population health improvement program kick-off …...population health improvement program kick-off...

Population Health

Improvement Program

Kick-Off Meeting

February 26, 2015

HealtheConnections

Cayuga Community Health Network

Seven Valleys Health Coalition

Madison County Rural Health Council

Central New York Health Home Network

Onondaga County Health Department

Oswego County Opportunities 1

2

“Connecting You to Better Care”

In collaboration with our Central New York stakeholders and participants, HealtheConnections' trusted and valued

services support healthcare transformation and efficiency initiatives focused on achieving the triple aim of better care,

better population health and lower healthcare costs.

HealtheConnections provides unbiased, neutral health information exchange (HIE) services*, population health

improvement support services, data analytics, and electronic health record adoption and meaningful use advisement

services for the eleven counties of the Central New York region.

The name HealtheConnections represents our commitment to connect and engage Central New York healthcare

physicians, hospitals, public health, mental and behavior health, human services and other health care providing

entities, insurers, business and consumers to implement services and initiatives that support New York State’s health

information exchange and population health improvement agendas.

In the pursuit of this mission, the actions of leadership, staff and our business partners will be guided by the following

values:

Integrity & Trust, Excellence, Teamwork & Collaboration, Respect, Commitment, Accountability, Responsibility, &

Diversity

HealtheConnections takes a business oriented approach to our non profit work; emphasizing value, efficiency, results

and sustainability.

*HealtheConnections is a Qualified Entity of the State Health Information Network of New York (SHIN-NY)

3

Introduction of the PHIP Team

HealtheConnections

Rob Hack

Rachel Kramer

Bruce Hathaway

Mary Carney

Megan Lee

John Snow, Inc.

Craig Stevens

Alec McKinney

Apter & O’Connor

Nancy Smith

County Agents

Cayuga: Cayuga County

Community Health Network

Cortland: Seven Valleys Health

Coalition

Madison: Madison County

Rural Health Council

Oneida: Central New York

Home Network

Onondaga: Onondaga County

Health Department

Oswego: Oswego County

Opportunities

4

Meeting Goal

By the end of the meeting, participants will understand:

• Activities necessary to meet NYS contractual obligations

• Objectives and priorities

• Framework and recommended approaches

• PHIP resources that can be leveraged

• County priorities across 6-county region

• Expectations for stakeholder involvement

• Contract parameters and payments from HeC

• Activities to be accomplished within first 6 months

Build an engaged and informed Central New York Population Health Improvement Program (PHIP) team.

• PHIP Overview

• Central New York PHIP Framework and Approach

• Example of PHIP Approach

• Working Lunch – Discussion of County Priorities

• Stakeholder Mapping

• Next Steps and Closing

5

Agenda

Better population

health

Better care

Fewer health

disparities

Lower health

care costs6

NYS DOH Population Health Improvement

Program (PHIP) will promote the Triple Aim

7

Promote population healthReduce health care disparities

Best Practices

Innovative Strategies

Identifying

Sharing

Disseminating

Helping to implement

PHIP contractors will provide a neutral forum for:

PHIP contractors will engage stakeholders, including but not limited to:

Health, behavioral health, & disabilities

service providers

Rural health networks

Insurers, and other payers Consumer & patient advocacy organizations

Behavioral health advocacy organizations Disability rights organizations

Local public health officials, other elected

officials

Local human service agencies

Business community Unions

Schools Higher education institutions

Local housing authorities Local transportation authorities

8

Stakeholder Engagement

• Support and advance the Prevention Agenda by

serving as a resource and assisting in the

implementation of evidence based initiatives to

address priorities

• Support and participate in the development,

implementation, measurement and evaluation of

innovative health system strategies that support the

goals and objectives of the SHIP

• Serve as a resource to DSRIP Performing Provider

Systems (PPS)

10

PHIP contractors will, within their regions:

