Prevention Agenda 2013-2018: New York State's Health Improvement Plan

Appendix 1: Preventing Chronic Diseases Action Plan Indicators

Indicator	Data Source	Frequency	Geographic Granularity	Sub-Populations	Baseline (Year)	Target for 2018 (Method)
Focus Area 1: Reduce obesity in children and adults
The percentage of WIC children (ages 2 through 4) who are obese (Overarching Objective 1.0.1)	Data Source: NYS Pediatric and Pregnancy Nutrition Surveillance System [PedNSS]	Annually	Reported by county Collected by WIC Provider	Race/ethnicity % Poverty	13.1% (2010)	12.4% (5% reduction)
The percentage of public school children in New York State reported to the Student Weight Status Category Reporting who are obese (Overarching Objective 1.0.1)	NYS Student Weight Status Category Reporting [SWSCR]	Reported Bi-Annually Collected annually	Reported by school district and county Collected by schools	NA	17.6% (2010-12)	16.7% (5% reduction)
The percentage of public school children in New York City represented in the NYC Fitnessgram who are obese (Overarching Objective 1.0.1)	NYC Fitnessgram	Annually	Reported by borough Collected by schools	Race/ethnicity Participation in free/reduced meal program	20.7% (2010-11)	19.7% (5% reduction)
The percentage of adult New Yorkers ages 18 years and older who are obese (and among adults with income of <$25,000 and adults with disabilities) (Overarching Objective 1.0.2)	NYS Behavioral Risk Factor Surveillance System [BRFSS]	State - Annually County – every 5 years	Statewide NYC/ROS County	Race/ethnicity Income Education Disability	All adults: 24.2% Low income: 26.7% Disabilities: 32.5% (2011)	All adults: 23.0% (5% reduction) Low income: 25.4% (5% reduction) Disabilities: 29.3% (10% reduction)
The percentage of adults who consume one or more sugary drinks per day (and among adults with income of <$25,000) (Goal 1.1; Objective 1.1.1)	NYS Behavioral Risk Factor Surveillance System [BRFSS]	State - Bi-Annually	Statewide NYC/ROS County	Race/ethnicity Income Education Disability	All adults: 20.5% Low income: 42.9% (2009)	All adults: 19.5% (5% reduction) Low income: 38.6% (10% reduction)
Indicator Data Source Frequency Geographic Granularity Sub-Populations Baseline (Year) Target for 2018 (Method) than a high school education) (Goal 1.1; Objective 1.1.2)		5 years		Disability	59.0% Disabilities: 49.9% (2011)	(10% improvement) Disabilities: 54.9% (10% improvement)
The number of municipalities that have passed complete streets policies (Goal 1.1; Objective 1.1.3)	Tri-States Transportation Campaign	Updated Regularly	Municipality County Statewide	NA	23 (2011)	46 (100% improvement)
Increase the number of school districts whose competitive food policies meet or exceed Institute of Medicine recommendations (Goal 1.2; Objective 1.2.1)	Local Wellness Policy Database (NYSDOH/NYSED)	To be updated Annually	School District County Statewide	NA	Not yet available (2012)	TBD
The number of school districts that meet or exceed NYS regulations for Physical Education (Goal 1.2; Objective 1.2.2)	Office of the New York State Comptroller; New York State Department of Education	Periodic Audits (OSC) Ongoing Collection (NYSED)	School District County Statewide	NA	5% compliance (2008)	TBD
The percentage of children and adolescents ages 3 through 17 years who had an outpatient visit with a primary care provider or obstetrics/gynecology practitioner during the measurement year, receiving appropriate assessment for weight status (Goal 1.3; Objective 1.3.1)	NYS Quality Assurance Reporting Requirements [eQARR]	Bi-Annually	Statewide Health Plan Provider Region	Race/ethnicity Participation in Medicaid or Child Health Plus	Commercial MC: 58% MMC or CHP: 72% (2011)	Commercial MC: 75% (29% improvement) MMC or CHP: 75% (5% improvement)
