Introduction to Community Health Improvement Models

1
Introduction to Community Health Improvement
Models

• NH Institute of Health Policy Practice
• John W. Seavey, PhD, MPH
• Department of Health Management Policy

2
Community Health Assessment

• The collection and evaluation of evidence based
  indicators of health inputs, health resources,
  and the health status of a population within a
  specific contiguous geographic area.

3
Elements of a Good Community Assessment

• Broad Definition of Health
• Broad Community Support
• Clear Definition of Community its relationship
  to the larger communities
• Appropriate Indicators of Health
• Solid Evidence Based InformationQuantitative and
  Qualitative
• Comparative Populations
• Assets
• Needs
• Clear Definition of Success
• Strategies
• Time Lines

4
NH Challenges for Community Assessment and
Evaluation

• Underdeveloped Public Health Infrastructure
• No State Health Board
• Town v. County or Regional Units as Unit of
  Analysis
• Few local Departments of Public Health
• Data collection has overlapping and inconsistent
  units of analysis
• Small numbers and confidentiality limits
• Underdeveloped Public Health Officer expertise
• Funding for public health

5
Turning PointRobert Wood Johnson FoundationW.K.
Kellogg Foundation

• To transform and strengthen the public health
  system in the United States to make the system
  more effective, more community-based, and more
  collaborative.

6
NH Turning Point Project Objectives

• Develop models of local public health
• Reduce disparities in outcomes related to race,
  ethnicity, income.
• Information technology requirements at local
  level
• Develop performance measures of local models
• Evaluate resource requirements
• Obtain legislative/regulatory authority to
  support successful local public health models

7
NH Turning Point Grants

• Caring Community Network of the Twin Rivers
  (Franklin)
• Greater Derry Community Health Services, Inc.
• North Country Health Consortium (Littleton)
• Canaan

8
Evans Stoddart ModelR.G. Evans and G. L.
Soddart Producint Health, Consumiong Healthcare,
in RG Evans and TR Marmor (eds.), Why are Some
People Health and Others Not? The Determinants
of Health in Populations. Berlin NY Walter
DeGruyter, 1994.
Social Environment
Physical Environment
Genetic Endowment
Individual Response Behavior/Biology
Disease
Health Care
Health Function
Well-Being
Prosperity
9
Mobilizing for Action through Planning and
Partnership (MAPP)National Association of County
and city Health Officials

• Organization
• Visioning
• Assessments
• Community Themes
• Local Public Health System Assessment
• Community Health Status Assessment
• Forces of Change Assessment
• Identify Strategic Issues
• Formulate Goals and Strategies
• Action Cycle
• Implementation Evaluation

10
Assessment Protocol for Excellence in Public
Health (APEXPH)National Association of County
and City Health Officials

• Prepare
• Form a Community Health Committee
• Collect Data
• Identify Analyze Community Health Problems
• Prioritize Community Health Problems
• Inventory Community Health Resources
• Develop a Community Health Plan

11
IOM Community Health Improvement Process

• Durch, JS Bailey, LA and Soto, MA. Improving
  Health in the Community A Role for Performance
  Monitoring. Washington, DC National Academy
  Press, 1997.
• Community Assessment Phase (John W. Seavey)
• Intervention and Evaluation Phase (Early Spring,
  Dorothy Bazos)

12
Institute of MedicineDurch, JS Bailey, LA and
Soto, MA. Improving Health in the Community A
Role for Performance Monitoring. Washington, DC
National Academy Press, 1997
13
Community Assessment Phase
14
I. Form Community Health CoalitionPrepare

• Organizational Capacity Assessment
• Identify Community Organizational Barriers
• Commitment of Needed Resources

15
I. Form Community Health Coalition

• Types of People
• Representative Citizens (minority populations)
• Medical Community
• Hospitals
• Safety Officials
• Mental Health
• Schools
• Social Service Organizations
• Substance Abuse Organizations
• United Way
• Law Enforcement
• Chamber of Commerce
• Unions
• Economic Develop Commissions
• Clergy

16
I. Form Community Health Coalition
VisioningMAPPNational Association of County
and City Health Officials

• Development of a shared community vision
  statement of the ideal future and the value
  clarification for guiding the planning process
  congruence
• How the pieces fit together delineates what
  constitutes success, what does it mean to be a
  healthy community?
• Sub-populations
• Use of a neutral facilitator
• Kept as a check on future products of the process

17
II. Prepare and Analyze Community Health Profile
Inventory of Health Resources

• Medical Resources
• Physicians, Hospitals, LTC, Primary Care, Rehab
• Health Resources
• Prenatal Clinics, Pools, University Training
  Programs
• Health Related Resources
• Transportation, Housing, Schools, Police, EMS
• Barriers
• Taxes, Lack of media, Turf

18
II. Prepare and Analyze Community Health
ProfileCollect Data

• Data
• Primary Data
• Surveys
• Secondary Data
• Epidemiological Data
• Demographic Data
• Environmental Data
• Economic Data
• Comparative Population

19
NH Health Data

• NH Health Data Inventory http//www.nhhealthdata.o
  rg
• NH Regional Profiles
• http//www.dhhs.state.nh.us/DHHS/HPR/LIBRARY/Prog
  ramReport/RHP.htm

20
Body Mass Index

• Body Mass Index Calculator
• http//www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm

21
Obesity Comparative DataOffice of the US Surgeon
General

• 61 of adults in the US were overweight (BMI25)
  in 1999.
• 13 of children 6 to 11
• 14 of adolescents 12-19
• For all racial and ethnic groups, women in lower
  SES (obese
• 69 of non-Hispanic black women are overweight or
  obese compared to 58 of non-Hispanic Black males.

