Improving Health with Communities: Forming and Maintaining Effective Community Engaged Partnerships

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Improving Health with Communities Forming and
Maintaining Effective Community Engaged
Partnerships to Inform Policy

• Theresa Cullen, MD, MS
• Chief Information Office
• Indian Health Service
• May 15, 2009

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Goal

• Session How to inform and maintain effective
  community engaged partnerships to inform policy
• Goal of informing policy
• Translate research and knowledge into action
• Create and sustain health equity

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(No Transcript)
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Community Oriented Primary Care (COPC) becomes

• Community Based Primary Care

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Indian HealthService

• IHS is the principle health care provider for 1.
  9 million American Indian/Alaska Native people
• Unique government to government relationships
  with tribal sovereignty
• Blend of clinical, family, community, population
  public health approach

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A Broader Picture of Health

• Personal Health
• Family Health
• Community Health
• Public Health
• Population Health
• Transparency of Data

• Patient and community sharing of information-
  demographics, environment, population data, and
  health conditions

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Models Within theIndian Health Service

• Community Health Profile (1990s)
• iCARE (2003)
• Allows local facilities to evaluate health data
  set to identify priorities
• Develop appropriate health reminders on the fly
• Facilitates clinical quality tracking of patient,
  family, community and population
• Community members are subject matter experts
• Innovations in Planned Care Collaboration- IPC
  (2006)
• Each facility and community sets its own
  priorities and objectives within a predefined set
• Local evaluation is conducted as well as a
  national collective evaluation
• Best practices approach
• Establishment of a learning community

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Community HealthProfile Measures

• Socio-demographic
• Rate of high school graduation.
• Proportion of children (018) who live with
  both natural parents, mother only, mother
• and another adult, father only, father and
  another adult, extended family member, or
• other.
• Health Status
• Prevalence of diabetes among all ages.
• Rate of hospitalization (discharges per 1,000)
  for injuries and poisonings.
• Rate of years of potential life lost (per 1,000
  person-years).
• Prevalence of caries (tooth decay) in 34 year
  old and 78 year old children.
• Mental Health and Functional Status
• Average number of healthy days for adults and
  seniors in the previous month.
• Health risk factors and positive health behaviors
• Proportion of children (ages 216) who have a
  weight associated with good health (i.e., a
• Body Mass Index 18 and 25).
• Proportion of pregnancies with prenatal care
  beginning in the first trimester.
• Proportion of women (ages 1865) with a Pap
  smear within the previous 24 months.
• Prevalence of alcohol or other drug use among
  adolescents.
• Prevalence of tobacco use among adolescents and
  adults.

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IPC-Building EffectiveRelationships

• Organizational stories of success addressing the
  development of positive relationships between
  the healthcare system/care team and the
  community, family, and individual.

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IPC-Developing Plans with the Community

• If your community is represented at todays
  meeting, this is an opportunity to connect over
  lunch with discussion on methods to strengthen
  and build an effective relationship between all
  entities supporting improved health and wellness.
• If your community representatives are not
  present, it can be a time to evaluate your
  current status and identify methods to connect
  with the community to develop plans.

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IPC-Self Management SupportShared Decision
Making in Prevention

• Shared decision making is the collaboration
  between patients communities and caregivers to
  come to an agreement about a healthcare decision.
  The session will focus on the difference in self
  management goals setting for chronic conditions
  and shared decision making in the area of
  prevention. Shared decision making helps the
  patients, family and community understand the
  likely outcomes of various options, think about
  what is personally important about the risks and
  benefits of the options, and participate in
  decisions about medical care.

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IPC-The Outcome Bundle

• A Blend of Change Ideas from Self Management,
  Community, Delivery System, Decision Support, and
  the Clinical Information System
• The outcome bundle is a new and challenging
  measure for all teams. What can make the
  difference in your approaches and tools to get
  the kind of results needed to improve the health
  and wellness of your community?

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IPC-Ideas and Execution

• Taking the ideas for change and material on
  accelerating improvement and building strong team
  communication and interaction, each team will
  take the time to build plans to execute change
  over the next Action Period.

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What Works?

• Attention to Community and Culture
• Crafting the message
• Access to Data
• Continuous identification and involvement of
  stakeholders in the priorities, requirements,
  development and implementation
• Integration of appropriate IT and support tools
  into the health care delivery model- with
  community access
• Integrated system change rapid-cycle PDSAs

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Model for Improvement
What are we trying to
accomplish?
Data to answer this question
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
Data to support the PDSA Cycle
Associates in Process Improvement, 1996
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How will we know when we are there?
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Or, what matters?

• Prescience
• Trust
• Attitude
• Commitment
• Access to knowledge for all stakeholders
• Appropriate tools for implementation and
  assessment
• Adequate Resources
• Humility

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Informing Policy

• Use a broad definition of health and health
  equity
• Community involvement from the beginning in the
  entire process (? Grant evaluation factor?)
• Community engagement costs.. Something (
  Financial factor?)
• Process and outcome evaluation
• Immediate and long term utilization of knowledge
• Design delivery system and HIT system to
• Ensure that collected data is available for
  clinical use at point of care
• Develop a process to integrate changes and
  recommendations quickly
• Measure and report outcomes at point of care as
  well as at community and population level

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Indian Wedding Prayer

• Now you will feel no rain for each of you will
  be shelter for the other. Now you will feel no
  cold for each of you will be warmth for the
  other. Now there is no loneliness. Now you are
  two persons but there is only one life before
  you. Go now to your dwelling to enter into the
  days of your life together and may your days be
  good and long upon the earth.

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Indian Health Service www.ihs.gov
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Additional Slide
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Community Health Profile

• Project Planning
• Conceptualizing the project
• Readiness
• Timeline
• Formalities
• Documentation
• Evaluation
• Tools
• Community Health Profile Readiness
• CHP Timeline
• Template Community Resolution
• Project Activity Log
• Program evaluation tools
• Developing an Indicator List
• Collecting and Analyzing Data
• Reporting and Using the Results
• Further information at http//www.npaihb.org/epice
  nter/project/indian_community_health_profile_ichp_
  project/