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.” 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 Policy Neighborhood/ Environmental Factors Public Health Child Care School Home & Family PCP Emergency DeptInpatient 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 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-being External alignment w/ regional, state initiatives Internal 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 AsthmaKindergarten readiness Injury, accident 2 PREVENTABLE3x2 = IMPACT3x2 = FEASIBLE3x2= COMMUNITY capacity 2x1.5 = BENCHMARKS EXTERNAL ALIGNMENT POLICY RELEVANCE INNOVATION INTERNAL ALIGNMENT OUTCOME PREDICTOR3132 SCORES X WEIGHTS

Infant Mortality Pyramid Infant Deaths Lifelong Handicaps Morbidity and/or Cost Prematurity Congenital Malformations SIDS Injury Pregnancy Complications Infection, 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%) ,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