Community Health Assessment Research Articles

Voices Across Kansas

Community health assessment (CHA) and community health improvement planning (CHIP) is central to public health accreditation and essential functions and therefore important to local health departments (LHDs). However, rural states face significant challenges to pursue public health accreditation. The purpose of this statewide study was to identify factors that impede or promote the timeliness of CHA and CHIP completion. Fifteen focus groups, representing 11 of 15 public health regions, were conducted via telephone, using a structured interview script between April and September 2012. The sampling frame for the project was represented by counties in Kansas that planned to conduct a CHA-CHIP activity during 2012. Participants (N = 76) were LHD administrators, hospital representatives, and key community stakeholders from frontier, rural, and urban settings who were involved in CHA-CHIP activities. They were predominantly female (86.0%) and 51 years or older (66.7%). The study assessed perceptions and opinions about the inputs, process, outputs, and outcomes of CHA-CHIP activities within the community. Overall, CHA-CHIP implementation in Kansas was in its early stages. Rural counties reported a lack of capacity and confidence to perform many CHA-CHIP activities. Early CHA-CHIP adopters were located in more populous, metropolitan areas and had progressed further into the CHA-CHIP process. Regardless of rural/urban status, a history of collaborative activity among community stakeholder groups appeared to promote progress in CHA-CHIP completion. Participants reported that additional funding, time, trained staff, technical assistance, and community leadership were needed to conduct CHA-CHIP activities. Barriers included maintaining required LHD services while conducting assessment and planning activities and differences in public health and federal cycles for performing CHA. Study findings have implications for strengthening rural workforce development and technical assistance for CHA-CHIP activities.

Analysis and Countermeasures for Writing Quality of Manuals of Medical Records in Outpatient and Emergency in Community Health Service Institutions

Objective. To formulate countermeasures by analyzing the defects in manuals of medical records in outpatient and emergency, in order to improve the quality of medical records. Method. The check and statistical analysis were performed according to Methods for the Administration of Beijing Community Health Assessment (Trial). Result. A total of 528 manuals of medical records in outpatient and emergency were checked at random, and defects of 119 medical records were identified. Conclusion. Methods for strengthening the education and training of general practitioners, establishing a sound performance appraisal system, implementing an accountability system, performing inspection and assessment regularly, enhancing the summary and communication, and performing continuous improvement, etc. should be adopted to improve the writing quality of manuals of medical records in outpatient and emergency by a variety of measures.

InterRAI home care quality indicators

BackgroundThis paper describe the development of interRAI’s second-generation home care quality indicators (HC-QIs). They are derived from two of interRAI’s widely used community assessments: the Community Health Assessment and the Home Care Assessment. In this work the form in which the quality problem is specified has been refined, the covariate structure updated, and two summary scales introduced.MethodsTwo data sets were used: at the client and home-care site levels. Client-level data were employed to identify HC-QI covariates. This sample consisted of 335,544 clients from Europe, Canada, and the United States. Program level analyses, where client level data were aggregated at the site level, were also based on the clients from the samples from Europe, Canada, and the United States. There were 1,654 program-based observations – 22% from Europe, 23% from the US, and 55% from Canada.The first task was to identify potential HC-QIs, including both change and prevalence measures. Next, they were reviewed by industry representatives and members of the interRAI network. A two-step process adjustment was followed to identify the most appropriate covariance structure for each HC-QI. Finally, a factor analytic strategy was used to identify HC-QIs that cluster together and thus are candidates for summary scales.ResultsThe set of risk adjusted HC-QIs are multi-dimensional in scope, including measures of function, clinical complexity, social life, distress, and service use. Two factors were identified. The first includes a set of eleven measures that revolve around the absence of decline. This scale talks about functional independence and engagement. The second factor, anchored on nine functional improvement HC-QIs, referenced positively, this scale indicates a return to clinical balance.ConclusionsTwenty-three risk-adjusted, HC-QIs are described. Two new summary HC-QI scales, the “Independence Quality Scale” and the “Clinical Balance Quality Scale” are derived. In use at a site, these two scales can provide a macro view of local performance, offering a way for a home care agency to understand its performance. When scales perform less positively, the site then is able to review the HC-QI items that make up the scale, providing a roadmap for areas of greatest concern and in need of targeted interventions.