22
II. Prepare and Analyze Community Health Profile
Community Health Status Assessment

• Social Environment
• Demographics
• Household Composition
• Educational Attainment
• Physical Environment
• Air Quality
• Water Quality
• Recreation
• Housing Stock
• Well Being
• Insurance
• Quality of Life
• Prosperity
• Income
• Income Distribution

23
II. Prepare and Analyze Community Health Profile
Community Health Status Assessment

• Genetic Endowment
• Specific Populations
• Parental Body Mass Index (BMI) Rates
• Individual Response/Behavior/Biology
• Behavioral Risk Factors (smoking, exercise,
  drinking, seatbelts, prenatal care)
• Health and Function
• Days of Disability reported health status
• Disease
• Morbidity Mortality (heart disease, cancer,
  diabetes, HIV)
• Health Care
• Physicians, Hospitals, Long Term Care, Community
  Mental Health

24
III. Identify Critical Health IssuesPrioritize

• Morbidity
• Incidence/Prevalence
• Mortality
• Rate
• Years of Life Lost
• Economic Costs
• Nominal Group Process
• Experts
• CDC
• NH Healthy 2010

25
III. Identify Critical Health Issues
Prioritizing ObesityOffice of the US Surgeon
General

• 300,000 Deaths Per Year
• Persons with BMI 30 have 50 to 100have 50
  increased risk of premature death
• Economic Cost of Obesity in the US in 2000 was
  117 billion
• 80 of people with diabetes are overweight or
  obese.
• Women gaining more than 20 pounds from 18 to
  midlife double the risk of postmenopausal breast
  cancer.
• Weight loss as modest as 5 to 15 of people
  overweight reduces the risk of heart disease.

26
III. Identify Critical Health IssuesIdentify
Analyze

• Analysis of Data
• Pediatric Obesity as Predictor of Adult Obesity
• Use of Health Services Research
• Risk Factors of Pediatric Obesity
• Weight to Height Ratios at Age
• Direct Contributing Factors
• Nursing/Bottle fed
• Diet Volume
• Diet Composition
• Exercise Patterns

27
III. Identify Critical Health Issues Identify
Analyze

• Indirect Contribution Factors
• Acceptance of Bottle Feeding
• Teen Self-esteem
• Social Convenience
• Internet
• Elimination of Physical Education Activities in
  schools

28
III. Identify Critical Health IssuesDevelopment
of a Community Plan

• Setting Goal
• Reduce health risks of the young adult population
• Setting Objectives
• Reduce BRFS reported lack of physical activity by
  10
• Increase school organized physical activity
  participation
• Increase participation in school lunch program by
  10 in each of the next five years
• Remove high school vending machines by 2005
• Community Bicycle Path by 2006
• Community Skating Rink by 2004

29
III. Identify Critical Health IssuesDevelopment
of a Community Plan

• Identifying Corrective Actions
• State legislation to require schools to adhere to
  USDA guidelines for school lunch programs, 2003
  legislative session
• Funding for physical Education, 2004 School Board
  Budget
• Community Recreational Committee, 2003
• Skating Rink, 2004
• Bicycle Path, 2006
• Tax soft drinks and sugary snacks with dedicated
  funding, 2003 legislative session

30
III. Identify Critical Health IssuesOrganization

• Community Readiness
• Change in leadership, events, right time
• Media attention to problem
• Reluctance
• Not enough time, expertise
• Organizations have done their strategic plans
• Nothing will come of it.
• Identification of Participants
• Legitimacy
• Resource Commitment
• Stakeholders

31
III. Identify Critical Health IssuesIdentifying
Strategic Issues

• The most important issues through the convergence
  of the four assessments
• Strategic Issues that are
• Significant
• Center around existing tensions needing
  resolution
• Seize upon opportunities
• Have no obvious solution
• Feasible

32
III. Identify Critical Health IssuesAction

• Implementation
• Evaluation

33
Community Assessment Sources

• MAPP (Mobilizing for Action through Planning
  Partnerships)
• http//www.naccho.org/project77.cfm
• APEXPH (Assessment Protocol for Excellence in
  Public Health)
• http//wonder.cdc.gov/wonder/prevguid/p0000089/p00
  00089.asp
• Durch, JS Bailey, LA and Soto, MA. Improving
  Health in the Community A Role for Performance
  Monitoring. Washington, DC National Academy
  Press, 1997
• http//www.nap.edu/catalog/5298.html

34
Sources

• Centers for Disease Control and Prevention
• http//www.cdc.gov
• Healthy NH 2010
• http//www.dhhs.state.nh.us/DHHS/OCPH/HealthyNew
  Hampshire2010/default.htm
• Healthy People 2010
• http//www.cdc.gov/nchs/about/otheract/hpdata2010/
  abouthp.htm
• National Association of County and City Health
  Officials
• http//www.naccho.org

35
Sources

• NH Health Data Inventory
• http//www.nhhealthdata.org/
• Nutrition and Your Health Dietary Guidelines
  for Americans. Fifth Edition (2000)
• http//www.usda.gov/cnpp/DietGd.pdf
• Surgeon Generals Call to Action to Prevent and
  Decrease Overweight and Obesity
• http//www.surgeongeneral.gov/topics/obesity/

36
Questions/Discussion