12

PHIP Regions

13

PHIP Contractors by Region

Central New York PHIP Objectives

1. Convene stakeholders and demonstrate

transparency

2. Incorporate health disparities strategies

3. Data-driven priorities and decision making

4. Advance state and county goals

5. Promote consumer engagement and coordinate

regional activities

14

HealtheConnections Roles & Responsibilities

• Ensure meaningful engagement of stakeholders

• Develop and implement governance structure

• Develop strategic plan and business plan

• Identify and disseminate best practices and innovative

strategies

• Identify and implement capacity-building trainings for region

• Support awareness and coordination of existing regional

initiatives

• Facilitate and support plans for regional health improvement

initiatives

• Develop website • Compile, analyze, interpret and present population health data

15

County Agent Roles & Responsibilities

• Convene local stakeholders to inform PHIP activities and

share best practices

• Collect, analyze and utilize county-specific data

• Support and advance county activities addressing Prevention

Agenda priorities

• Serve on Operating Committee and Leadership Advisory

Committee

• Support and participate in regional health improvement

initiatives

16

John Snow, Inc. Roles & Responsibilities

• Provide recommendations regarding:• PHIP governance structure

• PHIP strategic plan

• Best practices for community engagement and addressing health disparities

• Assist with county inventories

• Provide trainings to build capacity in community engagement

• Compile population health data with focus on health disparities

• Support the development of a public use data dashboard and portal

17

• Develop performance management plan • Incorporate evaluation outcomes and measures reflective

of strategic plan

• Prepare report on best practices for regional health improvement initiatives

18

Apter & O’Connor Roles & Responsibilities

• Hire HealtheConnections staff

• Establish contracts with County Agents, John Snow, Apter &

O’Connor

• Identify governance structure

• Put in place Leadership Advisory and Operating Committees

• Identify stakeholders and partners at county and regional level

• Identify county level prevention agenda priorities and existing

initiatives

• Review and compile regional data

• Review and compile best practices

• Complete business plan and strategic plan

• Launch PHIP website

First Six Months of PHIP

• Convene local stakeholders to inform PHIP activities and share best practices, with a focus on improving health and health equity

• Collect, analyze and utilize county-specific data

• Support and advance county activities addressing

Prevention Agenda priorities

Wo

rk W

ith

in t

he

Co

un

ty

21

Working Together Across the Region

• Serve as a nexus for data management and analytics

• Establish regional PHIP objectives that support Prevention Agenda priorities

• Participate in CNY regional population health improvement strategies

• Promote local participation in the PHIP Leadership Advisory Council (LAC) and other operating committees

22

Working Together Across the Region

Wo

rk W

ithin

th

e C

ou

nty

23

PHIP Vertical

and Horizontal

Alignment

Madison

Oswego

Cortland

Oneida

Cayuga

HeC

Onondaga 24

Working As A

Team

LEVERAGE and

CONNECT

PREP PLAN ACT SHARE

P1: Identify

County and

Hospital Priorities

P2: Identify

Stakeholders

P3: Examine Data

P4: Explore

Evidence-Based

Approaches

P5: Identify

Existing

Interventions

P6: Identify Gaps

and Opportunities

P7a: Implement

County-Level

Work and

Evaluation

(Vertical)

P7b: Implement

Regional Work

and Evaluation

(Horizontal)

P8: Report Back

P9: Illustrate

Impact

25

26

Introduction

to Lincoln

County

Prevent Chronic Diseases

• Reduce obesity

• Increase access to high-quality chronic disease preventive care and management

Promote Healthy Women, Infants, and Children

• Reduce premature births

• Increase the rate of babies who are breast fed

Lincoln County ExamplePhase 1: Identify county and hospital priorities

27

Lincoln County ExamplePhase 2: Identify stakeholders

Lincoln County Health Department National Alliance for the Mentally Ill (NAMI)

Excellus BlueCross BlueShield, Lincoln Valley Lincoln Valley Midwifery Services

Big Lincoln Hospital YMCA of Lincoln Valley

Four Trees Walk-In Community Clinic Lincoln Transit Authority

Lincoln City School District University of Lincoln Student Health Center

United Builders of Lincoln County, No. 56 American Cancer Society

Lincoln City Landscape Architecture Firm Little Lincoln Hospital

Maryam Mallory, Mayor of Lincoln City Big Brother Big Sisters

Planned Parenthood Associates for Cardiac & Vascular Surgery

28

Lincoln County ExamplePhase 3: Examine data

29

LincolnNYS

PA 2017

Percentage of infants exclusively

breastfed in the hospital (33)

