Arizona Department of Health Services 2013 Annual Report Arizona Department of Health Services Will Humble, Director Published by Arizona Department of Health Services Office of the Director 150 N. 18th Avenue Phoenix, Arizona 85007 This report is provided as required by A.R.S. § 36-137 Health and Wellness for all Arizonans Office of the Director 150 N. 18th Avenue, Suite 500 Phoenix, Arizona 85007-3247 (602) 542-1025 (602) 542-1062 (FAX) adhs.gov JANICE K. BREWER, GOVERNOR WILL HUMBLE, DIRECTOR June 2, 2014 The Honorable Janice K. Brewer Governor of Arizona State Capitol 1700 W. Washington Phoenix, AZ 85007 President Andy Biggs Senate President Arizona State Senate 1700 W. Washington Phoenix, AZ 85007 Speaker Andy Tobin Speaker of the House Arizona House of Representatives 1700 W. Washington Phoenix, AZ 85007 Dear Governor Brewer, President Biggs, and Speaker Tobin: In accordance with A.R.S. § 36-137, I am pleased to present the Annual Report for the Arizona Department of Health Services for the year 2013. In 2013, the Department finalized administrative rules aimed at reducing regulatory burden, awarded the state’s first integrated behavioral health contract, and worked to improve public health across the state. Rather than issue an annual report that merely summarizes other agency reports, I want to provide you with highlights and with direct links on the work the Department has completed in 2013. Health and Wellness for all Arizonans Over the last year, the Arizona Department of Health Services had many accomplishments. Behavioral Health  Arizona’s behavioral health system took the historic step of integrating health care and treating the whole person, increasing quality of life and improving outcomes, while reducing costs. The Maricopa County Integrated RBHA contract was awarded to Mercy Maricopa Integrated Care.  By December 2013, 4,716 Arizonans have been trained in Mental Health First Aid, teaching folks how to identify signs of possible mental illness and connect people with professional help. This includes nearly 200 adults who were trained in the new Youth Mental Health First Aid. Metal Health First Aid is an evidence based curriculum designed to give anyone the skills needed to help someone in need. Arizona State Hospital  The Arizona State Hospital continued its culture of care initiative by providing 27,875 hours of training in non-violent crisis intervention, developing a new acuity program for staffing units, implementing a new clinical assessment tool, and expanding clinical programming hours. This has resulted in a 31% reduction in patient and staff assaults over the course of the year. The State Hospital remains Joint Commission Accredited, CMS Certified, and State Licensed. Public Health Licensing  Inspected hundreds of Residential, Medical, and Long-Term Care facilities, along with Child Care centers and homes to make sure that folks are being treated right and have a safe environment.  The Division of Public Health Licensing, in collaboration with the Bureau of Epidemiology and Disease Control, launched an ongoing initiative, the ADVICE Collaborative, between public health and dialysis providers to implement evidence based and best practices related to infection control within their facilities. From this collaborative, the work of identifying and developing evidence based and best practices continues through a subcommittee of our Healthcare Associated Infections Advisory Committee.  Completed regulatory reform and published a comprehensive overhaul of the administrative rules governing health care institutions. Hundreds of hours of stakeholder meetings and input have created simple, nimble, and streamlined set of administrative rules, while protecting the safety of Arizonans. Health and Wellness for all Arizonans Public Health Preparedness  In 2013, 86,930 babies were born in Arizona. Of those, 97.5% were screened for 28 metabolic disorders by the newborn screening program, and 98% received a hearing screen at the hospital. 102 infants were diagnosed with congenital disorders and received treatment in a timely manner.  In 2009, Arizona had just seven Level 1 Trauma Centers, in 2013, Arizona had 31 Trauma Centers, including 16 Level 4 Centers in rural Arizona. Moving forward, ADHS has revised our Trauma System plan after consulting with the American College of Surgeons and continued to develop a robust state-wide trauma system, ensuring all Arizonans have access to life-saving care.  ADHS developed and launched a web-based application for Vital Records Electronic Registration of Birth System, which allows for registration of new and modification/amendment of previous birth-related events. The application is used statewide by hospitals, birthing centers, local county health departments and ADHS’ office of Vital Records.  In an effort to address rising vaccine exemption rates, ADHS developed an Action Plan to Address Increasing Vaccine Exemptions and updated school and childcare exemption forms to improve parent understanding of serious vaccine-preventable diseases.  Made major enhancements to the Medical Electronic Disease Surveillance Intelligence System (MEDSIS) including an integrated outbreak management module, case management, and a Spanish version allowing us to more easily share bi-national cases with our counterparts in Sonora Mexico. This application is a statewide web-based application used by local health departments for disease surveillance, and individuals and institutions responsible for reporting communicable diseases.  