Arthritis Action Plan
IX. Strategic Directions
The New York State Arthritis Plan adopts the three action framework areas published in the National Arthritis Action Plan (NAAP) (1) Surveillance, Epidemiology and Prevention Research; (2) Communication and Education; and (3) Programs, Policies and Systems as strategic directions. Within each of these categories, a corresponding set of goals and objectives has been formulated to articulate future priorities for arthritis disease management in the State of New York.
The Arthritis Coalition has delineated nine priority goals, identified in bold italics, which are identified under each strategic direction that it will focus on over the course of the next 2-3 years. Notably, concentration has been placed upon health education and communication, obtaining an accurate estimate of the prevalence and cost of arthritis and related diseases in New York State, continuing the implementation of proven interventions, and policy development that emphasizes "best practice" approaches to arthritis and related diseases.
The Centers for Disease Control and Prevention (CDC) places the highest priority for initial state arthritis program efforts on increasing the quality of life for people with arthritis, focusing on the reduction of pain and disability.
Strategic Direction Number One:
Programs
* Goal: By 2008, design and implement a protocol to evaluate NYS implementation of proven interventions such as the ASHC, PACE, and Aquatics program.
Objectives:
1. An evaluation protocol will focus on program effectiveness including behavior changes such as increase in physical activity, mood changes, and ADL accomplishments.
2. Results of the evaluation will be analyzed and disseminated to stakeholders and funding source.
NAAP Guiding Principle
"We must have a system of health services that bridges medical, voluntary, and public health agencies… community norms that promote prevention and improved quality of life…( and) a well trained public health workforce to implement a national arthritis prevention effort."
(Source: CDC)
* Goal: By 2008, increase the number of programs that address arthritis and related diseases in both rural and urban settings.
Objectives:
1. Identify the programs that address arthritis for baseline data.
2. Target under-served areas.
3. Engage the community with creative, grassroots collaborations.
4. Identify successful models such as the "Healthy Heart" initiative.
5. Communicate with decision-makers using data to stimulate their advocacy.
6. Expand awareness of arthritis and its related diseases among young people.
7. Work across multiple programs to communicate and educate populations.
8. Leverage resource networks in creative and collaborative ways.
* Goal: Through 2010, increase the number of participants in Arthritis Self Help Course (ASHC), Persons With Arthritis Can Exercise (PACE), and aquatics programs.
Objectives:
1. Identify current levels of participation as baseline data.
2. Develop additional trainers and community leaders by working with local professionals, health care specialists, staff from the YMCA and YWCA and after school program coordinators.
3. Collaborate with other agencies in under-served areas. 4. Develop an outreach plan. 5. Enlist the aid of physicians, other health professionals, and health insurers.
* Goal: Through 2010, increase physical activity among people with arthritis and related diseases.
Objectives:
1. Increase awareness of the need for more physical activity; describe activities consistent with disease prevention and symptom moderation.
2. Identify community programs geared toward exercise, walking and other appropriate physical activities.
3. Identify stakeholders and target messages to them.
4. Distribute information on resources and access.
5. Develop additional physical activity programs based on geographic and program gaps.
6. Publish guidelines for community fitness programs to enable them to accommodate persons with arthritis.
7. Educate physicians on the importance of prescribing physical activity to patients.
8. Investigate the cost associated with patient counseling and identify reimbursement mechanisms.
9. Work with existing state and local efforts directed at physical activity and nutrition such as the NYSDOH Physical Activity and Nutrition (PAN) Program.
NAAP Guiding Principle
"Efforts must be expanded beyond data and communication to modify our social systems to deal appropriately with arthritis… We must have supportive policies to establish an environment conducive to preventive efforts."
(Source: CDC)
* Goal: Through 2010, coordinate a chronic disease model that includes arthritis and related disease education, prevention, intervention, and treatment options.
Objectives:
1. Formulate and conduct a statewide needs assessment on the state of programs and services to the designated population.