From Vital Statistics data, February 2014

Lincoln County ExamplePhase 3: Examine data

Infants

breastfed

Average number

of live birthsPercentage

Black Non-Hispanics 33 101 32.6%

White Non-Hispanics 324 667 48.6%

Medicaid patients 140 401 34.9%

Non-Medicaid patients 254 487 52.2%

Total 389 888 43.8%

30

From Vital Statistics data, February 2014

Prevent Chronic Diseases

• Reduce obesity

• Increase access to high-quality chronic disease preventive care and management

Promote Healthy Women, Infants, and Children

• Reduce premature births

• Increase the rate of babies who are breast fed

Lincoln County ExampleRevisitation of Phase 1: Identify county and hospital priorities

31

Lincoln County ExampleRevisitation of Phase 2: Identify your stakeholders

32

Tabernacle Church of God in Christ Women’s Educational Opportunity Center

Obstetrics & Gynecology Care Network Dr. Kenneth Raymond & Rajeena Tiwari, NP

Lincoln County Health Department National Alliance for the Mentally Ill (NAMI)

Excellus BlueCross BlueShield, Lincoln Valley Lincoln Valley Midwifery Services

Big Lincoln Hospital YMCA of Lincoln Valley

Four Trees Walk-In Community Clinic Lincoln Transit Authority

Lincoln City School District University of Lincoln Student Health Center

United Builders of Lincoln County, No. 56 American Cancer Society

Lincoln City Landscape Architecture Firm Little Lincoln Hospital

Maryam Mallory, Mayor of Lincoln City Big Brother Big Sisters

Planned Parenthood Associates for Cardiac & Vascular Surgery

33

Lincoln County ExamplePhase 4: Explore evidence-based approaches

34

Lincoln County ExamplePhase 4: Explore evidence-based approaches

From the Lincoln County CHIP, 2013:

• Implement well-tested social marketing campaigns to change attitudes, social

norms and behaviors related to breastfeeding initiation, exclusivity and/or duration

• Train physicians, nurses, and other health care providers on the importance of

breastfeeding and lactation support, and reduce distribution of infant formula

• Ensure that businesses/organizations create an environment to support

breastfeeding, pumping and provide lactation support

35

Lincoln County ExamplePhase 5: Identify existing, current, local interventions

36


Organization(s) Interventions

Lincoln City School District Improved workplace breastfeeding & pumping

policies; Converted designated areas.

Big Lincoln Hospital Training for new hires in clinical roles;

discouraging distribution of free formula at birth

Little Lincoln Hospital Pinpointed their low-wage shift workers as at-risk

population; Planning to improve policies

37

Lincoln County ExamplePhase 6: Identify gaps and opportunities

DataCurrent

Interventions

Evidence Base

Stake-holders

CHA, CHIP, and

CSPs

38


Organization(s) Interventions

Lincoln City School District Improved workplace breastfeeding & pumping

policies; Converted designated areas.

Big Lincoln Hospital Training for new hires in clinical roles

Little Lincoln Hospital Pinpointed their low-wage shift workers as at-

risk population; Planning to improve policies

• Supply Little Lincoln Hospital with evidence based tools

• Participate in ongoing dialogue and engagement

• Convene Lincoln City School District administrators and

Little Lincoln Hospital project manager

39

Lincoln County ExamplePhase 7a: Implement county-level work and evaluation

ACT

• Engage Leadership Advisory Committee

• LAC engages 3 neighboring County Agents

• County Agents assist in formation of large work group

• Big Lincoln Hospital leverages their expertise &

resources to bring the region’s providers on board

40

Lincoln County ExamplePhase 7b: Implement regional-level work and evaluation

ACT

• Agencies contribute to a large-scale TV and radio media

campaign to highlight the importance of breastfeeding.