Using the community health assessment to screen for continued driving

This project used the interRAI based, community health assessment (CHA) to develop a model for identifying current elder drivers whose driving behavior should be reviewed. The assessments were completed by independent housing sites in COLLAGE, a non-profit, national senior housing consortium. Secondary analysis of data drawn from older adults in COLLAGE sites in the United States was conducted using a baseline assessment with 8042 subjects and an annual follow-up assessment with 3840 subjects. Logistic regression was used to develop a Driving Review Index (DRI) based on the most useful items from among the many measures available in the CHA assessment. Thirteen items were identified by the logistic regression to predict drivers whose driving behavior was questioned by others. In particular, three variables reference compromised decision-making abilities: general daily decisions, a recent decline in ability to make daily decisions, and ability to manage medications. Two additional measures assess cognitive status: short-term memory problem and a diagnosis of non-Alzheimers dementia. Functional measures reflect restrictions and general frailty, including receiving help in transportation, use of a locomotion appliance, having an unsteady gait, fatigue, and not going out on most days. The final three clinical measures reflect compromised vision, little interest or pleasure in things normally enjoyed, and diarrhea. The DRI focuses the review process on drivers with multiple cognitive and functional problems, including a significant segment of potentially troubled drivers who had not yet been publicly identified by others. There is a need for simple and quickly identified screening tools to identify those older adults whose driving should be reviewed. The DRI, based on the interRAI CHA, fills this void. Assessment at the individual level needs to be part of the backdrop of science as society seeks to target policy to identify high risk drivers instead of simply age-based testing.

Leveraging the strengths of an academic health system to improve community cancer care.

218 Background: To improve community cancer care quality, UC Davis Health System formed the UC Davis Cancer Care Network (CCN) to partner with select cancer centers in California to offer leading-edge care close to home. Hospital-based community cancer centers become affiliates of the UC Davis CCN through an evaluation process led by UC Davis. By synergizing the strengths of an academic health system and community-based oncology care, the network formalizes the commitment to collaboration with community providers. Methods: This quality model relies on a central university-based team interacting with affiliate sites to support them in their local missions. Affiliates progress through three phases of development of their cancer program. Each phase adds layers of quality to the organization. CCN staff members coordinate the phases: 1) Review and Develop Operations—site specific structures needed to be a comprehensive community cancer center; 2) Make Connections—within the network and the local community; 3) Become Self-Directed—identifying own needs and direction. The partnership attributes include: joint marketing, system synergies, certification assistance, coordinated service line development, dedicated personnel resources, on-site educational opportunities, and quality oversight. Results: Performance measurement includes: local market share, ACOS accreditation, adherence to national quality and patient satisfaction standards, assessment of community health needs and benefits, and enhancement of local capabilities (inpatient oncology unit, radiation, pathology, radiology, and surgical oncology services). Conclusions: This model demonstrates the benefit of partnering the strengths of an academic health system and community cancer programs to provide quality care.

Data Synthesis in Community Health Assessment

State and local health departments (LHDs) are increasingly conducting community health assessments, using models such as Mobilizing for Action through Planning and Partnerships. Within the peer-reviewed literature, relevant Web sites, and textbooks on health planning, there is limited practical guidance for bridging data collection and prioritization. The purpose of this article was to provide examples of how LHDs have bridged these steps through "data synthesis." We provide examples from 3 LHDs that have extensive experience with the Mobilizing for Action through Planning and Partnerships model. The LHDs provide a detailed synopsis of data synthesis activities, including the setting, participants, processes, and outcomes. Commonalities between the LHDs' processes emerged, including daylong (or more) retreats, multiple nominal group-like techniques, and iterative approaches to reduce the number of strategic issues. These processes provide examples of data synthesis and are relevant to current practice, given the national voluntary accreditation process and the new nonprofit hospital requirements to conduct community health assessments.

