MountainWise: A Strategic Analysis of Creating Healthier Communities in Southwestern NC Through the Community Transformation Grant Project

The North Carolina Division of Public Health Community Transformation Grant Project aims to create healthier communities by facilitating sustainable policy, systems and environmental change that increase opportunities connected to the four strategic action areas of active living, healthy eating, tobacco free living and community-clinical linkages. The evidence based practices for achieving this work in rural communities is minimal. The work of MountainWise : Region 1 Community Transformation Grant Project seeks to address this need. MountainWise serves the 8 most western counties of North Carolina which are Cherokee, Clay, Graham, Haywood, Jackson, Macon, Swain, and Transylvania. The panel presentation will provide: 1) the strategic vision of the regional work; 2) the relevance and power of a customized external communications plan; 3) the integration Health Impact Assessments for creating healthy communities through improved Comprehensive Plans; and 4) the relevance of conducting a rural healthy eating assessment to improve community nutrition status. MountainWise seeks to create healthier communities by bringing traditional and non-traditional partners to the decision making process for each of the four strategic action areas. Policy, systems, and environmental change approaches are promising and essential to addressing health inequities endured by rural Appalachian communities

Effect of Location on Tracheal Intubation Safety in Cardiac Disease-Are Cardiac ICUs Safer?

OBJECTIVES: Evaluate differences in tracheal intubation-associated events and process variances (i.e., multiple intubation attempts and oxygen desaturation) between pediatric cardiac ICUs and noncardiac PICUs in children with underlying cardiac disease. DESIGN: Retrospective cohort study using a multicenter tracheal intubation quality improvement database (National Emergency Airway Registry for Children). SETTING: Thirty-six PICUs (five cardiac ICUs, 31 noncardiac ICUs) from July 2012 to March 2016. PATIENTS: Children with medical or surgical cardiac disease who underwent intubation in an ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our primary outcome was the rate of any adverse tracheal intubation-associated event. Secondary outcomes were severe tracheal intubation-associated events, multiple tracheal intubation attempt rates, and oxygen desaturation. There were 1,502 tracheal intubations in children with underlying cardiac disease (751 in cardiac ICUs, 751 in noncardiac ICUs) reported. Cardiac ICUs and noncardiac ICUs had similar proportions of patients with surgical cardiac disease. Patients undergoing intubation in cardiac ICUs were younger (median age, 1 mo [interquartile range, 0-6 mo]) compared with noncardiac ICUs (median 3 mo [interquartile range, 1-11 mo]; p\u3c0.001). Tracheal intubation-associated event rates were not different between cardiac ICUs and noncardiac ICUs (16% vs 19%; adjusted odds ratio, 0.74; 95% CI, 0.54-1.02; p = 0.069). However, in a sensitivity analysis comparing cardiac ICUs with mixed ICUs (i.e., ICUs caring for children with either general pediatric or cardiac diseases), cardiac ICUs had decreased odds of adverse events (adjusted odds ratio, 0.71; 95% CI, 0.52-0.97; p = 0.033). Rates of severe tracheal intubation-associated events and multiple attempts were similar. Desaturations occurred more often during intubation in cardiac ICUs (adjusted odds ratio, 1.61; 95% CI, 1.04-1.15; p = 0.002). CONCLUSIONS: In children with underlying cardiac disease, rates of adverse tracheal intubation-associated events were not lower in cardiac ICUs as compared to noncardiac ICUs, even after adjusting for differences in patient characteristics and care models