• Regional Agents bring in medical anthropology fellows

from the University of Lincoln to consult on the content

41

Lincoln County ExamplePhase 7b: Implement regional-level work and evaluation

ACT

42

SHARELincoln County ExamplePhase 8: Report back

Communicate with County & Regional Agents

Com

mun

icate

with

Sta

keh

old

ers

43

Lincoln County ExamplePhase 9: Illustrate impact

SHARE

• Showed preliminary data from local hospitals

• Reported improvements to NYSDOH as part of

Prevention Agenda communications

• Presented approach & progress at NYSPHA conference

• Featured in media interviews and articles as part of

Central New York’s “Kids Health Week”

Subcontracts

Master services agreement with HealtheConnections

Exhibit will include statement of work (aligned with MOU)

Budgets and Payment

$70,000 annually for two years

12 monthly payments ($5,833)

Monthly invoice submitted by 10th of following month

Reimbursement contingent upon receipt of HeC vouchers

Reporting

Will align with HealtheConections’ reporting to NYSDOH

Monthly report to submit with invoice

Reporting format, content and schedule TBD

45

Subcontracts, Budgeting, and Reporting

• Provide feedback on meeting via Survey Monkey

• Meeting minutes

• Governance structure discussion – Friday, March 6th

• Nominations for Leadership Advisory Committee

• County assessment/inventory

• Monthly meetings of Operating Committee

• Weekly check-in with PHIP staff assigned to each county

46

Next Steps

Thank you!

47

Central New York Population Health Improvement Program (PHIP)

Regional Advisory Committee MeetingMay 27, 2015

Agenda

• Welcome/Introductions

• Population Health Improvement Program (PHIP) Overview

• Healthy Communities Institute (HCI) Website Presentation

• Regional Advisory Committee Roles and Responsibilities

• Next Steps

3

New York State’s PHIPwill promote the Triple Aim

Better population

health

Better care

Fewer health

disparities

Lower health

care costs

4


Promote population healthReduce health disparities

Best PracticesInnovative Strategies

Add value Fill gaps

Build capacity

Identifying

Sharing

Disseminating

Helping to implement

5


Health, behavioral health, & disabilities service providers

Rural health networks

Insurers, and other payers Consumer & patient advocacy organizations

Behavioral health advocacy organizations

Disability rights organizations

Local public health officials, other elected officials

Local human service agencies

Business community Unions

Schools Higher education institutions

Local housing authorities Local transportation authorities

Convening a broad set of stakeholders

6

PHIP Regions

7

NYS Health Improvement Initiatives

8

Central New York PHIP Team

Oneida

Onondaga

Oswego

Cayuga

Cortland

HeC

Madison

9

PHIP’s CNY Region

County Percentage

Onondaga 45%

Oneida 23%

Oswego 12%

Cayuga 8%

Madison 7%

Cortland 5%

6 Counties1,026,817 People

10

PHIP’s CNY Region

11

CNY PHIP Initial Activities

• Stakeholder engagement

• Governance structure established

o Steering Committee – met 2/26, 3/23, 4/13, and 5/11

o Regional Advisory Committee

• Generating reports on best practices:

• Models for population health improvement work

• Addressing health disparities

• Community engagement

• Identification of Central NY priorities

• Prevention Agenda Priorities Grid

• Identification of regional projects

• Development of website with health data, best practices and resources

12

CNY Prevention Agenda Priorities

Reduce obesity among children & adults

Reduce illness, disability and death related to tobacco use and secondhand

smoke exposure

Increase access to high quality chronic disease preventive care and management in both clinical and community settings

13

Supporting the Chronic Disease Self-Management Program (CDSMP) in CNY

14

Convening Function

Health Equity Dialogues• Partnering with several stakeholders• How to better address health equity and health

disparities• Dialogue designed to inform collective action for

stakeholders

Listening Forum• Sponsored by the YMCA, PHIP and other stakeholders• How to better connect healthcare and community

based organizations and services• Informs DSRIP, PHIP and NYS Prevention Agenda

15

Central New York Website

16

HCI Website Examples

www.ochealthiertogether.orgwww.ncnyhealthcompass.org

www.dchealthmatters.org

17

http://www.ncnyhealthcompass.org/

http://www.ncnyhealthcompass.org/

http://www.sfhip.org/

http://www.sfhip.org/

Improving Population Health in Central New York

Scott DahlDirector of Business Development, East RegionHealthy Communities Institute

