a perfect storm for population health - teaching prevention

DISCLOSURE: No relevant financial relationships with any ‘commercial interests’

March 17, 2015

@PracPlaybook

Concurrent 5A A Perfect Storm for Population Health

Denise Koo, MD MPH [email protected]

Lloyd Michener, MD [email protected]

Teaching Prevention 2015 | Charleston, SC

mailto:[email protected]

mailto:[email protected]

At the conclusion of this session, participants should be able to:

• Describe the forces that are coming together for population health improvement and the opportunitiesthat are enabling these partnerships to succeed

• Discuss innovative tools for those in the field to utilize in their population health efforts

What is population health?

Definition of population health“The health outcomes of a group of individuals, including, the distribution of such outcomes within a group”

David Kindig and Greg Stoddart

Why does population health matter?

State Rankings: Healthiness v. Cost


http://www.countyhealthrankings.org/

Percent Difference Between Medicaid Recipients Enrolled in CCNC and Those Not Enrolled in CCNC, for Rates of Asthma-Related Emergency Department Visits and Inpatient Admissions, 2008–2012

Note. CCNC, Community Care of North Carolina. NCMJ September/October 2013, Volume 74, Number 5

APTR Population Health Framework Components

SIM Opportunities/Awardees

• What are the roles of health care providers

in this health landscape change?

• What are the key knowledge, skills, and attitudes needed for this change?

Your Thoughts . . .

A Practical Playbook:Public Health and Primary Care Together

http://practicalplaybook.org/

Practical Playbook Overview

Practical Playbook Overview

The de Beaumont Foundation

• Training the public health workforce

• Building the public health infrastructure

• Improving information and data

management

Where we’ve been and where we’re going…Practical Playbook Phase II

• In Phase I, the de Beaumont Foundation, Duke Community and Family Medicine, and the Centers for Disease Control and Prevention launched the Practical Playbook website.

• In our first year of experience with the Practical Playbook website, it became evident that most primary care and public health groups need additional, hands-on guidance in order to integrate.

Where we’ve been and where we’re going…Practical Playbook Phase II

• To address that challenge, plans were developed for Phase II of the Practical Playbook.

• The de Beaumont Foundation has committed $5.76 million to fund Phase II of the Practical Playbook.

The Practical Playbook

• Use in public health and medical training curricula

• Curriculum Competitions and Learning Prizes

• Video content

• eBooks

• How do we find effective tools to help our learners learn how to share, collaborate, and rely on the strengths of others in this changing environment?

• How do we work as a team to achieve this change

in health care?

Your Thoughts . . . Our task: To partner with communities to accomplish what they want and need for improved health outcomes.

Doing things differently…

“We cannot solve our problems with the same thinking we used when we created them”

— Albert Einstein

Case Study in Community Engagement and Improving Community Health

Agenda

• Overview of case study

• Background

Background

• Origin of case study: CDC Experience Applied Epidemiology Fellowship for medical students

• Purpose: empower graduates to participate collaboratively in community health improvement (not just within health care system)

Background

• Additional goal: skill-building in leadership and being change agents

• Critical need: persons with systems thinking and approaches to solve complex problems that span the health system

Workshop Approach

• Use at CDC: mixed groups of

participants

• One-day workshop with small

groups

• Facilitators with varied backgrounds (public health, medical)

Workshop Approach

• Need: your feedback on utility of case study and materials to prepare workforce for health system transformation- Format- Content- Settings for use

Goal of Workshop

• Apply leadership skills and systems thinking skills to explore novel, population-based approaches for improving health outcomes

• Introduction/Reflection for participants: Why did you come today? Does this apply to your work?

Learning Objectives

• Explore the root causes of a complex health problem

• Identify key values and a shared vision as guiding principles for community action

• Reflect on how the leadership and systems thinking skills used to explore this case study could be applied to your work

The Story

• Widowed mother of 3; deceased husband was trucker who had MI, smoker

• Children all obese, low physical activity, cared for by sedentary, overweight grandmother while mother is at work

• Mother works for fast food company, brings leftovers home

Recap the Story

• What is the problem?

