plan for collaborating on a harford county community health improvement plan
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Plan for Collaborating on a Harford County Community Health Improvement Plan
Community Health Improvement Plan (CHIP) Coalition Steering Committee
November 2011
Today’s Agenda
• Rationale for a community health needs assessment and improvement plan
• Proposed approach for the planning process
• Broad-brush review of Harford County health data and priorities
• Next steps
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Who Says We Need a Plan for Improving the Community’s Health?
• CHNA – For Hospitals– Federal health care reform, as well as Federal and
State requirements, mandate community health needs assessment (CHNA).
• SHIP – For State Health Departments– Maryland’s Health Care Reform Coordinating Council
reaffirms the importance of a State Health Improvement Process (SHIP).
• LHIP – For Local Health Departments– National public health accreditation requires a Local
Health Improvement Plan (LHIP).3
What’s Required?Local Health Departments
State Health Improvement Process (SHIP) obligations
requiring a Local Health Improvement Coalition (LHIC) and Action Plan
Obesity Prevention Task Force report due to the
County Council
Public Health Accreditation Board (PHAB) prerequisite
Hospitals
State community benefits report to HSCRC
Federal IRS Form 990 Schedule H
New federal health care reform requirements for Community Health Needs
Assessment (CHNA)
4
Are We Duplicating or Streamlining Efforts?
5
Can We Build on Harford County Efforts?
6
Federal Health Care Reform
Requirements
LHD SHIP Mandates
Hospital CHNA Mandates
Healthy Harford Activities
COMMUNITY HEALTH IMPROVEMENT PLAN
A Common Vision and Mission?
VISIONTo make Harford County the healthiest community in Maryland
MISSIONTo protect, promote and improve the health, safety and environment of the residents of Harford County through community assessment, education, collaboration and assurance of services
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What is a Public Health Planning Process?
• MAPP = Mobilizing for Action through Planning & Partnerships
• Developed by NACCHO & CDC in 2001
• Consists of 4 assessments:– Quantitative data review– Qualitative data review– Internal review– External review
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MAPP
How Can We Get Started?
• Present the quantitative data we currently have to community audiences
• Then solicit reaction, including qualitative feedback
• In order to engage in a discussion about strengths, weaknesses, opportunities & threats
• To gain consensus on priorities, goals, strategies & action steps
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One Approach
First, Quick Facts About Our Community
Demographic Indicators Harford County Maryland
Population (2010) 244,826 5,773,552
Population % change (2000-2010) 12% 9%
White population % (2010) 81.2% 58.2%
Black population % (2010) 12.7% 29.4%
Hispanic population % (2010) 3.5% 8.2%
High school graduates (2005-09) 90.8% 87.5%
Bachelor’s degree or higher (2005-09) 30.3% 35.2%
Homeownership rate (2005-09) 81.3% 69.6%
Median household income (2009) $75,364 $69,193
Persons below poverty level (2009) 6.2% 9.2%
Persons per square mile (2010) 560.1 594.8
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Let’s start at the beginning . . . PREGNANCY DATA
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Infant Mortality RatesHarford County & Maryland
2001-05 to 2006-10
Source: Maryland Vital Statistics12
Infant Mortality RatesHarford County, By Race
2000-04 to 2005-09
Source: Maryland Vital Statistics13
Top 7 Leading Causes of Infant DeathMaryland, 2010
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Low Birthweight RatesHarford County & Maryland
2000-04 to 2005-09
Source: Maryland Vital Statistics15
Low Birthweight RatesHarford County, By Race
2004 vs. 2009
Source: Maryland Vital Statistics16
Teen Birth RatesHarford County & Maryland
2004 vs. 2009
Source: Maryland Vital Statistics17
Teen Birth RatesHarford County, By Race
2004 vs. 2009
Source: Maryland Vital Statistics18
1st Trimester Prenatal Care RatesHarford County & Maryland
2004-06 to 2007-09
Source: Maryland Vital Statistics19
1st Trimester Prenatal Care RatesHarford County, By Race
2004 vs. 2009
Source: Maryland Vital Statistics20
For pregnancy outcomes, Harford County ranks better than the State, but health disparities exist
Indicator Harford Maryland Comparison DisparityInfant
Mortality Rate
5.7/1000 7.6/1000
Low Birthweight
Rate
7.8% 9.3%
Teen Birth Rate
19.7/1000 31.2/1000
Early Prenatal
Care Rate
84.8% 80.0%
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Let’s move on to conditions that affect us over the years . . .CHRONIC DISEASE DATA
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Top 10 Causes of DeathMaryland, 2010
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Top 7 Causes of DeathHarford County, 2009
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450433
136
43
99
5941
Heart Disease Mortality RatesHarford County & Maryland
2004-06 to 2007-09
Source: Maryland Vital Statistics25
Heart Disease Mortality RatesHarford County, By Race
2004-06 to 2007-09
Source: Maryland Vital Statistics26
Cancer Mortality RatesHarford County & Maryland
2004-06 to 2007-09
Source: Maryland Vital Statistics27
Cancer Mortality RatesHarford County, By Race
2004-06 to 2007-09
Source: Maryland Vital Statistics28
Stroke Mortality RatesHarford County & Maryland
2004-06 to 2007-09
Source: Maryland Vital Statistics29
