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Shared responsibility for community indicators of child health-- a view from the hospital

Shared responsibility for community indicators of child health-- a view from the hospital. Barbara Rose MPH Child Policy Research Center Cincinnati Children’s Hospital June 28, 2007. “Any change, even a change for the better, is always accompanied by drawbacks and discomforts.”

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Shared responsibility for community indicators of child health-- a view from the hospital

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  1. Shared responsibility for community indicatorsof child health-- a view from the hospital Barbara Rose MPH Child Policy Research Center Cincinnati Children’s Hospital June 28, 2007

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

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

  4. 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”

  5. 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

  6. 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?

  7. Shared Responsibility for Population Outcomes Community Health System Individual Accountability of Health System Components Public Health Child Care Home & Family Emergency Dept Inpatient PCP School Child Population Health Outcome Neighborhood/ Environmental Factors Public Policy Socioeconomic Influences

  8. 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

  9. 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

  10. 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

  11. Defining criteria for population measures of child health Preventableinterventions exist Impact on volume, disability, QOL, cost Feasibility to measure Community system capacity

  12. Benchmarks available (local state, nat’l) Policy relevanceuseful for system change Innovation precedes evidence -based Outcome predictorlong-term, adult well-being External alignment w/regional, state initiatives Internal alignmentw/ hospital initiatives

  13. Criteria for selecting child health population measures

  14. Hamilton County Population measure (~ annual births) 150 Infant Deaths Lifelong 200 Handicaps 1,100 Morbidityand/or Cost Prematurity CongenitalMalformations SIDS 1,300 Injury PregnancyComplications Infection, etc. 4,000* High Risk Births 11,000 All Births *Age <18, smoked during pregnancy, no prenatal care or unmarried (50%) Infant Mortality Pyramid

  15. 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

  16. 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

  17. Change is essential • 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

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

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