• Is this a preventable problem? (but why?)

The Eight “Easy” StepsFor Community Health Improvement

1. Getting Things Started

2. Building a Case

3. Gathering Allies

4. Identifying Stakeholders

5. Walking a Mile in Someone Else’s Shoes

6. Creating a Compelling Vision

7. Developing a Strategy

8. Communicating Your Vision and Mission


• What do you think of this story? Can you relate to it based on your own

experience?

• Why should we care about obesity in our communities?

• Whose problem is it? Should health professionals care about this? If so, why?


• What are societal impacts of this problem

right now? What will they be if it continues

to grow?

• What do we know about obesity?


Resources• Robert Wood Johnson Foundation

2. Building a Case

• Characterize the problem

• What information and data do we need to ensure the problem of obesity is compelling, worthy of action, and preventable?

2. Building a Case

• What information and data will provide the strongest evidence as we build a case for tackling the problem of obesity in the community?

• What leadership skills will the clinician and public health leader need for success?

2. Building a Case

Resources• Practical Playbook: Finding data• The Community Tool Box: Analyzing Problems and Goals

toolkit

3. Gathering Allies

• What is the difference between “allies” and “stakeholders”?

• What is the importance of creating alliances to aid in tackling this problem?

• Who are some people or groups that might share your desire for change?

3. Gathering Allies:

Resources• “Tactics for Communicating”


• Who are some people or groups that are impacted by obesity?

• If obesity continues on its current path without an intervention, what groups of people may be impacted in the future?


Resources• Practical Playbook: Community Engagement


• The purpose of this step is for participants

to consider unique perspectives and what someone with this perspective would see as their goal.

• Each person will play the role of someone listed as a stakeholder in the previous step


• This subset of stakeholders has formed a coalition team and this is their first

meeting

• Take turns sharing the perspectives that need to be considered as you continue through the rest of the steps of the case study

• Clinician• Public Health Leader• Person with Diabetes• City Council Representative• Physical Education Teacher from Local

School • Chamber of Commerce Representative• United Way Representative• Others?


Character Sketches

• Name• Your Agenda• Motivation• Friends and Foes (“turf tension”)• What you hope to achieve • Questions to consider: Obstacles,

resources needed, resources to offer• Notes to make it more “real”


Rubric for Character Sketches


Resources


• Wrap up from prior step: Reflection• Why is it important to have a vision

statement?• What are some personal goals that can

contribute to the shared vision?


• What words are needed to ensure the vision statement inspires action and enables innovation?


Resources• Practical Playbook: Aligned Leadership• The Community Tool Box: Developing Vision and Mission

Statements


• What are the plans and priorities for moving forward?

• Who is needed to carry out the strategy andwhat do they need to do?


• What are some key milestones that must be

met in the first 12 months of the project to assure the effort is making a difference?


Resources• Practical Playbook: The Role of Early Wins• The Community Tool Box: Developing an Intervention


• What is your mission statement? Is it:- Concise

- Outcome-oriented

- Inclusive


• Who, or what groups, do you need to inform,persuade, coerce, convince, and solicit to ensure you attain the momentum needed in the community to bring about desired andsustainable change?


Resources• Practical Playbook: Celebrate/Share

Closure/Reflection: Workshop

• What was most surprising/important?

• What leadership tactics/practices contributed to success?

Closure/Reflection: Workshop

• What character made the contribution to helpyou gain insight?

• Did you change your mind about an approachor a particular stakeholder?

Workshop Feedback

• How could you apply this in your home community and state?

Workshop Feedback

• How might this exercise be used to support community health improvement processes?- What materials are most useful? - How might the exercise be improved?- Would a “Meeting in a Box” facilitate the initiation

of this work?

• Guidance for this integration work can be found

in the Practical Playbook and the other resources

we have shared with you. Are there other resources that you are aware of to support

it?

• There are national conversations happening around best practices for this work – let’s continue to share!

Your Thoughts . . .

a perfect storm for population health - teaching prevention

Healthcare

population health matter

population health improvement

population health efforts

public health infrastructure

public health groups

public health workforce

population health denise

improved health outcomes