2. Develop a care model and identify funding, access and ease of use.
3. Develop an alliance of organizations to advance the model.
4. Identify experts and specialists for the model program.
5. Capture support for "best practices" from stakeholder groups: public, private, and voluntary organizations, employers, insurers, health care providers, consumers, governmental representatives, and relevant industry representatives.
Strategic Direction Number Two:
Health Education and Health Communication
* Goal: By 2008, persons with arthritis and related diseases and their families know, practice and support disease management behaviors.
Objectives:
1. Provide arthritis information kits to physician offices, pharmacies, health insurers, libraries, and medical and professional associations.
2. Encourage individuals with arthritis and related diseases to become advocates at home, work, and in social settings to expand the public's awareness of and identification with the disease.
3. Provide culturally sensitive educational materials in multiple literacy levels and languages to diverse ethnic populations.
4. Disseminate published, informative clinical study information.
NAAP Guiding Principle
For all audiences:
- Use factual information.
- Use correct and consistent terminology.
- Convey that something can be done about arthritis.
(Source: CDC)
* Goal: By 2008, identify underserved groups lacking accurate knowledge of the nature of arthritis and related diseases and provide effective treatment interventions.
Objectives:
1. Partner with community-based organizations, providers, and health insurers to develop strategies to reach targeted populations to educate and motivate toward treatment and healthier behaviors.
* Goal: Through 2010, increase the understanding of arthritis and related diseases among health providers and insurers, medical and professional associations, and other allied health professionals in NYS.
Objectives:
1. Promote the inclusion of courses on arthritis and related diseases in NYS medical school curricula.
2. Integrate Continuing Medical Education (CME) credits for physicians and allied health personnel, for arthritis and related diseases education, into provider education opportunities.
3. Provide educational information for a full range of health personnel to improve understanding of arthritis and related diseases.
4. Support best practices and effective treatments, education, and coordination of care in medical delivery systems.
* Goal: Through 2010, improve the publics' knowledge about arthritis, including its prevention and treatments.
Objectives:
1. Include information on arthritis prevention and arthritis and related diseases in health education in the public schools.
2. Develop an effective "Speakers Bureau".
3. Develop linkages with corporate wellness programs.
4. Outreach to religious and social groups.
5. Design culturally sensitive, educational materials including different literacy levels and multiple languages appropriate to NYS ethnic populations.
6. Use public service announcements.
7. Use printed space on pharmacy bags for targeted messages about the disease.
8. Publish articles in health and fitness magazines.
9. Identify and partner with other organizations and programs that reach people at increased risk for arthritis and related diseases to incorporate arthritis prevention activities and behavior modification.
* Goal: Through 2010, develop and disseminate published material designed to reach a variety of targeted populations in NYS (consumers, educators, physicians and other allied health professionals). Communicate that arthritis and related diseases are serious public health problems expected to impact growing numbers of persons as the population ages. Endorse effective interventions when scientific or other credible bases for these therapies exist.
Objectives:
1. Use health communication media such as print, radio, the Web, public service announcements, and community outreach to the public, e.g., sponsored forums and educational and health related presentations.
2. Explore areas of collaboration such as designating spokespersons for some messages, and collaboration on specific Arthritis Foundation campaigns.
NAAP Guiding Principle
"Health communications is designed to increase awareness, the first important step in changing behavior."
(Source: CDC)
Strategic Direction Number Three:
Surveillance and Epidemiology
* Goal: By 2008, document a more accurate estimate of the number of people in NYS with arthritis and related diseases.
Objectives:
1. Continue to have an arthritis module in the core questions of the New York State Behavioral Risk Factor Surveillance System (BRFSS) and, if available, its expanded counterpart (E-BRFSS) as was recently accomplished in 2003. Ensure that the BRFSS and E-BRFSS modules require respondents to identify the type of arthritis or related disease they are reporting.
2. Continue to use relevant QARR data from managed care organizations as was recently accomplished in 2003.
3. Explore the relevance of other data sources such as Medicaid and hospital systems.
NAAP Guiding Principle
"Surveillance, epidemiology, and prevention research are the scientific tools of public health. These tools are used to obtain accurate and reliable data, identify knowledge gaps and ways to address them, and make provisions for disseminating data to appropriate people."
