Transcript The Latest in Tools for State and Community Health Improvement Planning Melody D.

The Latest in Tools for State and Community
Health Improvement Planning
Melody D. Parker
Public Health Advisor, Health Department and Systems Development Branch
Division of Public Health Performance Improvement
Office for State, Tribal, Local and Territorial Support
2012 APHA Annual Meeting
Monday, October 29, 2:30–4:00 pm
Session 3316.0
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support
Presenter Disclosure
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Melody Parker, Centers for Disease Control and Prevention
Denise Pavletic, Association of State and Territorial Health
Officials
Lowrie Ward, National Association of County and City Health
Officials
Michael Bilton, Association for Community Health Improvement
The following personal financial relationships with
commercial interests relevant to this presentation existed
during the past 12 months:
No relationships to disclose
Learning Objectives
At the end of this session you will be able to

List at least three questions to consider when choosing a
health improvement planning tool
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Identify common elements in health improvement planning
models and frameworks
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Find additional resources on health improvement planning
from a variety of sources
Importance of Tools

PHAB Accreditation Program Key Elements
 Standards and measures across 12 domains
• 10 Essential Services, administrative capacity, and governance
• Intended to provide a strong foundation for all public health
programs
 Three prerequisites
• State or community health assessment
• State or community health improvement plan
• Health department strategic plan
 Accreditation assessment process
Key Definitions (Excerpted)

Community Health Assessment—identify key health needs
and issues through systematic, comprehensive data
collection and analysis
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Community Health Improvement Process—ongoing
collaborative effort to identify, analyze, and address health
problems through coordinated strategies

