Office of Disease Prevention and Health Promotion, US Department of Health and Human Services 2007 Healthy People 2010 Health Status Objectives for the Nation [Electronic version] Retrieved January 19, 2007, from http:// wwwhealthypeoplegov 7 Pennsylvania Health Care Cost Containment Council 2007, Diabetes Hospitalization Report, 2005 [Electronic version] Retrieved January 19, 2007, from http://wwwphc4org 8 Pennsylvania Department of Health 2007
State Health Improvement Plan - SHIP 2006-2010, [Electronic version] Retrieved January 19, 2007, from http://wwwhealthstatepaus/ship
The Pennsylvania Diabetes Action Plan
33
Appendix E: Diabetes Resources
Below are state and national organizations that address diabetes Centers for Disease Control Division of Diabetes Translation wwwcdcgov/diabetes Pennsylvania Department of Health 1-877-PA-HEALTH wwwhealthstatepaus American Association of Diabetes Educators AADE http://aadenetorg American Diabetes Association http://wwwdiabetesorg/ American Dietetic Association http://wwweatrightorg American Heart Association–The Heart
of Diabetes http://wwws2mwcom/heartofdiabetes/indexhtml National Diabetes Education Program NDEP http://ndepnihgov/ National Institute of Diabetes and Digestive Kidney Diseases NIDDK http://wwwniddknihgov/health/diabetes/diabeteshtm
34
Appendix F: Healthy People 2010 Cross Cutting Indicators
Healthy People 2010 Diabetes Cross Cutting Indicators and Pennsylvania Profiles7
Indicator HP2010 Goal PA Profile
2005 unless noted
Objective 04-07 Decrease the rate of kidney failure due to diabetes Objective 12-09 Decrease the percentage of adults who have been told that their blood pressure was high Objective 19-02 Decrease the percentage of obese adults Objective 22-01 Reduce the percentage of adults who engage in no leisure time physical activity Objective 22-02 Increase the percentage of adults who engage in vigorous or moderate physical activity Objective 01-01 Increase the percentage of adults under 65 with health insurance Objective 27-01a Decrease the percentage of adults who smoke cigarettes
78
1374b
16
251a
15
261a
20
251a
50
491a
100
871a
12
241a
a BRFSS estimates age-adjusted to 2000 std population and including 95 confidence interval b 2003 rate age-adjusted to
2000 std population for deaths as underlying or contributing cause Vigorous is defined as large increases in breathing/heart rate for 20 min 3 times per week Moderate is defined as small increases in breathing/heart rate for 30 min 5 times per week
Data Source: Bureau of Health Statistics and Research, Pennsylvania Department of Health
The Pennsylvania Diabetes Action Plan
35
