Winnebago Community Health Assessment Project

Presented by Captain Lynn Lowry

April 28, 2011

Objectives

• Look at the Indian Community Health Profile Project Toolkit (ICHPP) as starting point resource• Describe the Winnebago Community Health Assessment Journey• Identify recommendations from the lessons-learned by the Winnebago Community Health Assessment process

The goal of all Indian Health programs is:The goal of all Indian Health programs is:

To elevate the health of American Indians and To elevate the health of American Indians and Alaskan Natives to the highest possible levelAlaskan Natives to the highest possible level

Overall GoalOverall Goal

What is a Community Health Assessment?

The Indian Community Health Profile The Indian Community Health Profile Project Toolkit Project Toolkit

From Northwest Tribal Epidemiology CenterFrom Northwest Tribal Epidemiology Center http://www.npaihb.org/resources/project_toolkits/http://www.npaihb.org/resources/project_toolkits/

The ICHPP is an instrument for assessing overall community health, whichThe ICHPP is an instrument for assessing overall community health, which• Uses a broad definition of healthUses a broad definition of health It covers multiple domains of health: physical, mental, environmental, and It covers multiple domains of health: physical, mental, environmental, and socialsocial• Generates data that are useful and usable at the communityGenerates data that are useful and usable at the community levellevel Contains 15 Contains 15 recommendedrecommended health indicators health indicators• Works within the context and interest of communitiesWorks within the context and interest of communities• Engages the community in systematic approach to Engages the community in systematic approach to eliminating health disparitieseliminating health disparities

Tribal interestin &support forimprovedhealth

Implementstrategies

Re-apply indicatorsto measureprogress towardimproved health

Identify priorityhealth concerns

Create workinggroup

Developindicators

Conduct datacollection

Report indicatorresults

Use indicator results,to identify prioritiesfor action

Design actionstrategies

Flow diagram of the Indian Community Health Profile process.

• Socio-demographicSocio-demographic

• Health StatusHealth Status

• Mental Health and Functional StatusMental Health and Functional Status

• EnvironmentEnvironment

The 15 recommended The 15 recommended Health Indicators From ICHPPHealth Indicators From ICHPP

Two measureable indicators

Four measureable indicators

Eight measurable indicators

Two measurable indicators

Winnebago Community Health Assessment Project Goal

Develop a strategic plan to improve health delivery services for the Winnebago community through health assessment and community engagement activities

Promotes opportunities for community engagement in a systematic approach to improve the health status of

community and community members

Promotes opportunities in:• Defining current overall health status • Implementing activities to improve overall health status• Measuring overall health status on a regular basis to determine the amount of improvement

Winnebago Community Health Assessment Project Purpose/Objectives

Winnebago Community Health Assessment Project Workgroup and

ConsultantsWinnebago Community Health Assessment Workgroup (WCHAW):

Tipi Means, Health EducatorLCDR Nichole Vetter, RN, Public Health Nurse

Pat Medina, MS, Tribal Health AdministratorCAPT Lynn Lowry, MSN, Director of Public Health Nursing

Nicky Solomon, Community AdvocateRuby Bellanger, Community Advocate

Consultants:Maurine Orwa, PhD, Northern Plains Tribal Epidemiology Center,

Aberdeen Area Tribal Chairmen’s Health BoardShinobu Watanabe-Galloway, PhD, College of Public Health,

University of Nebraska Medical Center

Winnebago Community Health Assessment Project INITIAL Timeline

May 2006

Aug 2006

Jul 2006

Jun 2006

Sept 2006

Oct 2006

Nov 2006

Dec 2006

Review copy of ICHP Manual, conduct pre-planning meeting and begin project readiness checklist

Meet with EPI center for partnership and technical assistance

Work on resolution for Tribal Council

Obtain Tribal Council approval for Project

Customize Project Activity Log

Form a Working Group, Choose a leader

Draft Community Health Profile Timeline

Finalize Community Health Profile Timeline

Announce Project to Community and invite volunteer participation

Formalize Technical Assistance Partnership with EPI center and invite to Winnebago for site visit

Draft Indicator list, define community, review existing models

Get technical feedback

Prepare Project Summary IRB approval

Revise Project goals and finalize workgroup membership

Finalize list of indicators

Revise BFRSS/YRBS survey questionnaires

Obtain permission from data managers/custodians to access data sources

Develop data abstract forms/data base

Develop and apply population-based sampling scheme for survey

EPI center site visit

Prepare survey interviewer training materials

Train survey interviewers

Continued…

Jan 2007

Feb 2007

Mar 2007

Apr 2007

May 2007

June 2007

July 2007

Aug 2007

Conduct Surveys

Abstract data from existing sources for quality

Review data from existing sources for quality

Design original data collection procedures

Design data base

Collect original data

Conduct analysis with technical assistance

Reform final calculations for indicators

Develop data reports/summaries

Identify audience and purpose of different reports

Create reports (different formats)

