Baseline Data Collection in New York

One program's response to low colon cancer screening rates

Rhonda Soberman, Manager of Program Development of VNSNY, talks about baseline data results in Chinatown and the NNORC program's response.

In 2006-07, working with the New York City Department for the Aging and the New York State Office for the Aging, the United Hospital Fund trained staff at all 54 NORC programs in New York State to conduct the Fund’s Health Indicators in NORC Programs Initiative survey process.  The New York programs administered the questionnaire over a three-month period to their clients seen in the regular course of their work. Interviews were conducted in person at the NORC program offices or in clients’ homes, and took approximately 15 minutes to administer.

A total of 6,333 surveys were completed in New York State, representing 44% of the client caseloads across the NORC programs.  The results provided a picture of the health status and health risks of older adults living in communities with NORC programs.    For the first time, each NORC program (as well as NYC’s Department for the Aging and NY State Office for the Aging) had information about the most prevalent health risks in its community, and learned how seniors were faring.

The data collected identified and described the characteristics of the clients served by the NORC programs, identified the most prevalent health conditions, and explored differences by demographic characteristics and health condition. The United Hospital Fund worked with the NORC programs to help them analyze the data to begin a conversation with community stakeholders about the findings. Each NORC program was given comparative city, state, and national data, when available, in a standard format that arrayed program findings and comparative data for easy sharing with program partners and community stakeholders.

Results
From the baseline data collected in New York City (5,069 surveys administered), three major health issues emerged: heart disease, diabetes, and falls.   Other highlights of the baseline survey include:

Demographics: The 5,069 seniors surveyed were predominantly female (76%), lived alone (58%), and were white non-Hispanic (56%); 37% were either black non-Hispanic or Hispanic. Sixty-six percent were between the ages of 65 and 84, and 26% were 85 or older. NORC programs in New York City Housing Authority developments had a high concentration of ethnic minorities (72% non-white) and a higher concentration of younger residents than seen in other developments  (i.e., private, moderate-income): 51% versus 27% 60-74 years old; 48% versus 72% 75 or older.

Access to Health Care: Nearly all the seniors surveyed had primary health insurance coverage (99%) as well as prescription drug coverage (95%). Most had a usual source of care (96%); among those, virtually all had seen their doctor at least once in the past year, and 22% had seen their provider seven times or more over the year. Thirty-four percent had used an emergency room in the past year, and 13% or approximately a third of them had done so more than once .

Health Promotion and Disease Prevention: Respondents in the 65+ age group were slightly more likely to rate their health fair to poor (46%) than the 65+ population of New York City as a whole (40%). These figures exceeded the statewide rate (28%) and the national rate (26%), a difference that held true even when including younger respondents by expanding the age group to 60+.  A self-reported health status of “fair to poor” was much more common among those with a chronic health condition; for example, 57% of those with diabetes and 62% of those with heart disease reported their health was “fair to poor.”   

Almost all the clients surveyed (96%) reported taking at least one medication, and 15% reported taking ten or more. In 2007, the group had higher rates of flu immunization (77%) and pneumonia vaccination (58%) than the citywide rates (57%, and 48%, respectively). 96% of the women surveyed had had a mammogram, and 76% of all seniors surveyed had had a colonoscopy, compared to a citywide rate of 33% for people over 65.

Chronic Conditions: 84% of seniors surveyed reported having at least one chronic condition. Overall, 25% had diabetes, 32% had heart disease, 66% had hypertension, 20% had lung disease or breathing problems, 26% were overweight or obese, 12% had had a stroke (in two NORC programs, 20% or more), 63% had arthritis, 32% had osteoporosis, and 27% had fallen in the past 12 months.

Quality Improvement
New York City’s NORC programs are currently using this information to focus their efforts on improving the management of heart disease, diabetes, or risk for falls.  Programs are following best practices and clinical guidelines in what older adults must do to manage and maintain their health (self-care), what the medical providers must do to effectively address the health issues of the residents (medical care), and what supports and services need to be available in the community to help older adults (community supports). The programs are focusing their efforts specifically on Knowing and Managing the Relevant Clinical Measures, Appropriate Medication Management, Health Care Maintenance, Diet and Physical Activity, and Education and Information.  In 2011, the United Hospital Fund intends to add quality improvement tools and processes to the Health Indicators section.    

 
 
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