Geographic Health Information Systems: A Platform To Support The ‘Triple Aim’

Despite the rapid growth of electronic health data, most data systems do not connect individual patient records to data sets from outside the health care delivery system. These isolated data systems cannot support efforts to recognize or address how the physical and environmental context of each patient influences health choices and health outcomes. In this article we describe how a geographic health information system in Durham, North Carolina, links health system and social and environmental data via shared geography to provide a multidimensional understanding of individual and community health status and vulnerabilities. Geographic health information systems can be useful in supporting the Institute for Healthcare Improvement's Triple Aim Initiative to improve the experience of care, improve the health of populations, and reduce per capita costs of health care. A geographic health information system can also provide a comprehensive information base for community health assessment and intervention for accountable care that includes the entire population of a geographic area.

Community Health Assessment by Local Health Departments: Presence of Epidemiologist, Governance, and Federal and State Funds are Critical

Using the data from the National Association of County and City Health Officials’ (NACCHO) 2010 Profile of Local Health Departments (LHDs) our study investigates whether or not infrastructural characteristics of LHDs were associated with completion of community health assessment (CHA). Our results show that local and shared LHD governance, greater share of revenue from federal and state sources, smaller population size in LHD jurisdiction, and having an epidemiologist significantly increased the odds of CHA completion in the past, after controlling for community characteristics and other independent variables. These findings have important implications for LHDs, PHAB and its partners.

Development of a case-mix funding system for adults with combined vision and hearing loss

BackgroundAdults with vision and hearing loss, or dual sensory loss (DSL), present with a wide range of needs and abilities. This creates many challenges when attempting to set the most appropriate and equitable funding levels. Case-mix (CM) funding models represent one method for understanding client characteristics that correlate with resource intensity.MethodsA CM model was developed based on a derivation sample (n = 182) and tested with a replication sample (n = 135) of adults aged 18+ with known DSL who were living in the community. All items within the CM model came from a standardized, multidimensional assessment, the interRAI Community Health Assessment and the Deafblind Supplement. The main outcome was a summary of formal and informal service costs which included intervenor and interpreter support, in-home nursing, personal support and rehabilitation services. Informal costs were estimated based on a wage rate of half that for a professional service provider ($10/hour). Decision-tree analysis was used to create groups with homogeneous resource utilization.ResultsThe resulting CM model had 9 terminal nodes. The CM index (CMI) showed a 35-fold range for total costs. In both the derivation and replication sample, 4 groups (out of a total of 18 or 22.2%) had a coefficient of variation value that exceeded the overall level of variation. Explained variance in the derivation sample was 67.7% for total costs versus 28.2% in the replication sample. A strong correlation was observed between the CMI values in the two samples (r = 0.82; p = 0.006).ConclusionsThe derived CM funding model for adults with DSL differentiates resource intensity across 9 main groups and in both datasets there is evidence that these CM groups appropriately identify clients based on need for formal and informal support.

The Role of Ethnicity in the Deposition of Body Fat- Five-year Results of the Multi-cultural Community Health Assessment Trial (M-CHAT)

The Role of Ethnicity in the Deposition of Body Fat- Five-year Results of the Multi-cultural Community Health Assessment Trial (M-CHAT)

Ethnic Differences in Beliefs and Attitudes Toward Other People’s Body Size from The Multi-cultural Community Health Assessment Trial (M-CHAT)

Ethnic Differences in Beliefs and Attitudes Toward Other People’s Body Size from The Multi-cultural Community Health Assessment Trial (M-CHAT)

Relationship Between Body Mass Index and Perception of Other People’s Body Size in The Multi-Cultural Community Health Assessment Trial (M-CHAT)