The percentage of infants born in NYS hospitals who are exclusively breastfed during the birth hospitalization (Goal 1.3; Objective 1.3.2)	Electronic Birth Certificate Bureau of Biometrics and Biostatistics, NYSDOH; NYC Office of Vital Records, NYC DOHMH	Annually	Statewide County Hospital Specific	Race/Ethnicity Participation in Medicaid or Child Health Plus WIC Participation	43.7% (2011)	48.1% (10% improvement)
The percent of small to medium worksites that offer a comprehensive worksite wellness program for all employees and that is fully accessible to people with disabilities (Goal 1.4; Objective 1.4.1)	NYSDOH Healthy Heart Program Worksite Survey	Every 5 years	Statewide; Criteria for determining comprehensive can be applied to individual worksites	NA	Not yet available	TBD (10% improvement)
The percent of employers with supports for breastfeeding at the worksite (Goal 1.4; Objective 1.4.2)	NYSDOH Healthy Heart Program Worksite Survey	Every 5 years	Statewide; Criteria for determining comprehensive can be applied to individual worksites	NA	Not yet available	TBD (10% improvement)
Focus Area 2: Reduce illness, disability and death related to tobacco use and secondhand smoke exposure
The prevalence of any tobacco use by high school age students (Goal 2.1; Objective 2.1.1)	NYS Youth Tobacco Survey	Collected Bi-Annually (even years)	Statewide New York City (NYC includes the 5 counties of Bronx, Kings, New York, Queens, and Richmond) and Rest of State (ROS)	Gender Race/ethnicity Grade (6-8 & 9-12)	21.2% (2010)	15.0% (30% reduction)
The prevalence of any cigarette smoking by adults ages 18 to 24 years (Goal 2.1; Objective 2.1.2)	NYS Behavioral Risk Factor Surveillance System [BRFSS]	Collected Annually	Statewide NYC/ROS County	Gender Race/ethnicity Income Education Disability	21.6% (2011)	18.0% (17% reduction)
Increase the number of municipalities that restrict tobacco marketing (including display bans, density and proximity to schools) (Goal 2.1; Objective 2.1.3)	Community Activity Tracking, CAT	Collected continually; reported Annually	Statewide	N/A	0 (2011)	10 (Improvement)
The number of unique callers to the NYS Smokers' Quitline (Goal 2.2; Objective 2.2.1)	NYS Smokers' Quitline Annual Report	Collected Annually	Counties	Gender Race/ethnicity Age group Income Education Insurance Disability	163,428 (2011)	200,000 (22% improvement)
The prevalence of cigarette smoking among all adults (and among adults with income less than $25,000 and adults with poor mental health) (Goal 2.2; Objective 2.2.2)	NYS Behavioral Risk Factor Surveillance System [BRFSS]; NY Adult Tobacco Survey	Collected Annually	Statewide NYC/ROS County	Gender Race/ethnicity Age group Income Education Disability	All adults: 18.4% Low income: 27.8% Poor mental health: 31.2% (2011)	All adults: 15.0% (18% reduction) Low income: 20% (30% reduction) Poor mental health: 26.5% (15% reduction)
The utilization of smoking cessation benefits among smokers who are members of Medicaid Managed Care plans (Goal 2.2; Objective 2.2.3)	Medicaid	Collected continually; Reported Annually	Counties	Race/ethnicity Income	17% (2011)	41% (141% improvement)
The percentage of adults who report being exposed to secondhand smoke during the past 7 days (Goal 2.2; Objective 2.3.1)	NYS Adult Tobacco Survey	Fielded Quarterly; Reported Annually	Statewide NYC/ROS	Gender Race/ethnicity Age group Income Education Insurance	27.8% (2009)	20.0% (28% reduction)