Publicize reports to community members and professional groups

Make plans for using result in program planning and management

Set tentative date for next round of indicator assessment

Identify key people to regroup for next round

Evaluation-ongoing

Assess what worked, what did not work and why

Assess adequacy of time project, resources and preparation

Assess whether changes should be made to indicator list

Begin planning for development of long range

Health plan for the Winnebago Tribe, utilizing results from Community Health Assessment project

• Developed workgroup and steering committee

• Identified and analyzed the existing health data

• Developed two health status reports

• Conducted community focus groups and survey to obtain community inputs

• Analyzed focus group and survey data

• Prepared presentation and final project report

Winnebago Community Health Assessment Project Activities

Phase I Phase II

To understand the health status and concerns of

Winnebago Community:

1. Examined the existing data such as:

- Winnebago Hospital data

- Community surveys (e.g. tobacco, risk factors) that have

already been implemented before this project

2. Collected new data through:

- Survey: Young Adults

- Focus Groups: Adult women/men, housing program, seniors

Winnebago Community Health Assessment Indicator list

PHASE 1

A. Demographic Characteristics of Winnebago Community ResidentsB. Health Status of American Indian People in NebraskaC. Use of Preventive Care and Health BehaviorD. Environmental Health

FOCUS GROUPS AND SURVEYS

Phase 2

Focus Group Facilitator Training

Objectives and Expected Outcomes of Focus Groups

1.Identify concerns and priority areas among community members

2.Find out community members’ experience with the health care system

3.Identify ways to improve health status of the community

• Health concerns and priority areas• Experience with the health care system• Ways to improve the community health status

Focus Group Topics

Major Themes and Recommendations

Perception of Community Health

1. Pessimism2. Mental health; drug and alcohol problems3. Chronic diseases 4. Obesity5. Children and youth6. Spiritual decline/ineptness

A. Perception of Community Health

B. Health Care Experience

1. “Only visit clinic and hospital when I am very sick”2. Appointments3. Misdiagnosis4. Needs for specialists and improved quality of care5. Referral and follow-up problem6. Provider-patient communication and interaction7. Praises for Dr. McNamara8. Pain management is poor, especially for the elderly9. CHRs10. ER and PA11. Billing problems

C. Recommendations to Improve Community Health

1. Roles of “Self” (Individual Community Members)2. Roles of “Community”3. Roles of “Health Care System and Providers”

CHA STEERING COMMITTEE RECOMMENDATIONS

1.DEVELOP ADVISORY HEALTH BOARD

A. Charge for Advisory Health BoardB. Recommendation for Board Membership

2. IMPROVE REFERRAL AND INPATIENT FOLLOW-UP

PROCESSES

A. Needs for Improved Referral and Follow-upB. Establish Improved Case Management ProcessC. Establish Improved Discharge Plan Process

3. IMPROVE THE PROVIDER-PATIENT RELATIONSHIP AND

COMMUNICATION

A. Needs for Improved Relationship and CommunicationB.Recommendation: Reinstate the Clinical Rotations

4. IMPROVE THE AFTER-HOUR ER CARE

A.Needs for Improved ER CareB.Evaluate the Current ER Care/Services

5. ENGAGE COMMUNITY TO IMPROVE THE COMMUNITY

HEALTH STATUS

A.InterventionsB.Develop and Implement Intervention Activities

6. ENGAGE THE COMMUNITY TO IMPROVE THE COMMUNITY

HEALTH STATUS

A. Accountability and MonitoringB. Monitor progress and conduct a follow-up evaluation

Project StatusPhase I: Completed• Developed workgroup and steering committee• Identified and analyzed the existing health data• Developed two health status reports

Phase II Completed November 2008• Conducted community focus groups and survey to obtain community inputs• Analyzed focus group and survey data• Prepared presentation and final project report Phase III: Timeline to be determined• Implement activities to improve community health status• Measure health status on a regular basis to determine the amount of improvement

Summary• Existing health data shows a need for improvement in the community’s health status• Community members expressed their concerns about health care system• Based on community inputs, CHA Workgroup made several specific recommendations including the establishment of the Advisory Health Committee to follow up with these concerns