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Data driven community health priorities: The community health improvement process in Kitsap County, Washington

Beth Lipton, DVM MPH CPHSiri Kushner, MPH CPH

APHA, San Francisco, CAOctober 29, 2012

Presenter Disclosures

(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

Beth LiptonSiri Kushner

“No relationships to disclose”

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At the end of this presentation you will be able to:

1. Describe the data components of a community health improvement process

2. Identify key epidemiological methods for community health assessment

3. Discuss ways to ensure data drive decision-making related to community health priority setting

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Kitsap County, Washington

2012 Population: 254,500

http://en.wikipedia.org/wiki/Kitsap_County,_Washington; WA State Office of Financial Management

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PHAB Standards for CHA/CHIP

• Standard 1.1 Participate in or conduct a collaborative process resulting in a comprehensive Community Health Assessment– Describes the population served by public health– Accessible to agencies, organizations and the general public

• Standard 5.2 Conduct a comprehensive planning process resulting in a Community Health Improvement Plan– Implementation in partnership with others– Monitor progress on implementation in collaboration with

stakeholders and partners

http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf

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MAPP^ Assessments

Community Health Improvement Process

Community Health Assessment (CHA)

Community Health Status

Forces of Change

Community Themes & Strengths

Local Public Health System

Community Health Improvement Plan

(CHIP)

*PHAB: Public Health Accreditation Boardhttp://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf^MAPP: Mobilizing for Action through Planning and Partnerships http://www.naccho.org/topics/infrastructure/mapp/

PHAB* Standards

and Measures

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Kitsap Community Health Priorities (KCHP)

• Comprehensive community health improvement process initiated and led by public health, nonprofit hospital and United Way – socioeconomic, environmental and medical context – forum for collaboration/discussion on health and well-being– data repository– community-wide health priorities– plan for addressing and monitoring progress on health priorities

http://www.naccho.org/topics/infrastructure/mapp/upload/MAPPfactsheet-systempartners.pdf

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Data Collection (1)Community-wide Survey Targeted Surveys

Method:

Electronic: email, websites,

newspaper, promotional

‘business’ card

Paper: distributed by

community partners

Paper and audience response: completed at meetings of

invited community representatives

Content: Demographics, health status, influence of community attributes on health

Produced data for: Themes & Strengths

Data Collection (2)Focus Groups Meta-Analysis

Method:Held within meetings of invited community

representativesPulled data from

standard public health data sources

Reviewed results of community agency leader survey and WA Public Health

Standards

Content:

Health status, influence of community

attributes and trends on health

Demographics, SES, environment, health

care, pregnancy/births, quality of life,

behaviors, morbidity, mortality

Performance on and prioritization of

essential public health services

Produced data for:

Themes & Strengths, Forces of Change Health Status Local Public Health

System

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Qualitative Analysis

SAMPLE POPULATION

MEASURE

THEMES QUOTES

SPSSEXCEL TAGXEDO

ANALYSIS TOOLS

What prevents best possible healthCATEGORY Representative survey responses

* poor personal choices related to health habits - lack of exercise, smoking, alcohol and drug abuse.

* Attitude of indifference...bad eating, smoking and drinking habits. Lots of overweight people.

* Stuck in their ways. Bad habits.

* For many, it is apathy. Don't take the time to exercise.

* lack of good family role models who "live" a healthy, active life

* lack of exercise (being lazy); parents not caring about children's health

* Sedentary l ifestyles. Staring at screens all day. Some people just aren't will ing to get off their butts.

PERSONAL BEHAVIORS

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Quantitative Analysis

AGE

INCOME

GENDER

EDUCATIONSUB-

COUNTY AREA

SAMPLE POPULATION

MEASURE

PROPORTION

MEAN

RATE

POINT IN TIME

TREND

COMPARISON

*CHAT Community Health Assessment Tool. Washington State Department of Health, Center for Health Statistics**Joinpoint Regression Program. http://surveillance.cancer.gov/joinpoint/

SPSS

EXCEL

CHAT*

JOINPOINT**

ANALYSIS TOOLS

CHI-SQUARE

CONFIDENCE INTERVALS

1992-94 2007-09 TRENDWA STATE 18.3% 10.1%

KITSAP COUNTY 20.2% 12.7%

KITSAP COMPARED TO WA worse worse

• 17.6% of pregnant women age <25

• 10.5% of pregnant women age 25-34

• 6.7% of pregnant women age 35+

• 24.9% of pregnant women on Medicaid

• 32.0% of pregnant women with less than high school education

E.1.4. SMOKING DURING PREGNANCY

KITSAP PREGNANT WOMEN BY SUBGROUP: 2007-2009

Sources: Birth Certificate Database, WA State Department of Health Center for Health Statistics; First Steps Database, WA State Department of Social and Health Services. Trend years: 1992-94 to 2007-09.

14.4%

10.3%

7.7%

14.0%

2.6%

South Kitsap

North Kitsap

Central Kitsap

Bremerton

Bainbridge

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Turning Data into Health Priorities• Audience– who should review the data?

• Visual and verbal presentation– how should the data be presented?

• Guidance on interpretation– what do the data tell us?

• Priority setting– where should efforts be focused?

• Action on priorities– how do the data continue to drive decisions?

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Measuring Progress

Health Priority

Process Objectives

Baseline measurement

Ongoing measurement

Outcome Objectives

Strategies

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Data and Evaluation Drive the Process

Plan process and engage partners

Conduct assessments and establish priorities

Identify and implement strategies

Better Health

Measure and report progress

Update assessments and re-evaluate priorities

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Questions?

siri.kushner@kitsappublichealth.org

beth.lipton@kitsappublichealth.org

kitsapchp.com