Post on 26-Dec-2015
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