Monday, November 16, 2009

Healthy People 2020: Your input is needed


Healthy People 2020: Your input is needed!

Every 10 years, The US Government produces Healthy People, a statement of the Public Health Goals for the Nation. The Healty People document becomes very influential, and is considered by policy makers and funders. For the first time ever, there is a concerted effort to directly address Geriatric Issues in Healthy People. The Geriatrics and Palliative Care communities need to do all they can to assure that the final report of Healthy People 2020 fully bears the fruit of this effort.

A draft of Healthy People 2020 is now available for public comment. Your comments can influence the final Healthy People 2020 statement of US Public Health Goals. It is important Geriatrics and Palliative Care providers help shape Healthy People 2020.

In the past, health goals for the elderly played a minimal role in Healthy People. For the first time, Healthy People 2020 includes a section devoted to health objectives for older adults. Amy Berman, Program Officer at the John A Hartford Foundation, and others on the Older Adults Workgroup within Healthy People 2020 helped lobby for more attention to the needs of older persons in Healthy People.

The draft is an important advance over previous versions of Healthy People. However, the document can go further in advancing the health of older adults. For example, there is no goal focused on caregiver depression. Also, there is not much focus on symptoms and disease related suffering. Therefore, the input of palliative care experts could be particularly helpful .

To comment, first go the HP2020 comments section and register. You can go to this page to see the list of topic areas. Click here to see older adult health objectives. You can then post comments on any goal, such as suggestions for more specificity, better measures, etc. You can also suggest additional objectives. You will be asked to describe the objective, give a rationale, and suggest a datasource that could be used to measure the objective. While in this post, I have focused on the older adult objectives, it may be useful to comment in other topic areas as well. For example, while the cancer topic area includes a new objective related to cancer survivorship, it has nothing on palliative care for cancer patients.

This may be an important opportunity for the Geriatrics and Palliative Care communities to influence an important public health initiative.

6 comments:

Alex Smith said...

Thanks for bringing this to our attention, Ken. I noticed 3palliative care related proposed objectives under "Quality of Life and Well Being." These are related to advance care planning and hospice access (NHPCO proposed one).

There are no planned or proposed objectives relating to palliative care under cancer.

Many of the planned/proposed objectives under "Older Adults" also would fall under the umbrella of palliative care (e.g. reduced depressive symptoms among caregivers of persons with dementia).

I signed up under the organization name "GeriPal: A Geriatrics and Palliative Care Blog." What should we propose? Or what proposals should we make? Something about increased attention to the palliative needs of the elderly, I think.

Eric Widera said...

Alex - a couple of thoughts for GeriPal comments:

1. Disability and Seconday Conditions Objective - DSC HP2020–16: Reduce the proportion of older adults with disabilities who use inappropriate medications.

Why limit this to only older adults with disability? Seems like we should be following the Beers Criteria which recommends avoiding a list of inappropriate medications for all older adults.


2. Cancer Objective: interesting how the sole focus seems to be on decreasing death rates and not so much on improving the quality of life or the symptom severity of those with cancer. I guess that may go into the empty "Quality of Life and Well-Being" objective. (oh, wait - pain is addressed in the "Medical Product Safety" objective - good place to store that one)

3. What about "Increase the proportion of the health care workforce with palliative care certification"???

Dan Matlock said...

This is important!

While discussing HP 2010 during my MPH courses, I asked: "when public health has done all it can, what will the 10 leading causes of death be?" The professor didn't like the question at all and she definitely had no response. In my mind, this public health philosophy of preventing death is one of the main reasons why palliative care struggles. Until definitions of "health" include some discussion of "health in dying," (whatever that is) palliative care will remain absent from these documents and the public health agenda.

That said, while the "older people" section of HP 2020 is thin, it marks is a huge leap forward.

Perhaps one tactic:

1) All of us should comment all over the older adults section with the goal of expanding it - note: metric are important as a key of HP 2020 is that they want to be able to measure a change come 2020.

2) Push palliative care into cancer (as Eric suggested). One way to do this is to comment extensively under this objective: "(Developmental) Increase the proportion of cancer survivors who report physical health-related quality of life similar to the general population." Beyond HRQOL, we could propose metrics such as % reporting that their pain was addressed, % reporting that they had designated a proxy decision maker or written a living will, or, if we really want to go big, % dying in hospice.

Thanks for orgainzing this. I will forward this around locally.

Alex Smith said...

I added a proposal under quality of life. Unfortunately, the source for my comment is anonymous. I logged in correctly, but I think I took too long to write my proposal, and the system logged me out! Well...at least it's posted.

Under "Quality of Life and Well-Being"

Objective: Increase the proportion of the health care workforce with palliative care certification.
a. Physicians
b. Nurses
c. Social workers

Rationale: Palliative care should be offered to improve the quality of life of all seriously ill patients. Patients with symptoms that are difficult to treat or who face challenging goals of care discussions may benifit most from palliative care. Palliative efforts to enhance quality of life should be offered alongside curative and/or restorative medical care. Over the next several decades the greatest growth in the need for palliative care services will occur among older adults (see Retooling for an Aging America: Building the Health Care Workforce, National Academies Press 2008). Regardless of age, however, all patients living with serious illness and their family caregivers are likely to experience improvements in quality of life from increased availability of palliative care services (see Lorenz Annals of Internal Medicine, 2008;148(2):147-159) . In addition to established improvements in quality of life, palliative care consult services save money (see Morrison Arch Intern Med. 2008;168(16):1783-1790). For more in depth justification, please see the following websites: GeriPal: A Geriatrics and Palliative Care Blog (www.geripal.org); The Center to Advance Palliative Care (www.capc.org); and the American Academy of Hospice and Palliative Care (www.aahpm.org).

Data Sources: American Boards of Internal Medicine, Anesthesiology, Family Medicine, Physical Medicine and Rehabilitation, Psychiatry and Neurology, Surgery, Pediatrics, Emergency Medicine, Radiology, and Obstetrics and Gynecology; American Osteopathic Association Bureau of Osteopathic Specialists; American Nurses Credentialing Center; National Association of Social Workers.

ken covinsky said...

Many great comments here. Of note, I would not refrain from commenting or recommending a new objective just because someone else has already made a similar recommendation. Perhaps repeat comments or recommendations will support a sense that there is a larger constituency supporting an objective.

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