Stroke Mortality RatesHarford County, By Race
2004-06 to 2007-09
Source: Maryland Vital Statistics30
COPD Mortality RatesHarford County & Maryland
2004-06 to 2007-09
Source: Maryland Vital Statistics31
COPD Mortality RatesHarford County, By Race
2000-07 to 2004-09
Source: Maryland Vital Statistics32
For chronic disease outcomes, Harford County ranks worse than the State
Indicator Harford Maryland Comparison DisparityHeart
Disease Mortality
210 197.8
Cancer Mortality
185.8 177.7
Stroke Mortality
57.3 55.7
COPD Mortality
45.7 35.6
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Note: Rates are deaths per 100,000 population
Now let’s look at lifestyle choices . . .LIFESTYLE DATA
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Leading Actual Causes of DeathUnited States, 2000
35Source: Mokdad AH, et al, JAMA, Mar 2004
Adult Smoking RatesHarford County & Maryland
2005-07 to 2008-10
Source: CDC Behavioral Risk Factor Surveillance System36
Adult Smoking RatesHarford County
2010 CHAP & BRFSS Data
37
Adult Cigarette Smoking RatesHarford County & Maryland
2000 to 2010
38Source: CDC Behavioral Risk Factor Surveillance System
Youth Tobacco Use RatesHarford County & Maryland
2000 to 2010
Source: Maryland Youth Tobacco Survey 39
Secondhand Smoke Exposure RatesHarford County & Maryland, 2008
Source: CDC Behavioral Risk Factor Surveillance System40
Adult Obesity/Overweight RatesHarford County & Maryland
2005-07 to 2008-10
Source: CDC Behavioral Risk Factor Surveillance System41
Adult Obesity/Overweight RatesHarford County
2010 CHAP & BRFSS Data
42
Physical Activity Rates*Harford County & Maryland
2005-07 to 2008-10
* NOTE: Moderate activity 30 minutes/day, 5 days/week43
Source: CDC Behavioral Risk Factor Surveillance System
Physical Activity RatesHarford County
2010 CHAP & BRFSS Data
44
NOTE: Moderate activity 30 minutes/day, 5 days/weekNOTE: Moderate activity 30 minutes/day, 3 days/week
Fruits & Vegetables Intake Rates*Harford County & Maryland
2005-07 to 2008-10
45Source: CDC Behavioral Risk Factor Surveillance System* NOTE: 5 or more daily servings of fruits or vegetables
Fruits & Vegetables Intake RatesHarford County
2010 CHAP & BRFSS Data
46
NOTE: 3 more daily servings of fruit and 3 more daily servings of vegetables
Fruits, 18.3%
Fruits/Vegetables, 37.1%
In lifestyle choices, Harford County ranks worse than or even with the State
Indicator Harford Maryland ComparisonTobacco
Use20.3% 15.1%
Obesity/ Overweight
63.5% 64.1%
Physical Activity
37.1% 33.9%
Fruits/ Vegetables
25.2% 27.3%
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And what about access to health care . . .ACCESS DATA
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% Who Could Not Afford to See M.D.Harford County & Maryland
2005-07 to 2008-10
Source: CDC Behavioral Risk Factor Surveillance System49
Adult Influenza Vaccination RatesHarford County & Maryland
2005-07 to 2008-10
Source: CDC Behavioral Risk Factor Surveillance System50
Childhood Influenza Vaccination Rates
County Leaders, 2010
Source: CDC Behavioral Risk Factor Surveillance System51
Anxiety Disorder RatesHarford County & Maryland
2005-07 to 2008-10
Source: CDC Behavioral Risk Factor Surveillance System52
Binge Drinking RatesHarford County & Maryland
2005-07 to 2008-10
Source: CDC Behavioral Risk Factor Surveillance System53
Population to Provider RatiosHarford County & Maryland
54Source: Maryland Primary Care Office, DHMH
Primary Care & Dental Care Shortage Areas in Harford County, 2010
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With access to care, Harford County has specialty area needs
Indicator Harford Maryland ComparisonAfford to See
M.D.10.4% 12.0%
Adult Flu Vaccine
38.7% 41.2%
Child Flu Vaccine
63.3% 53.7%
Anxiety 19.0% 12.8%Binge Drink 16.0% 13.7%
Pop:Provider Ratio (MH)
44,354:1 12,253:1
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Now, putting the pieces together . . .COMPOSITE DATA
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SHIP
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Which of the 39 SHIP objectives does Harford County rank worse than the State?
1. Seasonal flu vaccination rate2. Heart disease death rate3. Cancer death rate4. Adult tobacco use5. Youth tobacco use6. Behavioral health-related admissions to E.R.7. Alzheimer’s-related admissions to the E.R.
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County Health Rankings
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Which of the 27 County Health Rankings objectives does Harford County rank worse
than the State?1. Adult smoking2. Adult obesity3. Access to recreational facilities4. Air pollution ozone days5. Mammography screening6. Motor vehicle crash death rate7. Primary care physician availability8. Preventable hospital stays9. Poor mental health days10. Poor physical health days11. Unemployment
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Do the data suggest common themes for determining Harford County health
priorities?
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Next Steps?
• Agree that the Community Health Improvement Plan (CHIP) Coalition will serve as the unifying framework for Community Health Needs Assessment, Local Health Improvement Plan, and the Obesity Task Force efforts.
• Finalize membership of the CHIP Steering Committee and the larger Coalition.
• Preliminarily select 3 to 5 priority areas of focus and identify partners for leading those improvement efforts.
• Solicit feedback from others in the community – via meetings, website communications, and other avenues.
• Other thoughts?
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