The number of Local Housing Authorities that adopt a tobacco-free policy for all housing units (Goal 2.3; Objective 2.3.2)	Community Activity Tracking, CAT	Collected continually; Reported Annually	Statewide	N/A	3 (2012)	12 (400% improvement)
Focus Area 3: Increase access to high quality chronic disease preventive care and management
The percentage of women aged 50 to 74 with an income of <$25,000 who receive breast cancer screening based on the most recent clinical guidelines (mammography within past 2 years) (Goal 3.1; Objective 3.1.1)	NYS Behavioral Risk Factor Surveillance System [BRFSS]	Collected Bi-Annually (even years)	Statewide	Race/ethnicity Income Education Disability	76.7% (2010)	80.5% (5% improvement)
The percentage of women aged 21 to 65 years with an income of <$25,000 who receive a cervical cancer screening based on the most recent clinical guidelines (Pap test within the past 3 years) (Goal 3.1; Objective 3.1.2)	NYS Behavioral Risk Factor Surveillance System [BRFSS]	Collected Bi-Annually (even years)	Statewide	Race/ethnicity Income Education Disability	83.8% (2010)	88.0% (5% improvement)
The percentage of all adults (50-75 years) and those with an income of <$25,000, who receive a colorectal cancer screening based on the most recent clinical guidelines (blood stool test in the past year or sigmoidoscopy in the past 5 years and a blood stool test in the past years or a colonoscopy in the past 10 years) (Goal 3.1; Objective 3.1.3)	NYS Behavioral Risk Factor Surveillance System [BRFSS]	Collected Bi-Annually (even years)	Statewide	Gender Race/ethnicity Income Education Disability	All >50 adults: 68.0% Low income: 59.4% (2010)	71.4% (5% improvement) 65.4% (10% improvement)
The percentage of adults 18 years of age and older who had a test for high blood sugar or diabetes within the past three years (Goal 3.1; Objective 3.1.4)	NYS Behavioral Risk Factor Surveillance System [BRFSS]	Collected Annually	Statewide	Age group Race/ethnicity Income Education Disability	58.8% (2011)	61.7% (5% improvement)
The rate of asthma emergency department visits among NYS residents ages 0-4; 5-64; and 65+ years (and all residents)) (Goal 3.2; Objective 3.2.1)	New York Statewide Planning & Research Cooperative System [SPARCS]	Rolling data collection; Rates calculated Annually (As 3-year moving averages)	Statewide Region County	Age group Gender Race/ethnicity	0-4y: 218.3 per 10,000 5-64y: 81.6 per 10,000 65+y: 31.4 per 10,000 (2007-09) all ages: 83.4 per 10,000 (2007-09)	0-4y: 156.9 per 10,000 (28% reduction) 5-64y: 65.4 per 10,000 (20% reduction) 65+y: 22.3 per 10,000 (29% reduction) all ages: 75.1 per 10,000 (10% reduction)
The rate of asthma hospital discharges among NYS residents ages 0-4; 5-64; 65+ years (Goal 3.2; Objective 3.2.2)	New York Statewide Planning & Research Cooperative System [SPARCS]	Rolling data collection; Rates calculated Annually (As 3-year moving averages)	Statewide Region County	Age group Gender Race/ethnicity	0-4y: 58.8 per 10,000 5-64y: 15.5 per 10,000 65+y: 31.2 per 10,000 (2007-09)	0-4y: 38.5 per 10,000 (35% reduction) 5-64y: 11.9 per 10,000 (23% reduction) 65+y: per 25.8 10,000 (17% reduction)
The percentage of health plan members, ages 5 to 64 years, with persistent asthma who were dispensed appropriate asthma controller medication for at least 50% of the treatment period (Goal 3.2; Objective 3.2.3)	NYS Electronic Quality Assurance Reporting Requirements [eQARR]	Reported Bi-Annually (Odd years)	Statewide Region	Plan type (Medicaid vs. Commercial managed care) For MMC enrollees only: By gender, age, race/ethnicity	MMC or CHP: 58% Commercial MC: 65% (2012)	MMC or CHP: 65% (12% improvement) Commercial MC: 71.5% (10% improvement)
