Programs and Communities

Disease burden is higher in the United States than in comparable countries. The Patient Self Determination Act of 1990 requires healthcare facilities to provide Advance Care Planning (ACP) information to all Medicare patients. The healthcare staffs’ (n=7) commitment to 3-days of ACP training increase ACP rates in the primary care setting. The Medicare Incentive Program is the platform for this initiative. This quantitative project used a valid and reliable pre and posttest design that consisted of 27 items on a Likert-scale. A 3.5-month chart audit (n=91) was conducted to assess the completion rate. Descriptive statistics was used to describe the demographic data.

The results of the two-tailed Wilcoxon signed rank test were significant based on an alpha value of 0.05, V = 0.00, z = -2.37, p = .018. There was a significant increase in the post-readiness to change average scores. A Mann Whitney test was used to analyze the statistically significant difference between the averages in two ACP types and electronic health record documentation (EHR). Staff did not always code (Mdn = 0.00) but they documented in the EHR (Mdn =1.00; 512.00, p = 0.003). ACP discussion was performed 63% of the time during Annual Wellness Visits (AWV), and there was a 49% increase in the EHR documentation. Trained staff are key stakeholders in guiding ACP conversations. They understand the barriers, impact, and consequences related to the lack of advance directives.

The tables and graphs in this chartbook were created using data collected by Camden Public Schools for the school year 2008-2009. Rutgers Center for State Health Policy obtained de-identified data from the schools and computed a BMI score and a BMI percentile (BMIPCT) for each child. Weight status is defined using the following BMIPCT categories.

BMIPCT

BMIPCT < 85

BMIPCT ~ 85

BMIPCT ~ 95

BMIPCT ~ 97

Weight Status

Not Overweight or Obese

Overweight and Obese

Obese

Very Obese

BMIPCT categories are presented at the city level and in sub-group analysis by age, gender, and race. Aggregate data are also presented at the school level, with notation, where representativeness of the data was a concern.

Tables and graphs on pages 5, 7, 9, and 11 show comparisons with national estimates (National Health and Nutrition Examination Survey, 2007-2008). The national data are representative of all 2-19 year old children in the US.

Each graph and table is accompanied by brief summary statements. Readers are encouraged to review the actual data presented in tables and graphs as there is much more detail.

The New Jersey Childhood Obesity Study, funded by the Robert Wood Johnson Foundation, aims to provide vital information for planning, implementing and evaluating interventions aimed at preventing childhood obesity in five New Jersey municipalities: Camden, Newark, New Brunswick, Trenton, and Vineland.

These five communities are being supported by RWJF's New Jersey Partnership for Healthy Kids program to plan and implement policy and environmental change strategies to prevent childhood obesity.

Effective interventions for addressing childhood obesity require community-specific information on who is most at risk and on contributing factors that can be addressed through tailored interventions that meet the needs of the community.

Using a comprehensive research study, the Center for State Health Policy at Rutgers University is working collaboratively with the State Program Office for New Jersey Partnership for Healthy I<ids and the five communities to address these information needs. The main components of the study include:

• A household survey of 1700 families with 3 -18 year old children

• De-identified heights and weights data from public school districts

• Assessment of the food and physical activity environments using objective data

Data books and maps based on the results of the study are being shared with the community coalitions in the five communities to help them plan their interventions.