(Source: CDC)
* Goal: Through 2010, describe people who may be at risk of developing arthritis and, especially, related diseases for the purpose of identifying risk factors and developing a better understanding of the diseases.
Objectives:
1. Work with rheumatologists to help them to identify risk factors among their patients.
2. Work with physicians (including internists, family practitioners, and pediatricians) and health insurers to identify trends and changes they are seeing in the population with arthritis and related diseases.
3. Analyze BRFSS and E-BRFSS data as published and made available.
4. Capture the racial/ethnic characteristics of people with arthritis by utilizing existing data.
* Goal: Through 2010, assess programs serving people with arthritis and related diseases to identify gaps.
Objectives:
1. Develop data from hospitals, Arthritis Foundation chapters, health insurers, other providers and advocacy groups concerning programs and services offered, numbers of persons using programs, geographic distribution of these programs, and gaps in services.
2. Work with stakeholder groups to identify other potential service providers, assess programs and services offered, numbers of persons using programs, geographic distribution of these programs, and gaps in services.
* Goal: Through 2010, explore a statewide arthritis and, especially, related diseases database.
Objectives:
1. Explore funding and grant opportunities for the design, development and maintenance of the database.
NAAP Guiding Principle
- To obtain better scientific information.
- To disseminate that information to those who need to know.
- To translate information into action.
(Source: CDC)
Strategic Direction Number Four:
Prevention Research
* Goal: By 2008, assess arthritis-related health issues in the work place that impact the workforce.
Objectives:
1. Partner with the Center for Health Workforce Studies at SUNY Albany.
2. Develop a plan to share the results of such an assessment
* Goal: By 2008, develop evidence-based information about the effectiveness and implementation of NYS Arthritis Program activities.
Objectives:
1. Evaluate the implementation of the proven interventions (ASHC, PACE, AF Aquatics) offered by the Arthritis Program.
2. Develop evaluation plan methods and outcome indicators.
3. Identify collaborators and resources.
* Goal: Through 2010, analyze arthritis and related diseases, with direct and indirect cost estimates for counties. Use Statewide Planning and Research Cooperative System (SPARCS) data.
Objectives:
1. Identify potential collaborators to conduct an economic analysis.
2. Refine objectives of data analysis in an analysis plan.
3. Seek resources to conduct analysis.
* Goal: Through 2010, better understand the factors that motivate people to engage in physical activity, and apply motivational models among people with arthritis and related diseases.
Objectives:
1. Collaborate with SUNY Albany School of Public Health and others on research in this area and develop a community-based demonstration project related to physical activity.
2. Work with existing state and local efforts directed at physical activity and nutrition such as the NYSDOH Physical Activity and Nutrition (PAN) Program.
Strategic Direction Number Five:
Policy
* Goal: Through 2010, policy for arthritis and related disease management integration will focus on availability, accessibility and affordability of prevention and treatment.
Objectives:
1. Identify barriers to care such as access to providers, access to health insurance, access to accurate information, and case management coordination, and steps to alleviate the barriers.
2. Capture support from stakeholders to carry out the identified action steps such as, but not limited to, enlisting health insurers to adapt relevant goals from the NYS Arthritis Plan into their medical benefit programs, networking with county health departments, and partnering with Area Health Education Centers (AHECs) to disseminate arthritis and related disease information.
3. Emphasize components and values identified in the NAAP in the developed policies.
* Goal: Through 2010, coordinate chronic disease health policy and include arthritis and related diseases.
Objectives:
1. Explore current policy of other state chronic disease programs both within NYS and in other states and identify references to arthritis and related diseases.
2. Collaborate with other NYS chronic disease programs to incorporate arthritis and related disease information into their policies, if applicable, or develop and introduce policy that incorporates other chronic diseases and arthritis.
NAAP Guiding Principle
"Structure health communication messages and health education about arthritis to reach three broad audiences: the public, people with arthritis and their families, and health professionals."
(Source: CDC)
