Hello, my name's Diane Thorson. I'm the Director and Public Health Administrator for Otter Tail County and Fergus Falls, Minnesota. Our county has a population of approximately 58,000 people. We are located in West Central Minnesota. Our county has 1,000 of Minnesota's 10,000 lakes. So we have a lot of recreational opportunities in our county. Which brings with it, public health issues that we need to address. We also have a population that are elderly, so that the little gray bunny depicts the gray, the the graying of our population. Over 34% of our population is over the age of 65. The last little picture there talks about the community. When I look at what are the leading causes of death in Otter Tail County, they are tobacco use, lack of physical activity, not eating enough fruits and vegetables, and a little too much of alcohol consumption. Today we are going to talk about the Omaha System. And I'm going to show you a little bit about how I use it for community assessment, program planning, evaluation and reporting. The Omaha System is a specialized terminology system, that is used to classify problems that we might depict in public health. We can identify specific signs and symptoms. We develop targets and client-specific interventions, and then we can measure outcomes of the client's knowledge, their behavior and their status. My Omaha System Owners Manual comes from two different sources. One is the Omaha System textbook, which has all of the information describing the Omaha System and all of the ack, exact terminology. Every agency needs to have a copy of the Omaha System book that they can refer to. The other resource is the Minnesota Omaha Systems User Group, that is a web based system and we have a group of people around the state of Minnesota, as well as other parts of the United States, and other countries that participate with us on conference calls, to share how we might all use the Omaha system, and improve our use. When I first learned about the Omaha system, I looked at the Omaha system website. And, I participated in one of the meetings and learned about the work that the state of Washington did. They had developed a standardized pathway and a standardized reporting system that was used. I had to ask myself, if the state of Washington could do that, why could we not do that in Minnesota, for capturing our record information and planning public health programs. We've also worked as a user group to expand the use of evidence based practice. A few of our Omaha system programs er, problems have been encoded with evidence based guidelines. And those are available, also, on the website for agencies to pick up and share. I use the Omaha system for community level practice in ways that other agencies in our state have not yet done so. I'm going to give you a little description about our community level care plan for SHIP. We selected the problem healthcare supervision. And in order to keep it straight in our electronic health records system, we added the HIPC in from of it, so I knew that this my community level intervention. We created a pathway for the nurse who was working in this community level practice. To document how she did surveillance, teaching, guidance and counseling, and case management with her clinics. This nurse worked with ten provider clinics in our county, to help them translate evidence-based guidelines into their practice on a day to day basis. The clinics represented a traditional health care clinic, a migrant health center, a federally qualified health center, and a PT and OT standalone clinic, as well as four public health agencies. [COUGH] within the projects, and this care, care plan here talks about individual-level use of the Omaha system, at the public health nurse working at the community level, encouraged our agency to incorporate those same clinical evidence based guidelines into our public health practice. We, again, had to look at ourselves and say, if we're asking our other practitioners in the community to do this kind of work, why are we not doing it with out own public health clients? So we incorporated The Omaha System and the problems of nutrition, physical activity and substance use into our client programs for the Nurse Family Partnership, our Universal Home Visits to first time parents our early childhood screening for three and four year olds, our care coordination for persons on government health plans, and our case management for persons with latent or active tuberculosis. As you can see from the surveillance data for 2012, for nutrition, physical activity and substance use, we identified many of our clients that actually had problems with inadequate diet, inadequate physical activity and/or use of substance use. We had identified another group of people who had potential problems. These are people who may be exposed, or have the issues but they are just not ready to address those. So we've identified those as potential problems. And then there's the people who are not showing any signs and symptoms, and are doing a great job with eating fresh fruits and vegetables, and being physical active and they're not using tobacco. They're not being exposed to secondhand smoke. We classify them as health promotion and we reaffirm and support their efforts to continue those types of behaviors. As a result of these uses in Otter Tail County, this allowed me to compare and to, to begin to tabulate some data for our community assessment. When we aggregated the data on the signs and symptoms using the standardized terminology. We learned that the most common signs and symptoms found in these populations were overweight, inadequate or inconsistent exercise routine, smoking or using tobacco products, sedetary lifestyle, unbalanced diet, inappropriate