1. Using Measurement in Community Health Improvement Processes to Identify Priorities and Drive Change
Michael A. Stoto, PhD
Collaborative Working Group on CHNAs Principles & Practices
National Academy of Medicine, Washington, December, 2018

2. Measurement for Community Health Improvement Processes
Background
Builds on work with Mary Davis and Abby Atkins
Funded by the Robert Wood Johnson Foundation
Changes in the U.S. healthcare delivery system
Transformation from volume to value
Manifestations: ACOs, AHCs, CMS goals, SIM, etc.
Accountability for outcomes, which must be measured
Multi-sector collaboration on “community health improvement” (CHI) processes
Kania & Kramer Collective Impact framework
Common agenda, Mutually reinforcing activities,
Backbone support organization, Continuous communication,
Shared measurement systems
Measurement for Community Health Improvement Processes

3. Measurement for Community Health Improvement Processes
Background
CHNA requirements have potential to bridge efforts of healthcare delivery sector, public health agencies, other organizations to improve population health
Case studies of 10 exemplary CHI processes found
“Excess variation” in how hospitals
define the community they serve
identify priorities
More focus on conducting CHNAs than on
developing implementing strategies
monitoring efforts and evaluating the results
Methods: document review + site visits
Measurement for Community Health Improvement Processes

4. Shared CHNAs 10/10 processes created a shared CHNA or CHA Includes
Usually prepared by local health department
Includes
population description (demographics)
Based on Census, American Community Survey, etc.
population health profile
Based on vital stats, survey data, public health surveillance data, hospital & ED data, etc.
Does not have to be a survey!
Population of interest typically = one county
hospital service areas cover more or less area
some identified more targeted populations of interest
Specific measures and presentation varies markedly
Data lag more of an issue for performance measures

5. Shared CHNAs Suggestions Make more effective use of small area data
to identify priority populations
Community Needs Index (Dignity Health)
Area Deprivation Index (University of Wisconsin)
US Small-area Life Expectancy Estimates Project (CDC)
to highlight disparities and inequities
hospital data by Zip code (varies by state)
UDS Mapper (safety net clinic data, AAFP)
model-based estimates (CDC‘s 500 Cities project)
Standardize CHNA measures to allow for benchmarking
trends
peer communities
among priority populations

6. ACHI Community Health Improvement Model
Performance measures to monitor accountability for actions
Steps 1-6:
High alignment among collaboratives and members
ACHI model – CHI improvement Planning model
Shared Community Health Profile with standard measures for benchmarking
Steps 7-9:
Least developed and more variability in format and content than CHNAs
Measurement for Community Health Improvement Processes

7. Performance measures Performance measurement is not well developed
despite involvement with ACOs and AHCs
may be a function of who does the CHNA/IS
The most developed IS’s had
Population-level goals/objectives
Cecil County (chronic disease priority): By, 2019, reduce high blood pressure among adults by 5%; baseline: 30.1% in
Strategies, activities, … with clear accountability & metrics
(Bexar County) Methodist Hospital (diabetes priority)
Strategy: Provide diabetes education to patients
Measure: number of classes & individual instruction provided to patients. Target: 1,500 diabetes educator visits in 2017
Other IS’s are less developed
“We’re so busy doing assessments that we don’t have time for implementation”

8. Performance measures Suggestions
Implementation and performance monitoring should be a continuous process
Performance measures ≠ population health profiles
As in other areas, performance measures should
be tailored to a joint implementation strategy, with clear indication of individual organizations’ accountability
include a range of output and process measures (for evidence- based interventions)
also outcome measures (as a “north star”)
all with established validity and reliability
More integration/collaboration among
CHNA/IS staff
Community Benefits office
hospital management and strategic planning
ACO and other population health staff