Community Health Improvement Plan—written document
used to set priorities and coordinate resources
Excerpted from PHAB Standards and Measures, Version 1.0, http://www.phaboard.org
Common Elements in Community Health
Improvement Process Models
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Prepare and organize
Engage the community
Develop a goal or vision
Conduct community health assessment(s)
Prioritize health issues
Develop community health improvement plan
Implement community health improvement plan
Evaluate and monitor outcomes
A Variety of Tools Over Time
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PATCH (1983)
APEXPH (1991)
PACE-EH (2000)
MAPP (2001)
Catholic Health Association (updated 2010)
Association for Community Health Improvement (updated
2011)
ASTHO/CDC SHIP Framework (2011)
Community Health Assessment and
Improvement Models: Differences to Consider
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Who’s facilitating the process?
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What’s the scope of collaboration?
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How comprehensive are the data used and issues
addressed?
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Are there underlying models or concepts?
Thank you!
Melody D. Parker, MM, MLIS
Public Health Advisor, Health Department and Systems Development Branch
Division of Public Health Performance Improvement
Office for State, Tribal, Local and Territorial Support
404.498.0362
[email protected]
For more information, please contact CDC’s Office for State, Tribal, Local and Territorial
Support
4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected] Web: http://www.cdc.gov/stltpublichealth
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support
Link to PHAB:
PHAB Standard 5.2: Conduct a comprehensive
planning process resulting in a
tribal/state/community health improvement
plan
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A long-term systematic effort to address issues identified by the
assessment and community health improvement process
Is broader than the health department and should include partners
Considered current by PHAB if developed or updated within a 5 year
time period prior to application
Based on community health assessment
Relates directly to Domain 5
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ASTHO collaborated with Purdue University’s Healthcare TAP
and the CDC in 2010
In depth look into state health improvement planning to find
trends, common themes and examples
ASTHO SHIP Guidance and Resource found at
http://www.astho.org/Programs/Accreditation-andPerformance/
2010 Survey
percent
100
80
60
40
20
0
54%
46%
58%
63%
Developed SHIP Developed SHIP Developed SHIP
SHIP links to
within last three more than three using results of
local HIPs*
years
years ago
a health
assessment
State Health Improvement
Plan :
• 54% of states reported
having a SHIP developed
within the last 3 years, while
46% of states had a SHIP
that was developed over 3
years ago.
• 58% of states indicated
SHA data was used to
develop the SHIP
• 63% of states reported the
SHIP linked to LOCAL health
improvement plans
Our research identified 9 Basic Components of
what went into a State Health Improvement
Process
1. Establish a Planning Process or Select Model
2. Identify and Engage Stakeholder in Planning and
Implementation
3. Engage in Visioning and Systems Thinking
4. Collect or Analyze Data
5. Establish Priorities & Identify Issues Through Priority Setting
6. Communicate/Vet Priories
7. Develop Objectives, Strategies, and Measures
8. Develop and Implement Workplan
9. Monitor, Evaluate, and Update the SHIP
Key Components
1. Establish a Planning
Process or Select Model
The SHIP development process can range from 12 to 48
months. A good planning process builds commitment,
Link to PHAB:
engages system partners as active participants, uses time According to
efficiently and produces a plan that can be realistically
measure 5.2.1S,
implemented.
Remember to:
 Identify someone to drive the development process
 Engage health department leadership
 Engage broad-based stakeholders early on
Possible Products or Activities:
 Process Timeline
 Steering or Planning Committee
 Asset Map (Personnel and Financial)
 Communications Plan
the state health
department must
provide
documentation
of a completed
state health
improvement
planning process
using a model
that supports a
participatory
process.
Key Components
2. Identify and Engage
Stakeholder in Planning and
Implementation
Developing a SHIP is an opportunity to drive
an ongoing state collaborative improvement
process. The development, implementation
and monitoring of a SHIP can be led by the
state health agency but should be a shared
responsibility among state health system
partners.
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Your partners should:
Be committed
Provide a broad range of perspectives
Contribute necessary resources
Be able to impact outcomes
Be diverse
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Throughout the process you should:
◦
Evaluate partner participation
Link to PHAB:
PHAB measure
5.2.1S requires
documentation
of a health
improvement
planning process
that includes
broad
participation of
public health
system partners.
Key Components
3. Engage in Visioning
and Systems Thinking
According to the MAPP strategic tool, a vision is a picture
of the future you wish to create. It can help provide focus,
purpose, and direction…, and mobilize participants to
collectively achieve a shared vision of the future.
Identifying a vision for the state can support health
improvement.
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During this step, the state partners address questions such as
“What would we like our state and our state’s public health to
look like in 10 years?”
Points to Consider
◦ Can other visioning efforts be incorporated?
◦ Conducts a vision effort that includes broad state
representation
◦ Hold a visioning session
◦ Make sure to capture information and disseminate with
planning group
◦ Use a facilitator
◦ Refer to vision statement throughout SHIP development
process
Link to PHAB:
Indirectly relates
to measure 5.2.1
as this step
includes broad
system partner
participation and
focuses on
identifying what
is important to
all partners
regarding health.
Key
Components
4. Collect or Analyze Data
There are several types of data that can be used and
methods for collecting data for a SHIP. For PHAB
requirements, a SHIP must be data driven (should
incorporate data from the state’s community health
assessment) and evidence based. Including data supports
the rationale for choosing the priorities and indicators in
the plan.
Remember that Data Should
• Align with the community/state health assessment
• Include health indicator and infrastructure/system
capacity data
Data Can Provide Information on the Following:
• Themes and Strengths
• Forces of Change
• Health Status
• System Capacity Data (e.g., NPHPSP results)
Link to PHAB:
• As part of PHAB measure 5.2.1
S, evidence that system
partners identified issues or
themes to be addressed in the
plan is a requirement.
Additionally, states must show
that assets and resources were
identified and considered in
the SHIP process.
• PHAB measure 5.2.1 S requires
evidence that issues (and
themes) were identified by
stakeholders.
• PHAB measure 5.2.1 S indicates
that states must be able to
show that data from the
community health assessment
was used to inform the SHIP.
Additionally, other data sets
used in the plan must be
identified.
• PHAB measure 5.2.1 S indicates
that states must be able to
show that data was used to
inform the SHIP.
Key Components
5. Establish Priorities &
Identify Issues Through
Priority Setting
A SHIP should describe the priorities that a state
chooses to address over a period of time. The
information gathered in the previous steps should
provide the necessary information to determine
what the critical issues are that need to be
addressed in the SHIP.
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Priorities can center on health outcomes, as
well as system or infrastructure improvements
Remember to:
◦ Identify issues through priority setting
exercise(s)
◦ Priorities are supported by data
◦ Communicate and vet priorities among
partners
◦ Be Strategic
Link to PHAB:
Priority setting
must be described
in the SHIP (PHAB
measure 5.2.2 S),
including evidence
that system
partners
contributed to the
process.
Additionally,
priorities must
align with tribal
(where
appropriate), local
and national
priorities.
Key Components
6. Communicate/Vet
Priorities
To ensure momentum and support from leaders and
stakeholders, build momentum for implementation, and utilize
broad expertise related to the selected SHIP priorities, it is
important to seek input and communicate progress throughout
the SHIP planning and implementation process.
Steps:
 Identify who needs to be communicated with
 Determine how communication will occur and if feedback is
necessary
Link to PHAB:
Indirectly
 Develop a communication plan with a timeline
Suggestions for Modes of Communication:
 Online reports, presentations, public hearings, press
releases, social media, newsletters, etc.
linked to
measure 5.2.1
S by engaging
broad
participation in
the SHIP
process.
Key Components
7. Develop Objectives,
Strategies, and Measures
Including time-framed measurable objectives in a SHIP
provides a foundation for a SHIP implementation
workplan and helps states track progress on the
objectives for each priority over time.
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While objectives should push states toward
achieving higher levels of health or performance,
they should also be achievable and take into
account the resources available to reach them.
Tips
 Use evidence based interventions
 Consider time frames, resources, and policies.
 Be SMART!
Link to PHAB:
PHAB measure
5.2.2 S requires
that all SHIPs
include objectives,
improvement
strategies and
performance
measures with
time-framed
targets. Strategies
should be
evidence-based.
Policy changes
needed to
accomplish
objectives must
also be described
in the SHIP.
Accountable parties
for each objective
must be identified.
Key Components
8. Develop and
Implement Workplan
As states identify strategies and measures for
assessing outcomes, this information should be
conveyed in an implementation plan (workplan). The
implementation plan should indicate which
organization(s) will carry out the SHIP strategies.
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Steps
◦ Develop an implementation workplan
◦ Identify responsible partners
◦ Include measurable outcomes, policy changes,
and guidelines for monitoring
◦ Implement the workplan by carrying out the
objectives and strategies
Link to PHAB:
States must submit
a SHIP that was
developed within
five years of
applying for
accreditation.
Measure 5.2.3 S
also requires that
evidence be
provided to show
the actions taken to
implement
strategies, partners
involved and status
of strategies. This
can be done
through a SHIP
workplan.
Key Components
9. Monitor, Evaluate, and
Update the SHIP
SHIP efforts should be developed as part of a cycle that
facilitates continuous quality improvement. A SHIP can
be a guide for ongoing system performance
measurement and quality improvement for each
identified priority. States should also monitor progress
and make changes to the process as needed.
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Activities:
◦ Determine appropriate check-in opportunities
◦ Develop an evaluation for the SHIP
◦ Determine who will evaluate the plan and make
changes
◦ EVALUATE the plan
◦ Adjust plan as needed
◦ Share updates
◦ Use information for next process
Link to PHAB:
PHAB measure
5.2.4 S requires
evidence that plans
are being
monitored. States
should be able to
provide evaluation
reports of annual
progress for
measures and
health indicators as
well as any
revisions made to
SHIPs based on
evaluation results.
 State
Health Assessment
 State Health Improvement Plan
 Strategic Plan
For more information:
Denise Pavletic [email protected]
Web address:
http://www.astho.org/Programs/Accreditation-andPerformance/
Community Health Improvement Tools
and Support from NACCHO
Lowrie Ward, MPH, CPH
Program Analyst, Accreditation Preparation & Quality Improvement