Relationship Between Body Mass Index and Perception of Other People’s Body Size in The Multi-Cultural Community Health Assessment Trial (M-CHAT)

Ethnic Differences in Motivation and Attitudes Toward Physical Activity in The Multi-Cultural Community Health Assessment Trial (M-CHAT)

Ethnic Differences in Motivation and Attitudes Toward Physical Activity in The Multi-Cultural Community Health Assessment Trial (M-CHAT)

Spatial and Multidimensional Visualization of Jeddah Health Resources: A Community Health Assessment of the Primary Clinics

Spatial and Multidimensional Visualization of Jeddah Health Resources: A Community Health Assessment of the Primary Clinics

Using More Activities to Address Health Disparities

Local health departments (LHDs) are expected to address health disparities. Little is known, however, about what factors influence the activities used by an LHD in addressing health disparities. The objective of this study was to examine factors such as an LHD's leader, jurisdiction, and organizational characteristics that could be considered to influence the approaches used within LHDs to address health disparities. We used a cross-sectional, 2-level, mixed linear model with secondary LHD data nested within states. National data were used, depicting activities conducted by LHDs. The sample consisted of the 2332 LHDs that responded to the National Association of County and City Health Officials's 2008 National Profile of LHDs Survey. The activities used by LHDs in addressing health disparities were depicted as respondents indicating that they had employed 0 to 8 types of the activities listed in the Profile Survey in relation to addressing disparities. Local health departments significantly vary in the number of types of activities used in addressing health disparities. Significant associations exist between more types of health disparities activities used by LHDs and LHDs having a "top executive" with more education, clinical training, and/or less than 5 years of experience as the LHD's top executive. Local health departments with a jurisdiction that is urban, with a higher percentage of black residents, with a higher percentage of Hispanic residents, with higher per capita LHD expenditures, and/or that has conducted a community health assessment in last 3 years were also significantly associated with higher numbers of types of health disparities activities used. Local context and the characteristics of an LHD's top executive appear to be important factors related to the activities used to address health disparities across LHDs. A focus on the competencies and development of LHD leaders may be important in promoting LHD engagement in a wider range of approaches toward reducing disparities.

Commentary: A Public Health and Hospital System Collaboration for Conducting Community Health Assessments and Community Health Improvement Plans: Seven Hospital Systems in Oregon and Washington and Four County Public Health Departments in Oregon and One in Washington

Commentary: A Public Health and Hospital System Collaboration for Conducting Community Health Assessments and Community Health Improvement Plans: Seven Hospital Systems in Oregon and Washington and Four County Public Health Departments in Oregon and One in Washington

The effect of body fat distribution on ethnic differences in cardiometabolic risk factors of Chinese and Europeans

This study aimed to examine the differences in body fat distribution and cardiometabolic risk between individuals of Chinese and European origin and the role of body fat distribution on ethnic differences in cardiometabolic risk. A total of 418 participants from the Multicultural Community Health Assessment Trial were assessed for visceral adipose tissue (VAT), subcutaneous abdominal adipose tissue (SAT), anthropometric variables, blood pressure, and lipid, insulin, and glucose levels. Multiple regression analyses were split by sex and adjusted for appropriate covariates in model 1a and further adjusted for VAT in model 1b or SAT in model 1c. A secondary model replaced body mass index (BMI) with waist circumference (WC). Chinese males had higher levels of triglycerides, insulin, homeostasis model assessment, and SAT than European males, as well as higher total cholesterol (TC), glucose, and VAT in the model adjusted for WC. Chinese females had higher glucose levels than European females after adjustment for either BMI or WC. When VAT was added to the models, differences in cardiometabolic risk factors remained significant but were attenuated between Chinese and European males and females; SAT did not attenuate the ethnic difference in cardiometabolic risk. These findings suggest that the higher VAT levels seen in the Chinese population do not fully account for the ethnic disparities in these risk factors. Given the observed interethnic difference in body composition, current BMI and WC cutoffs might be misleading when it comes to identifying Chinese individuals at risk for type 2 diabetes or cardiovascular disease.

