Electronic Medical Records A trench warfare approach
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“So many of our health problems can be avoided through diet, exercise and making sure we take care of ourselves. By promoting healthy lifestyles, we can improve the quality of life for all Americans, and reduce health care costs dramatically.” Tommy G. Thompson, Secretary, DHHS U.S. Department of Health and Human Services http://aspe.hhs.gov/health/prevention/prevention.pdf
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Consumer Health Major Health Problems
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Priority Health Problems Homicide HIV/AIDS Flood Car crashes Airplane crashes Cancer Tornados All accidents Drowning Heart disease Cancers Arthritis Asthma Drug abuse Overweight/Obesity Diabetes Cancer Alcohol addiction
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Major Health Problems Overview Diseases Cardiovascular Disease Cancer Diabetes Arthritis Health Promotion
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Chronic Disease Overview Chronic diseases cardiovascular disease (primarily heart disease and stroke), cancer, and diabetes the most prevalent, costly, and preventable of all health problems 7 of 10 (1.7 of 2.4 million) deaths 1 of 10 (25 million) have major limitations in activity
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Causes of Death in the US Most Common
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Causes of Death in the US Actual
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Causes of Death in the US In 2000, more than 105 million people were told that they had high total blood cholesterol levels ~90% of middle-aged Americans will develop high blood pressure in their lifetime Each year, 440,000 people die of diseases causes by smoking or another form of tobacco use—that’s about 20% of all deaths in the United States.
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Leading Causes of Disability
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Costs of Chronic Disease The United States cannot effectively address escalating health care costs without addressing the problem of chronic diseases: More than 90 million Americans live with chronic illnesses. Chronic diseases account for 70% of all deaths in the United States
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Costs of Chronic Disease Chronic diseases people have account medical care costs for more than 75% of the nation’s $1.4 trillion medical care costs Reminder: $2.6 trillion in 2010 Chronic diseases account for 65% of the years of potential life lost before age 65
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Costs of Chronic Disease In 2003, approximately $351 billion was spent on all cardiovascular diseases Over $150 in lost productivity was due to cardiovascular disease Cancer costs $172 billion Diabetes direct and indirect costs of are nearly $132 billion a year Arthritis has estimated total costs (medical care and lost productivity) of almost $82 billion medical care costs of over $22 billion, and estimated
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Costs of Chronic Disease The direct medical costs associated with physical inactivity was nearly $76.6 billion in 2000 Smoking has estimated direct and indirect costs associated exceeding $75 billion annually
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Estimated Per Capita Health Expenditures
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Healthy People 2010 Heart Disease 12-1. Reduce coronary heart disease deaths. Target: 166 deaths per 100,000 population. Baseline: 208 coronary heart disease deaths per 100,000 population in 1998 Target setting method: 20 percent improvement. Data source: National Vital Statistics System (NVSS), CDC, NCHS.
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Heart Disease Cardiovascular diseases cost the Nation $351 billion in 2003 950,000 deaths Heart disease and stroke are the first and third leading causes of death in the United States In 2003 1.1million Americans will have a heart attack Check Your Heart Healthy IQ
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Healthy People 2010 Cancer 3-1. Reduce the overall cancer death rate. Target: 159.9 deaths per 100,000 population. Baseline: 202.4 cancer deaths per 100,000 population occurred in 1998 Target setting method: 21 percent improvement. Data source: National Vital Statistics System (NVSS), CDC, NCHS.
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Cancer $172,000,000,000 $61 billion medical $111 billion lost productivity 1.3 million new cases per year Take Cancer Risk Test
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Healthy People 2010 Diabetes 5-2. Prevent diabetes. Target: 2.5 new cases per 1,000 population per year. Baseline: 3.5 new cases of diabetes per 1,000 population Target setting method: Better than the best (retain year 2000 target). Data source: National Health Interview Survey (NHIS), CDC, NCHS.
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Diabetes Cost is $132 billion 18.2 million Americans with diabetes nearly one-third of them (or 5.2 million people) do not know it! People with diabetes lost more than 8 days per year from work, accounting for 14 million disability days Diabetes Risk Assessment
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Healthy People 2010 Arthritis 2-5. Increase the employment rate among adults with arthritis in the working-aged population. Target: 78 percent. Baseline: 67 percent of adults aged 18 to 64 years with arthritis were employed in the past week in 1997 Target setting method: Better than the best. Data source: National Health Interview Survey (NHIS), CDC, NCHS.