National Association of County & City Health Officials
The Community
Health Improvement
Process
Community Health Improvement Process
Community
Health
Improvement
Plan
Community
Health
Assessment
Community
Health
Improvement
Process
Local Public Health System
Police
Community
Centers
MCOs
LHD
EMS
Schools
Churches
Home
Health
Laboratory
Facilities
Parks
Elected
Hospitals
Doctors
Officials Nursing Mass Transit
Homes
Philanthropist
Environmental
Civic Groups
Health
Urban
Fire
Planners
Tribal Health
Economic
Employers
Drug
Corrections
Development
Mental
Health
Treatment
Common Elements in Community Health Improvement
Process Models
1)
2)
3)
4)
5)
6)
7)
8)
Prepare and plan
Engage the community
Develop a goal or vision
Conduct community health assessment(s)
Prioritize health issues
Develop community health improvement plan
Implement community health improvement plan
Evaluate and monitor outcomes
Common Community Health Improvement Process
Models/Frameworks
• PRECEDE-PROCEED (1970s)
• Planned Approach to Community Health (PATCH) (1983)
• Healthy Communities (1980s)
• Assessment Protocol for Excellence in Public Health (APEX PH) (1991)
• Protocol for Assessing Community Excellence in Environmental
Health (PACE EH) (2000)
• Mobilizing for Action through Planning and Partnerships (MAPP)
(2001)
• Association for Community Health Improvement (ACHI) Toolkit
• State-specific models/frameworks
Mobilizing for Action through Planning and
Partnerships (MAPP) is…
A community-wide strategic planning
process for improving public health.
A method to help communities
prioritize public health issues,
identify resources for addressing
them, and take action.
• Mobilizing: Engaging the community
• Action: Implementing a health
improvement plan
• Planning: Applying strategic planning
concepts
• Partnerships: Involving local public health
system and community partners
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Community Health Assessment
A community health assessment is a systematic examination of
the health status indicators for a given population that is used
to identify key problems and assets in a community.
Community Health Assessment
participating in
a CHA process
N=2,091
Source: 2010 Profile of National Health Departments
PHAB Standards and Measures: CHA
Standard 1.1: Participate in or conduct a collaborative process
resulting in a comprehensive community health assessment
Measure: 1.1.1 T/L: Participate in or conduct a local partnership
for the development of a comprehensive community health
assessment
Measure 1.1.2 T/L: Complete a local community health
assessment
Measure 1.1.3 A: Ensure that the community health assessment is
accessible to agencies, organizations and the general public
Community Health Improvement Plan
A community health improvement plan is a long-term,
systematic effort to address public health problems on the
basis of the results of community health assessment
activities and the community health improvement process.
Community Health Improvement Plan
PHAB Standards and Measures: CHIP
Standard 5.2: Conduct a comprehensive planning process
resulting in a Tribal/state/community health improvement plan
Measure 5.2.1L: Conduct a process to develop a CHIP
Measure 5.2.2L: Produce a CHIP as a result of the community
health improvement process
Measure 5.2.3A: Implement elements and strategies of the health
improvement plan, in partnership with others
Measure 5.2.4A: Monitor progress on implementation of
strategies in the CHIP in collaboration with broad participation
from stakeholders and partners
CHA and CHIP Resources
NACCHO Accreditation Preparation and Quality Improvement website
www.naccho.org/accreditation
CHA and CHIP Resources
NACCHO CHA/CHIP Resource Center
www.naccho.org/chachipgeneral
CHA and CHIP Resources
Mobilizing for Action through Planning and Partnerships:
www.naccho.org/mapp
CHA and CHIP Resources
Mobilizing for Action through Planning and Partnerships:
www.naccho.org/mapp
Hospitals as Community Health
Assessment and Improvement Partners
Michael Bilton ([email protected]; 415-464-9211)
Executive Director
Association for Community Health Improvement (ACHI) – www.communityhlth.org
American Hospital Association
October 29, 2012
Prepared for the American Public Health Association
(session 3316.0 SCI)
“Community health assessment is a critical
strategic planning and management tool for
health care organizations.”
Community Health Assessment Checklist.
VHA, Inc.
1994.
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Healthcare Executive,
July/August 2010
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CHNA and Affordable Care Act of 2010
 Section 9007 of the Act created IRS Sec. 501(r)
Requires community health needs assessments
(CHNA) by tax exempt hospitals every three years
 “Input from persons who represent the broad interests
of the community… including those with special
knowledge of or expertise in public health”
 Adopt an “implementation strategy to meet the
community health needs identified”
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CHNA Documentation Guidance
per IRS Notice 2011-52*
1. Community served, and how determined
2. Assessment process and methods
 Data sources & dates, analytical methods, gaps,
collaborators, contractors
3. Prioritized community health needs, including
methods/criteria to determine
4. Existing health care and other resources available
to meet needs
Michael Bilton
Association for Community Health Improvement
* http://www.irs.gov/pub/irs-drop/n-11-52.pdf
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Implementation Strategy
Documentation, per IRS Notice 2011-52*
1. Describes how hospital plans to meet each
identified community health need (or explains why
the hospital does not intend meet a given need)
2. Identifies programs and resources, and
anticipated impact
3. Describes any planned collaboration
4. Approved by “authorized governing body” of the
hospital organization
Michael Bilton
Association for Community Health Improvement
* http://www.irs.gov/pub/irs-drop/n-11-52.pdf
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CHNA Resources Used by Hospitals