The Telephone CPR program published an abstract showing at three Arizona 9-1-1 centers, where the program was implemented, the rates of telephonic CPR doubled and the time to start CPR dropped by 80 seconds, both statistically significant findings. Preliminary analysis suggests that cardiac arrest patients were more than twice as likely to survive in the program’s post-implementation period as in the preimplementation period.  Published the Annual Vital Statistics Big Book 2012 in a mobile friendly format, the annual Behavior Risk Factor Surveillance System (BRFSS) report, and a comprehensive Aging Report in 2012 examining issues related to aging in Arizona.  The EMS for Children’s Program Pediatric-Prepared Emergency Care added six facilities to its membership of emergency departments prepared to care for children. The Health and Wellness for all Arizonans Pediatric-Prepared Emergency Care Program is a partnership between the American Academy of Pediatrics - Arizona Chapter, hospitals, physicians, nurses, and emergency personnel, and the EMSC Program. This partnership has been established to improve outcomes for ill and injured children through a system of regionalized pediatric emergency care.  ADHS published the Arizona Medical Marijuana Program Annual Report and the 2013 End of the Year report.  ADHS published the comprehensive 2012 Abortion Report, showing a 7.4 percent overall decrease in abortions in Arizona. Public Health Prevention  The Arizona Department of Health Services has streamlined and standardized the screening and referral processes for the home visiting program. Now, child-health professionals who visit homes of new parents now also screen for chronic disease and lead paint dangers – effectively steering families into managing their own diseases while reducing health care costs.  ADHS has seen a decrease in overweight and obese 2-5 year old Arizona WIC Program participants (Overweight 14% in 2011 to 13.3% in 2013; Obese 13.2% in 2011 to 12.4% in 2013). This reflects ADHS work on the winnable battle to decrease obesity.  The Arizona Department of Health Services continues to reduce the health and social burdens of teen births through the provision of teen pregnancy prevention services in all 15 counties and 3 tribal communities. Arizona realized a 38% decline in teen pregnancy rates from 2007 through 2012.  The Primary Care Workforce Programs successfully increased the number of eligible practice sites in Health Professional Shortage Areas (HPSA) of Arizona, a growth of 118% over one year from 500 in 2012 to 1,093 in 2013, allowing primary care providers working at those sites to participate in loan repayment or other incentives programs.  The Bureau of Tobacco and Chronic Disease collaborated with AHCCCS to allow the state to claim the 50% federal administrative match rate for the Arizona Smokers Helpline (the ASHLine) for smoking cessation services that are provided to AZ Medicaid beneficiaries. Arizona has successfully reduced tobacco use from 19.1% in 2012 to 17.1% in 2013. Health and Wellness for all Arizonans Operations  Completed critical regulatory reform related to a number of important health subjects including emergency services, emergency stroke care, physical plant health and safety codes, midwifery licensing, behavioral health court ordered program approvals, child care group homes and care facilities.  ADHS has developed a Continuous Quality Improvement Program to support the Governor’s Four Cornerstones of Reform as we work to develop metrics to track and monitor our agency’s progress.  ADHS continues working towards becoming nationally accredited. National Public Health Accreditation verifies the provision of the ten essential public health standards through quality improvement initiatives. Oversight and guidance for this effort is being provided by the Managing for Excellence program.  Processed over 400 administrative health related cases, including over 100 decisions issued by the director on contested cases and provided over 350 public record and subpoena requests for information in an effort to provide transparency and accountability. Legislative Implementation  ADHS worked with the Arizona Department of Education to publish rules regarding the use of Epinephrine auto-injectors in schools as required by Laws 2013, Chapter 243 (SB 1421).  The FY 2014 budget required ADHS to collaborate with AHCCCS to publish the Hospital Charge Master Transparency report, helping pave the way for clearer consumer information.  Laws 2013, Chapter 220 (SB 1375) mandates ADHS begin closely tracking specific outcomes and budget information related to behavioral health services for foster children, to ensure services are being delivered to those in need. Here are the eight topics required by statute in the ADHS Annual Report .    Each year, ADHS compiles the Arizona Health Status and Vital Statistics Report with information on vital statistics and the health status of Arizona residents. In addition to the highlights previously outlined, the activities of the Department are chronicled on the Director’s blog. County Public Health Departments continue to serve a vital role in public health and had many accomplishments in 2012. Health and Wellness for all Arizonans      ADHS monitors and tracks various diseases throughout the state. Public health expenditures by the state and counties add up to millions of dollars. Obesity remains the largest public health threat to Arizona. The Arizona State Hospital serves an important role for the Department. The functions of CRS were successfully transferred to AHCCCS in 2011. There is much more information available about the Department on our website at www.AZDHS.gov. Please feel free to explore the online content for each of our Divisions and the many programs that we provide for the people of Arizona. Sincerely, Will Humble Director, ADHS Health and Wellness for all Arizonans