Prevention/Care Management, 2008
New York City Department of Health and Mental Hygiene
The New York City Department of Health and Mental Hygiene (DOHMH) has incorporated U.S. Preventive Services Task Force recommendations into the development of materials for an educational outreach program, known as Public Health Detailing. This program works with primary care providers to improve patient care relating to key public health challenges.
Modeled after the pharmaceutical sales approach, health department representatives promote clinical preventive services and chronic disease management through the delivery of brief, targeted messages to health care providers and staff at their practice sites. The Public Health Detailing Program builds on the DOHMH's extensive experience in medical provider education, health care quality improvement, and community-based health promotion.
The Detailing Program is organized around specific clinical topics, chosen largely because of their anticipated impact on morbidity and mortality. Each campaign targets a limited number of key recommendations, rather than a full set of guidelines. The messages identify specific DOHMH recommendations about actual and best practices. The Task Force recommendations were used in all campaigns except colon cancer screening. In that instance, the local recommendation was more stringent than the Task Force recommendation.
"Detailing Action Kits" containing clinical tools, provider resources, and patient education materials to promote evidence-based best practices are distributed during visits. The Action Kits support the key recommendations of the campaign and are designed to have the look and feel of a commercially developed product in order to compete with private industry materials. The Action Kits include, but are not limited to, the following materials:
- Clinical tools (flow sheets, reminder stickers, and self-administered questionnaires) to support delivery of evidence-based care.
- Peer-reviewed journal articles and guidelines on evidence-based care.
- Patient education materials (brochures, posters, and 2 x 3-inch "palm cards").
The Adult Preventive Care Flow Sheet—based on the Task Force recommendations, as well as the "Take Care New York 10" priority indicators—is a clinical tool designed for use with all patients and is included in the Action Kit for any campaign targeting a clinical preventive service. This Flow Sheet has been one of the most requested pieces by health care providers. It allows health care providers and their staff to document all pertinent preventive services in a single place in the chart. It includes recommended screenings and tests, immunizations, health counseling, and certain screening tools including BMI, depression, and alcohol screening, among others. Many sites have adapted the Department's Flow Sheet in either electronic or hard copy for their own unique needs.
The program targets three communities in New York City burdened by poor health: East and Central Harlem, North and Central Brooklyn, and the South Bronx. There are approximately 240 primary care practices in these areas. Public health offices in each of these neighborhoods serve as the home of the Public Health Detailing Program.
The initial campaigns conducted in 2003 and 2004 focused on influenza vaccination, colon cancer screening, and smoking cessation. During these first campaigns, over 2,500 one-on-one interactions were completed by six Health Department representatives at approximately 200 sites. Subsequent campaigns have included asthma, diabetes, contraception, hypertension, depression screening, cholesterol, alcohol screening/brief intervention, HIV testing, electronic health records, identifying and reporting child abuse and neglect, the New York City Nurse-Family Partnership, and adult obesity.
Since being launched in 2003, the Detailing Program has grown beyond the three targeted neighborhoods and now includes several city-wide campaigns. These city-wide efforts have included campaigns for tobacco cessation, diabetes, and HIV testing. The success of the program has also attracted the interest of the New York State Department of Health.
All DOHMH representatives undergo extensive training in disease content as well as selling and communication skills. Most of these individuals have a public health background and are further trained to promote clinical preventive services and chronic disease management. In the visits made to a clinical setting, Health Department representatives spend, on average, 10 to 12 minutes with each health care provider and staff person they contact in the practice. This is known as the "total office call."
The Public Health Detailing Program is part of the Department's Division of Health Promotion and Disease Prevention, Bureau of Chronic Disease Prevention and Control, Clinical Systems Improvement Unit.
All materials from this program are publicly available. For more information on the Public Health Detailing Program and to view or download all the previous as well as current Action Kits, visit: http://www.nyc.gov/health/publichealthdetailing.
The Adult Preventive Care Flow Sheet can be viewed at: http://home2.nyc.gov/html/doh/downloads/pdf/csi/hyperkit-clin-ptvcare-flowsht.pdf [PDF File, 70 KB; Plugin Software Help].
Impact Case Study Identifier: CP3 08-11
AHRQ-Sponsored Activity: U.S. Preventive Services Task Force (USPSTF)
Scope: New York
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Current as of September 2009
Impact Case Studies and Knowledge Transfer Case Studies: Prevention/Care Management, 2008. September 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/casestudies/pcm/pcm2008.htm