An Evaluation of Community Assessment for Public Health Emergency Response (CASPER) in North Carolina, 2003-2010

Community Assessment for Public Health Emergency Response (CASPER) is a group of tools and methods designed by the US Centers for Disease Control and Prevention (CDC) to provide rapid, reliable, and accurate population-based public health information. Since 2003, North Carolina public health professionals have used CASPERs to facilitate public health emergency responses and gather information on other topics including routine community health assessments. To date, there has been no evaluation of CASPER use by public health agencies at the state or local level in the US. Local health departments of North Carolina reported when and how CASPERs were used during the period 2003 to 2010 via an online survey. Data on barriers and future plans for using CASPERs also were collected. Fifty-two of North Carolina's 85 local health departments (61%) completed the survey. Twenty-eight departments reported 46 instances of CASPER use during 2003 to 2010. The majority of CASPERs were performed for community health assessments (n = 20, 43%) or exercises (n = 11, 24%). Fifty-six percent of respondents indicated they were "likely" or "very likely" to use CASPERs in the future; those who had prior experience with CASPERs were significantly more likely (P = .02) to report planned future use of CASPERs compared to those without prior experience with the tool. Lack of training, equipment, and time were the most frequently reported barriers to using CASPERs. Local public health agencies with clear objectives and goals can effectively use CASPERs in both routine public health practice and disaster settings.

Collaboration Between Local Health Authorities, Hospitals, Residents, and Community-Based Organizations in Boston

As public health practitioners in Boston, we read with interest both the original article from Sprague Martinez et al.1 about youth perceptions of neighborhood sanitation in our city as well as the follow-up exchange between the authors and Jarris et al.,2 who noted rightly that these neighborhood-level observations should be shared with local, state, and federal health agencies to improve public health and quality of life. In fact, Jarris et al. posited, new Internal Revenue Service regulations and accreditation standards will soon require local health agencies and hospitals to complete community health assessments in collaboration with local residents. In their response to Jarris et al., Sprague Martinez et al.,3 with some skepticism, asked whether true collaboration involving neighborhood residents, community-based organizations, local health authorities, and hospitals could be operationalized given various constraints on time, resources, and political will. “Cabbages & Condoms” is a restaurant with an important message to share that recently opened in Oxfordshire, UK, and is based upon a concept that originated in Thailand. The name of the eatery refers to the idea that people might ... We are pleased to report that this collaboration is well under way in Boston. Together with community health coalitions and community-based organizations, the Boston Alliance for Community Health is undertaking a community health planning process in partnership with the Boston Public Health Commission (our local health agency) and hospitals. This process, which is expected to take two years, will be used to mobilize residents around their neighborhood’s prioritized health issues, support local organizations to improve their service delivery systems, create strategies for collective action, and advocate increasing the amount and more effective use of scarce resources. We invite and encourage Sprague Martinez and all others with a stake in health planning and policy in Boston to join us in this process.

Paying for Prevention: A Critical Opportunity for Public Health

Despite spending an increasing amount on health care and more than every other industrialized country, the U.S. ranks 37th in health outcomes. The implementation of the Patient Protection and Affordable Care Act (ACA) promises to ensure better access to health care for many Americans through expanded public and private insurance coverage, including basic preventive health care. Public health must seize this critical opportunity by taking steps to ensure that prevention, especially primary prevention, is embedded in our health system. This manuscript outlines four areas where public health officials across the U.S. can immediately capitalize on opportunities created by the ACA to ensure that prevention is a key component of health reform: (1) leading the way on community health assessments; (2) linking clinical and community prevention; (3) supporting the development of alternative payment methodologies to pay for prevention; and (4) serving as a community resource for the coordination of care and building the non-traditional health workforce.