The percentage of health plan members, ages 18 to 85 years, with hypertension who have controlled their blood pressure (below 140/90) (Goal 3.2; Objective 3.2.4)	NYS Electronic Quality Assurance Reporting Requirements [eQARR]	Reported Bi-Annually (Odd years)	Statewide Region	Plan type (Medicaid vs. Commercial managed care) For MMC enrollees only: By gender, age, race/ethnicity	Commercial MC: 63% MMC: 67% Black adults among MMC: 58% (2011)	Commercial MC: 69.3% (10% improvement) MMC: 72% (7% improvement) MMC among black adults: 66.7% (15% improvement)
The age-adjusted rate of hospitalization for heart attack among NYS residents (Goal 3.2; Objective 3.2.5)	New York Statewide Planning & Research Cooperative System [SPARCS]	Rolling data collection; Rates calculated Annually (As single year rates)	Statewide Region County	Age group Gender Race/ethnicity	16.0 per 10,000 (2010)	14.4 per 10,000 (10% reduction)
The percentage of health plan members with diabetes whose blood glucose is in good control (hemoglobin A1C less than 8.0%) (Goal 3.2; Objective 3.2.6)	NYS Electronic Quality Assurance Reporting Requirements [eQARR]	Reported Bi-Annually (Odd years)	Statewide Health Plan Provider Region	Plan type (Medicaid vs. Commercial managed care) For MMC enrollees only: By gender, age, race/ethnicity	MMC: 58% Commercial MC: 55% Black adults among MMC: 56% (2009)	MMC: 62% (7% improvement) Commercial MC: 60.5% (10% improvement) Black adults among MMC: 62% (10% improvement)
The percentage of Medicaid Managed Care plan members who received all four screening tests for diabetes (HbA1c testing, lipid profile, dilated eye exam and nephropathy monitoring) (Goal 3.2; Objective 3.2.7)	NYS Electronic Quality Assurance Reporting Requirements [eQARR]	Reported Bi-Annually (Odd years)	Statewide Health Plan Provider Region	Plan type (Medicaid vs. Commercial managed care) For MMC enrollees only: By gender, age, race/ethnicity	All adults w/ diabetes: 50% Black adults w/ diabetes: 45% Non-Hispanic white adults w/ diabetes: 46%	All adults with diabetes: 52.5% (5% improvement) Black adults with diabetes: 49.5% (10% improvement) Non-Hispanic white adults with diabetes: 50.6% (10% improvement)
Reduce the rate of hospitalizations for short-term complications of diabetes (Goal 3.2; Objective 3.2.8)	New York Statewide Planning & Research Cooperative System [SPARCS]	Rolling data collection; Rates calculated Annually (As single-year rates)	Statewide Region County	Age group Gender Race/ethnicity	6-17y: 3.4 per 10,000 18+y: 5.4 per 10,000 (2007-09)	6-17y: 3.06 per 10,000 (10% reduction) 18+y: 4.86 per 10,000 (10% reduction)
The percentage of adults with arthritis, asthma, cardiovascular disease, and/or diabetes who have taken a course or class to learn how to manage their condition (Goal 3.3; Objective 3.3.1)	NYS Behavioral Risk Factor Surveillance System [BRFSS]	Collected Annually (beginning in 2013)	Statewide NYC/ROS County	Type of chronic condition Age group Race/ethnicity Income Education Disability	Not yet available (2013)	TBD (5% improvement)
The percentage of adults with current asthma who have received a written asthma action plan from their health care provider (Goal 3.3; Objective 3.3.2	NYS Behavioral Risk Factor Surveillance System [BRFSS]	Collected Annually	Statewide	Age group Race/ethnicity Income Education Disability	29% (2010)	40% (38% improvement)

Note: The Prevention Agenda 2013-2017 has been extended to 2018 to align its timeline with other state and federal health care reform initiatives.