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The Latest in Tools for State and Community Health Improvement Planning
Melody D. ParkerPublic Health Advisor, Health Department and Systems Development BranchDivision of Public Health Performance ImprovementOffice for State, Tribal, Local and Territorial Support
2012 APHA Annual Meeting Monday, October 29, 2:30–4:00 pmSession 3316.0
Centers for Disease Control and PreventionOffice for State, Tribal, Local and Territorial Support
Presenter Disclosure 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 ObjectivesAt the end of this session you will be able to
List at least three questions to consider when choosing a health improvement planning tool
Identify common elements in health improvement planning models and frameworks
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
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 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 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 Who’s facilitating the process? What’s the scope of collaboration? How comprehensive are the data used and
issues addressed? Are there underlying models or concepts?
For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support
4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-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.
Thank you!Melody D. Parker, MM, MLIS
Public Health Advisor, Health Department and Systems Development BranchDivision of Public Health Performance ImprovementOffice for State, Tribal, Local and Territorial Support
Centers for Disease Control and PreventionOffice for State, Tribal, Local and Territorial Support
The Nuts & Bolts of State Health
Improvement PlanningDenise Pavletic RD, MPH
Director, Public Health Systems Improvement
What is a State Health Improvement Plan?
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
Link to PHAB: PHAB Standard 5.2: Conduct a comprehensive planning process resulting in a tribal/state/community health improvement plan
SHIP Environmental Scan 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-and-Performance/
A Look at National Data
Developed SHIP within last three
years
Developed SHIP more than three years ago
Developed SHIP using results of a health as-sessment
SHIP links to local HIPs*
0102030405060708090
100
54% 46%58% 63%
2010 Survey
perc
ent
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
Lessons Learned From the ScanOur research identified 9 Basic Components of what went into a State Health Improvement Process1. Establish a Planning Process or Select Model2. Identify and Engage Stakeholder in Planning and
Implementation 3. Engage in Visioning and Systems Thinking4. Collect or Analyze Data 5. Establish Priorities & Identify Issues Through Priority
Setting 6. Communicate/Vet Priories7. Develop Objectives, Strategies, and Measures8. Develop and Implement Workplan9. Monitor, Evaluate, and Update the SHIP
Key Components
The SHIP development process can range from 12 to 48 months. A good planning process builds commitment, engages system partners as active participants, uses time efficiently and produces a plan that can be realistically 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
1. Establish a Planning Process or
Select ModelLink to PHAB: According to measure 5.2.1S, 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
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.
Your partners should:◦ Be committed◦ Provide a broad range of perspectives◦ Contribute necessary resources◦ Be able to impact outcomes◦ Be diverse
Throughout the process you should:◦ Evaluate partner participation
2. Identify and Engage Stakeholder in Planning
and Implementation
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
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.
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
3. Engage in Visioning and
Systems Thinking
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
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)
4. Collect or Analyze Data
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
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.
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
5. Establish Priorities & Identify Issues Through Priority
Setting
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
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 Develop a communication plan with a timeline
Suggestions for Modes of Communication: Online reports, presentations, public hearings, press
releases, social media, newsletters, etc.
6. Communicate/Vet Priorities
Link to PHAB: Indirectly linked to measure 5.2.1 S by engaging broad participation in the SHIP process.
Key Components
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.
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!
7. Develop Objectives,
Strategies, and Measures
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
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.
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
8. Develop and Implement Workplan
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
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.
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
9. Monitor, Evaluate, and Update the SHIP
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 AssessmentState Health Improvement Plan
Strategic Plan
More State Resources To Come…
Thank You!For more information:
Denise Pavletic [email protected] address: http://www.astho.org/Programs/Accreditation-and-Performance/
Lowrie Ward, MPH, CPH
Program Analyst, Accreditation Preparation & Quality Improvement
National Association of County & City Health Officials
Community Health Improvement Tools and Support from NACCHO
The Community Health Improvement
Process
Community Health Improvement Process
Community Health
Improvement Process
Community Health
Assessment
Community Health
Improvement Plan
Local Public Health System
MCOsHome Health
Parks
Economic Development
Mass Transit
Employers
Nursing Homes
Mental HealthDrug
Treatment
Civic Groups
Laboratory Facilities
Hospitals
EMS
Community Centers
Doctors
LHD
Churches
Philanthropist
Elected Officials
Tribal Health
Schools
Police
Fire
Corrections
Environmental Health Urban
Planners
Common Elements in Community Health Improvement Process Models
1) Prepare and plan2) Engage the community 3) Develop a goal or vision 4) Conduct community health assessment(s)5) Prioritize health issues 6) Develop community health improvement plan7) Implement community health improvement plan8) 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
38
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
Community Health Assessment
N=2,091Source: 2010 Profile of National Health Departments
participating in a CHA process
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
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
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 CHIPMeasure 5.2.2L: Produce a CHIP as a result of the community
health improvement processMeasure 5.2.3A: Implement elements and strategies of the health
improvement plan, in partnership with othersMeasure 5.2.4A: Monitor progress on implementation of
strategies in the CHIP in collaboration with broad participation from stakeholders and partners
NACCHO Accreditation Preparation and Quality Improvement websitewww.naccho.org/accreditation
CHA and CHIP Resources
NACCHO CHA/CHIP Resource Centerwww.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
CHA and CHIP Resources
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.orgAmerican Hospital AssociationOctober 29, 2012
Prepared for the American Public Health Association (session 3316.0 SCI)
50
“Community health assessment is a critical
strategic planning and management tool for
health care organizations.”
Community Health Assessment Checklist. VHA, Inc. 1994.
51
Healthcare Executive, July/August 2010
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”
52
CHNA Documentation Guidanceper 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
53* http://www.irs.gov/pub/irs-drop/n-11-52.pdfMichael BiltonAssociation for Community Health Improvement
54
Implementation Strategy Documentation, per IRS Notice 2011-52*
* http://www.irs.gov/pub/irs-drop/n-11-52.pdf
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 BiltonAssociation for Community Health Improvement
55
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)
Many non-profit organizations, academic institutions, firms and consultants are offering assessment tools and services, to both hospitals and public health
CHNA Resources Used by Hospitals
Six Step Community Health Assessment Process
56
www.assesstoolkit.orgACHI and AHA members have access to this online guide.
Examples of Hospital Associations Engaged in CHNA Support
57
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.
58
Examples of Collaborative CHNAs with Hospitals
St. Croix County, WisconsinHealthier Together (www.hudsonhospital.org/community/)
Greater Cincinnati, OhioA.I.M. (Ask. Inform. Make a Difference) for Better Health(healthcareaccessnow.org)
Lancaster County, PennsylvaniaLancaster Health Improvement Partnership (www.partnershipforpublichealth.org)
Jacksonville, FloridaHealth Planning Council of Northeast Florida (www.hpcnef.org)
San Francisco, CaliforniaBuilding a Healthier San Francisco and the Community Benefit Partnership(www.healthmattersinsf.org)
Kearney, NebraskaBuffalo County Community Partners(www.bcchp.org)
59
Hospital Community Health Improvement Planning in a
Context of Health System Change
60
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
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
61
Current Context and Related Factors
62
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
http://www.hpoe.org/resources-and-tools/1610009735 63
Working with Hospitals on Community Health Improvement Planning
64
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)
65
Hospitals as Community Health Assessment and Improvement PartnersThank you