Association for Community Health Improvement’s
ACHI Community Health Assessment Toolkit
(www.assesstoolkit.org)

Catholic Health Association’s
Assessing and Addressing Community Health Needs
(www.chausa.org/communitybenefit)
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Many non-profit organizations, academic institutions,
firms and consultants are offering assessment tools and
services, to both hospitals and public health
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www.assesstoolkit.org
Six Step Community Health
ACHI and AHA members have access
toAssessment
this online guide. Process
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Examples of Hospital Associations
Engaged in CHNA Support
 Hospital Council of Northwest Ohio (www.hcno.org) has
been conducting collaborative CHNAs since 1999.
 Dallas–Fort Worth Hospital Council Foundation
(www.dfwhcfoundation.org) offers a community health
data warehouse and assessment tools.
 Iowa, Missouri and New Jersey hospital associations
have offered CHNA training (webinars, conferences).
 The North Carolina hospital association’s
“collaborative CHNA” program with public health,
focused on reducing care costs and health disparities.
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Examples of
Collaborative CHNAs with Hospitals

St. Croix County, Wisconsin
Healthier Together

(www.hudsonhospital.org/community/)
Lancaster County, Pennsylvania
Lancaster Health Improvement
Partnership
(www.partnershipforpublichealth.org)

Greater Cincinnati, Ohio
A.I.M. (Ask. Inform. Make a
Difference) for Better Health
(healthcareaccessnow.org)

Jacksonville, Florida
Health Planning Council of
Northeast Florida
(www.hpcnef.org)

San Francisco, California
Building a Healthier San Francisco
and the Community Benefit
Partnership
(www.healthmattersinsf.org)

Kearney, Nebraska
Buffalo County Community
Partners
(www.bcchp.org)
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Hospital Community Health
Improvement Planning in a
Context of Health System Change
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 Suggests partnerships
to “conduct CHNAs
and develop
community health
improvement plans”
 Its health priorities
are reflected in many
hospitals’ existing
community programs
 Many of its
recommendations
lend themselves to
action based on CHNA
data
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Current Context and Related Factors
 National Quality Strategy (March 2011)

One of three Aims: “Improve the health of the
U.S. population by supporting proven
interventions to address behavioral, social and
environmental determinants of health in addition
to delivering higher-quality care” (emphasis added)

One of six Priorities: “Working with communities
to promote wide use of best practices to enable
healthy living”
Source: www.healthcare.gov/center/reports/nationalqualitystrategy032011.pdf
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Current Context and Related Factors
 Accountable Care Organizations

Patient-Centeredness Criteria: Evaluate health
needs of assigned population, identify high-risk
individuals and develop care plans for targeted
populations, including use of community
resources. (emphasis added)

Quality Measurement: Includes measures for
readmissions, and admissions for ambulatory
care sensitive conditions
Source: AHA Regulatory Advisory on ACO Final Rule, Nov. 8, 2011
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http://www.hpoe.org/resources-and-tools/1610009735
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Working with Hospitals on Community
Health Improvement Planning
 Become acquainted with hospitals’ requirements
 Approach them early, if possible
 Find out who is leading their assessment (it will vary)
 Ask about their assessment process and goals
 Offer to help with data, community input,
facilitation or staff expertise, as appropriate
 Balance short-term needs (fulfilling IRS or public
health accreditation requirements) with longer-term
opportunities (sustained health improvement
collaboration)
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Hospitals as Community Health
Thank
you
Assessment and Improvement Partners
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