Shared responsibility for community indicators

of child health-- a view from the hospital

Barbara Rose MPHChild Policy Research CenterCincinnati Children’s Hospital

June 28, 2007

“Any change, even a change for the better, is always accompanied by drawbacks and discomforts.”

Arnold Bennett

What is the change?

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

Cincinnati Children’s 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”

Hospital leadership

• What’s going on in the community? • Passion and expertise for working in

the community 200+ initiatives• Corporate responsibility - with

investment comes accountability toward shared responsibility

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?

Child Population Health Outcome

Shared Responsibility for Population Outcomes

Public PolicyNeighborhood/

Environmental Factors

Public Health

Child Care

School

Home & FamilyPCP

Emergency Dept Inpatient

Socioeconomic Influences

Community Health System

Individual Accountability of Health System Components

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

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

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

Defining criteria for population measures of child health

Preventable interventions exist Impact on volume, disability, QOL,

cost Feasibility to measure Community system capacity

Benchmarks available (local state, nat’l)

Policy relevance useful for system change Innovation precedes evidence -based Outcome predictor long-term, adult well-beingExternal alignment w/ regional, state initiativesInternal alignment w/ hospital initiatives

Criteria for selecting child health population measures

Primary prevention 3=high, 2=medium, 1=low     

WT Priority Selection Criteria

Infant mortality

Asthma Kindergarten readiness

Injury, accident

2 PREVENTABLE 3x2 = 6 1 1 3

2 IMPACT 3x2 =6 3 3 2

2 FEASIBLE 3x2= 6 2 3 3

1.5 COMMUNITY capacity

2x1.5 =3 1 2 2

1.5 BENCHMARKS 3 2 2 3

1 EXTERNAL ALIGNMENT

3 2 2 3

1 POLICY RELEVANCE

3 2 2 2

1 INNOVATION 1 2 1 2

1 INTERNAL ALIGNMENT

2 3 1 3

1 OUTCOME PREDICTOR 3 1 3 2

SCORES X WEIGHTS 37.5 26.5 29 35.5

Infant Mortality Pyramid

Infant Deaths

LifelongHandicaps

Morbidity and/or Cost

PrematurityCongenital Malformations

SIDSInjury

Pregnancy ComplicationsInfection, etc.

High Risk Births

All Births

Population measure Hamilton County (~ annual births)

11,000

4,000*

1,300

*Age <18, smoked during pregnancy, no prenatal care or unmarried(50%)

200

150

1,100

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

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

• 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

Change is essential

“The test of the morality of a society is what it does for its children”

Dietrich Bonhoeffer