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Arthritis $85,000,000,000 $15 billion medical $65 billion lost productivity 15% of population 43 million 60% working age Take Arthritis Test
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Tip-offs to Rip-offs The vendor or practitioner claims the treatment or product works by a secret formula Legitimate scientists share their knowledge so their peers can review the data There are claims that the treatment is an amazing or miraculous breakthrough or a "cure.“ Real medical breakthroughs are few and far between, and when they happen, they're not touted as "amazing" or "miraculous" by any responsible scientist or journalist
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Tip-offs to Rip-offs The treatment is publicized only in the back pages of magazines, over the phone, by direct mail, in newspaper ads that pretend to be news stories, or on 30-minute commercials in talk show format ("infomercials") The results of studies on bona fide treatments are generally reported first in medical journals. "Proof" for the treatment relies solely on testimonials from satisfied customers These people may never have had the disease the product is supposed to cure, may be paid representatives, or may simply not exist. Often they're identified only by initials or first names.
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Savings with Health Promotion Direct medical costs associated with physical inactivity was $29 billion in 1987 and nearly $76.6 billion in 2000 Engaging in regular physical activity is associated with taking less medication and having fewer hospitalizations and physician visits For a cost ranging from $1,108 to $4,542 for smoking cessation programs, 1 quality-adjusted year of life is saved Smoking cessation interventions have been called the gold standard of cost-effective interventions
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Savings with Health Promotion From 1981 to 1990, reductions in risk factors such as high blood pressure and high cholesterol reduced heart disease rates by an estimated 7%–11% According to one Northern California study, for every $1 spent on the Arthritis Self-Help Program, $3.42 was saved in physician visits and hospital costs.
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Savings with Health Promotion A mammogram every 2 years for women aged 50–69 costs only about $9,000 per year of life saved This cost compares favorably with other widely used clinical preventive services. After controlling for physical limitation and major socioeconomic factors, more than 12% of annual medical costs of the inactive persons with arthritis is associated with physical inactivity Physical activity interventions may be a cost-effective strategy for reducing the burden of arthritis
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Savings with Health Promotion From 1981 to 1990, reductions in risk factors reduced coronary heart disease costs by an estimated 9 from about $240 billion to about $220 billion These reductions in risk factors resulted in 430,000 fewer heart disease deaths between 1981 and 1990 55% were due to reductions in blood pressure and 38% to reductions in cholesterol levels
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Reliable Information Sources Prevention http://www.cdc.gov/nccdphp/ Treatment http://www.fda.gov/opacom/lowlit/medfraud.html Protecting Yourself Against Health Fraud http://www.cfsan.fda.gov/~dms/wh-fraud.html
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Summary Basic Concepts Extent of the Problem Weight Loss Drugs, Products, Procedures Suggestions for Weight Control
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STDs / HIV 25-11. Increase the proportion of adolescents who abstain from sexual intercourse or use condoms if currently sexually active. Target: 95 percent. Baseline: 85 percent of adolescents in grades 9 through 12 abstained from sexual intercourse or used condoms in 1999 Target setting method: 12 percent improvement. Data source: Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.
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STDs / HIV
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STDs / HIV
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Asthma Approximately 23 million adults and 9 million children have been diagnosed with asthma at some point within their lifetime 10.3 million currently have asthma with costs near $14 billion per year Take the Asthma Test
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Consumer Use of CAM 43% of US population Due to chronic conditions Most frequent users Cancer, chronic pain, HIV Ethnic populations Dietary Supplements 158 million users $17,000,000
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Cancer and CAM At least one CAM approach: 63% to 75% Women more than men More use for surgery, chemotherapy or both than neither Most frequent approaches Nutritional: 63%, Massage: 53%, Herbs: 44% Spiritual approaches, relaxation, imagery, exercise, lifestyle, diet, nutritional supplementation therapies Reasons for use “stimulate an immune response:” 73% Outcomes QAL, coping, decrease discomforts, sense of control
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HIV and CAM Frequent Substances Vitamin C: 63%, Multiple vitamin supplements: 53%, Garlic: 53% Frequent practitioners Massage: 49%, acupuncturists: 45%, nutritionists: 37% Frequent activities Aerobic exercise: 63%, prayer: 58%, massage: 53%, meditation: 46%
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... PowerPointElectronic Medical RecordsEarl.pptClinical Associate Professor Department of Family a
... PowerPointElectronic Medical RecordsEarl.pptClinical Associate Professor Department of Family and Community Medicinemobile displays (get patients involved). Learn to type