amount or type of exercise for their age of condition, exposure to cigarette smoke and abnormal results of developmental screening tests, as well as uninsured medical expenses. So, having these standardized definitions of what our problems were we could begin to address program planning. So what did we do wit that information? As a part of our program planning, we trained our staff in motivational interviewing to enhance their skills to address lifestyle behavior issues with their clients. We began working with healthcare providers and dental offices to link their clients to tobacco quit line. We worked with our active living programmers to increase access to parks, sidewalks, and bike trails. We collaborated with the school system for referrals for special education evaluations, and we linked people to the Minnesota health care programs in order to access health insurance. Another use of community level, Omaha system problems is for our disease outbreak investigations, tobacco compliance checks and grant evaluation, as well as additional evidence based pathway development. This is an example of a care plan for a disease outbreak. We in our county follow up on clients who have had an animal bite situation. Our first approach is to look at whether or not they've been exposed to any kind of communicable or infectious condition. In this case, it's rabies. So, we look at what was the situation related to the animal bite, and we determine whether or not the person who has been bitten needs to undergo rabies pro-, post-exposure prax-, profilaxis. Following the 10 day quarantine period, we then put on our public health safety hat and public health nuisance hat, and we begin to address neighborhood and workplace safety. And then we enforce our animal control ordinance to, in order to assure that these animals will not bite again in the future. And that it, people are safe walking, and being out in the community. When we look at it for programming evaluation debt, using the standardized approach of documentation, we found that dogs are our primary source of animal bites. Not surprisingly, but we also have cats or stray, stray cats. In the past, we've even had animal bites from tigers, and other rare animals. We have a legal system to enforce our animal control ordinates. If it's a first bite, the person gets a warning and said reminds them that we have an animal ordinance, and then if we have a second bite, we have to in, hold an animal control hearing. And you can see that we had to do some hearings as well as some followup. And then we look to see whether or not the animal has been updated with the and whether they are current on their rabies vaccine. As a result of this data, we've been looking at ways that we need to, update our animal control ordinance and that is a process that is currently in, under, being undergoing. Another infectious condis, condition is Perinatal Hepatitis B. In Minnesota we receive funding from the State Health Department to follow up with women who haven been diagnosed with perinatal hepatitis B. There's two levels of intervention here. We have the, the followup with the individual, which is with the young lady who has been diagnosed with perinatal hepatitis B, and followup of the infant after delivery. At the bottom of the screen shows a community-level intervention And that is our work with the clinician in order to make sure that they are following through an evidence based guidelines and treatment and follow-up for this woman. We use it for enforcement of other ordinances, another pathway that we have developed is for our tobacco compliance checks. We, in this case the problem is substance use, and we are looking at, or surveilling as to whether they're passing the tobacco compliance check, and then we have to do teaching guidance and counseling regarding consequences of the ordinance violation. And then if there is a violation, we do case management to enforce the ordinance provision. Again, looking at the data, we find in this case that we had two cli, of our organizations that had now reached their third violation. Our interventions for case management at this point is to send letters out by certified mail. And then we have to take in a firm compliance and whether or not they have paid the monetary fine as a result of our ordinance and enport, enforcing the ordinance for compliance. Another area that I've been using the system for at the community level, is for my grant documentation. To look at this way, I can keep track of what it is that I'm doing as a project manager as a part of grants. So for example, am I looking at correspondence, am I making agendas, doing minutes, am I doing other am I actually at the work group meeting, am I doing grant activities, reporting that type of thing? Things that are specific related to your grant, or maybe a contract could be captured and documented in the Omaha system using health care supervision as your problem. Future uses of the Omaha system, we're looking at how we might increase the use of the Omaha system data for public health grant reporting. We want to partner with researchers to analyze data to determine which interventions have the most impact. We are currently in a study with the University of Minnesota, to look at some our data related to our CHIP interventions and the pr, providers that I mentioned earlier in the presentation. And then, we've had, there's been studies done where we've have used the Omaha System to determine caseload ratios for employees from that study. And that needs to be replicated to see if it can be used in other population groups. But you find that the more problems that the person has, that the nurse is dealing with. That lower the case load ration might need to be for that type of situation.
