Shared responsibility for community indicators of child health a view from the hospital

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Shared responsibility for community indicatorsof
child health-- a view from the hospital

• Barbara Rose MPH
• Child Policy Research Center
• Cincinnati Childrens Hospital
• June 28, 2007

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• Any change, even a change for the better, is
  always accompanied by drawbacks and discomforts.
  
• Arnold Bennett

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What is the change?

• .. develop and evaluate a new process for
  monitoring population child health measures for
  the community served by CCHMC

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Cincinnati Childrens Hospital

• Long tradition of providing exceptional and
  innovative care pediatric clinical care, research
  and training
• New strategic goal- achieve strong community
  partnerships that target high impact and
  evidence- based initiatives affecting child
  health

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Hospital leadership

• Whats going on in the community?
• Passion and expertise for working in the
  community 200 initiatives
• Corporate responsibility - with investment comes
  accountability toward shared responsibility

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Measurement Domains

• What are the child level outcomes associated w/
  CCHMC community work?
• What are the child level outcomes that result
  from the health system in which we SHARE
  responsibility?

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Shared Responsibility for Population Outcomes
Community Health System
Individual Accountability of Health System
Components
Public Health
Child Care
Home Family
Emergency Dept
Inpatient
PCP
School
Child Population Health Outcome
Neighborhood/ Environmental Factors
Public Policy
Socioeconomic Influences
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Our mission

• Knowing if we are making a difference
• Quality improvement, raising the bar on quality
  within the hospital- the best at getting better
• Taking lessons into our community work

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3 components of our community strategy

• Inventory of hospital-based community initiatives
• Unofficial count- 200 from 35 divisions (health,
  education, relations)
• One to many per division
• Many serve the same vulnerable, at-risk children
• No cohesive methods to know what others at CCHMC
  are doing in the community

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Evaluation support

• Tool kit for evaluating effectiveness
• Identify target population, measurable outcomes,
  drivers, interventions
• Develop aim statement, frequent measurement with
  a purpose , small tests of change, scaling up and
  spreading success

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Defining criteria for population measures of
child health

• Preventable interventions exist
• Impact on volume, disability, QOL, cost
• Feasibility to measure
• Community system capacity

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• Benchmarks available (local state, natl)
• Policy relevance useful for system change
• Innovation precedes evidence -based
• Outcome predictor long-term, adult well-being
• External alignment w/ regional, state initiatives
• Internal alignment w/ hospital initiatives

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Criteria for selecting child health population
measures
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Infant Mortality Pyramid
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Kindergarten readiness as a population measure?

• Local United Way efforts Success by 6, Community
  impact 9.6 million investment
• STRIVE community movement creating world
  class education system where children succeed
  birth to college
• Primary care redesign proposal

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Much more to do!

• As a leader in pediatric health care, Cincinnati
  Children hospital articulated the need to
  improve the health of children in the community
• 3 prong strategy- inventory of community
  initiatives, provide evaluation support to those
  working in the community, devise and disseminate
  population measures

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Change is essential

• Moving outside the walls of the hospital
• Shared responsibility for community measures of
  child health
• Know who is doing what in the community, teach
  different techniques of measurement, rapid cycle
  test of change, spread successes
• Refine criteria for population measures

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• The test of the morality of a society is what it
  does for its children
• Dietrich Bonhoeffer