Working Cities Challenge Learning Community

Transcription

1 Working Cities Challenge Learning Community Lifting People and Places Out of Poverty: Strategies for Linking Human Capital and Neighborhood Development Robert Kahn, MD MPH Associate Chair for Community Child Health, Cincinnati Children s Hospital Medical Center March 12, 2015

2 Overcoming Obstacles to Health, Robert Wood Johnson Foundation, 2008

3 Changing the Outcome, Closing the Gap Population health work Asthma and housing Community agency - health care collaborations Beyond collaborations to networked production Moving beyond health care Hospital level Clinic level

4 Population Health Initiative Hamilton County: 190,000 children age 0-17yrs Cincinnati 66,000 children 0-17 yrs Goal and Initiatives Vision Be the leader in improving child health Purpose Lead, advocate and collaborate to measurably improve the health of local children and reduce disparities in targeted populations High Level Measures By June , Reduce the use of the ED and inpatient services by 20% in children with asthma covered by Medicaid

5 CCHMC

6 Asthma admission rate per 1,000 children (by neighborhood) Children from RED neighborhood: Quintile 1: 5x more likely to live in poverty 18 admits among 29,000 kids 0.6 per x more likely to lack reliable transportation Quintile 5: 299 admits among 17,900 kids 16.7 per x more likely to be substandard housing

7 Who are the critical partners? Pharmacies Cincinnati Public Schools Cincinnati Health Department Community Development Corp Community health workers Legal Aid Society

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11 Attacking social determinants directly

12 Engaging Avondale and Legal Asthma Aid: Child-Health Neighborhood Law Partnership approach total utilizations 130 ED visits, 51 admissions Days Since Previous Utilization /01 01/10 01/20 02/08 02/15 02/24 02/29 03/12 03/15 03/21 03/25 04/04 04/11 04/15 04/25 05/10 05/22 05/28 06/15 06/30 07/10 07/17 07/25 08/08 08/18 08/28 09/01 09/04 09/11 09/13 09/24 10/02 10/08 10/11 10/16 10/21 10/29 11/06 11/09 11/18 11/26 12/10 12/12 12/17 12/23 12/ Date of Utilization Days Since Previous Utilization Average Days Between Utilizations Control Limits Beck (2014)

13 Avondale Beck (2014)

14 Avondale Heat map of building code violations Beck & D. Jones (2014)

15 Avondale CHOICE Buildings to be refurbished by The Community Builders Beck (2014)

16 Avondale Beck (2014)

17 Asthma admissions (Medicaid) Rolling 12 Month Average Number of Admissions per 10,000 Hamilton Co. Medicaid Patients age 2 through 17 years old : 185 patients NOT admitted Admission Rate Meds In-hand for hospitalized children Enhanced inpatient and outpatient screening & Connections to Health Department and Legal Aid Baseline % reduction 5.8 Current 4.7 Care coordination Expanded home health care Primary care asthma follow up visit redesign School-based health Move further upstream, neighborhood deep dive 0 Month CL Control Limits Moving Average Special Cause Last update: by T. Cole Data source: Epic

18 Goal and Initiatives Purpose Moving beyond health care: Hospital Population Health Initiative Hamilton County: 190,000 children age birth -17yrs Lead, advocate and collaborate to measurably improve the health of local children and reduce disparities in targeted populations By June , Reduce the use of the ED and inpatient services by 20% in children with asthma covered by Medicaid Reduce infant mortality by 15%, 20 infant deaths per year Reduce the occurrence of unintentional pediatric injuries 30% Reverse the trend of increasing childhood obesity in grades K-3 Early mental health promotion and intervention School readiness and Grade 3 reading

19 Other health conditions in Hamilton County

20 Moving beyond health care: Clinics What A Prepared Clinic Will Detect Unemployment; lack of high school degree; higher level job training Maslow s Hierarchy of Needs Achieving potential Potential Collaborations Overwhelmed new parents; lack of parenting role models Esteem & Respect Domestic violence; mental health issues; inadequate education services Hunger; homelessness; denial or delay of benefits; utility shut offs Belonging Safety Basic Human Needs Henize, Kahn (2013)

21 Using QI to enhance partnership

22 Lessons Shared vision change outcomes, close the gap, and develop intentionality Population denominator approach Otherwise great silos, lousy outcomes Measurement and analytic capacity Building network of partnerships Span missions, but also daily operations, data Building innovation and improvement capacity community capacity for design thinking, QI, measurement Funding hospital, foundation, payment reform, community development

23 Thank Cincinnati Children s Hospital Medical Center

24 Attributes Adequate funding Shared vision, goals Skilled leadership Mutual respect Established relationships, communication Innovation Collaboration history Existing models, best practices

25 Network of care community health worker Legal Aid pharmacy schools CHOICE building case manager Figure. Collaborations between agencies serving children with complex chronic conditions. Acad Ped 2012