• Mission‒ Improve the health, vitality and environmental

sustainability of communities, counties and states

• Problem/Solution‒ Health data is too decentralized, quickly out of date, doesn’t identify health problems‒ Need to move beyond a traditional medical/disease model towards an active and systemic

philosophy that seeks to better prevent and manage disease‒ Built upon WHO/Healthy Cities Initiative – a catalyst to community health improvement,

widespread through the ubiquity of the internet, dynamic

• Our Unique ApproachProactive and dynamic integrated technology and services for monitoring disparities, synthesizing data, evaluating results, and creating action plans for health improvement and health equity

• National Relationships / Awards / Coverage:‒ Department of Health and Human Services Healthy People 2020 Award‒ Health Data Initiative Forum III Best Community App Award‒ VHA and CHA National Agreements‒ >130 million lives in the United States, 485 counties, 7 states, 425 hospitals

Healthy Communities Institute: focused on health informatics for community health since 2002

mm

Benefit from an experienced team of epidemiologists, biostatisticians, informatics experts

• Ambassador Kevin Moley, U.S. Ambassador to United Nations 2001-06, Assistant Secretary, Health and Human Services

• Kevin Patrick, MD, Professor UCSD, Editor In Chief American Journal of Preventive Medicine

• Len Duhl, MD, Professor UC Berkeley, Co-Founder Healthy Cities Movement

• Linda Neuhauser, PhD, Clinical Professor, School of Public Health, Co-PI Health Research for Action, UC Berkeley

• David Holbrooke, MD, Founder PerSe Techs, Board Advisor McGill University Medical School

• Larry Leisure, Global Healthcare Practice Leader Accenture, CRO Kaiser Permanente

• Hans Ploos Van Amstel, CFO Levi Strauss

• David Warthen, Founder Ask Jeeves

HCI Advisors• Deryk Van Brunt, DrPH, President/CEO‒ Associate Clinical Professor, UC Berkeley;

CEO, eMedicine; COO HealthCentral• Marcos Athanasoulis, DrPH, CTO

‒ Director IT, Harvard Medical School; VP Engineering RelayHealth; CTO HealthCentral.com

• Florence Reinisch, MPH, VP Content/Research/ClientSvcs ‒ Research Director, CA Health Department

• Robert Murphy, Marketing Director‒ SVP Marketing iMetrikus

• Jan Barker, RN, FNP, MS, Business Development Advisor ‒ MedVenture

• Kathi deFremery, MBA, Director of Finance ‒ Finance Director, Center for Volunteer & Non-profit

Leadership• Sheila Baxter, MPH, Business Development

‒ WHO, UCSF, Kaiser Permanente

• Scott Dahl, MBA, Business Development, ‒ VHA, Kimberly-Clark, Texas Health Resources

HCI Management

• 100 – 200 indicators• Constantly updated• Analytic tools

Community Knowledge

• >2000 in database• Programs & policies• Evaluation-based

Promising Practices

• Form working groups • Set local goals• Manage achievement

of objectives

Collaboration Centers• HP 2020 tracker

• Local Priorities tracker

• Comparative and longitudinal evaluation

Evaluation &Tracking

Continuous health improvement: Effectively moving from data to action

Stakeholder Engagement

Management and Legal

Entity

Operations

HealtheConnections Steering Committee Regional Advisory Committee

6 County Advisory Groups

Standing Committees

Short-term Committees

Individual Outreach

Strategic Input StakeholderEngagement

22

Thank you!


Regional Advisory Committee MeetingAugust 18, 2015

Agenda

• Welcome/Introductions

• PHIP Funding Changes

• PHIP Scope of Work – Past and Future

• HealtheCNY Website – Launch and Promotion

• Next Steps

2

PHIP Funding Changes

• Reduction in PHIP funding

• 50% cut - retroactive to January 2015

• Consultant work taken on by HeC staff

• Overhead and business costs absorbed by HeC

• County Agent contracts significantly reduced

• Explore new funding opportunities

3

PHIP Scope of Work

Convening Stakeholders___________

• PHIP regional and local stakeholders

• Clinic to community linkages

• Health equity

Data and Best Practices

_____________• HealtheCNY

• Promoting best practices

• CDSMP

• NYS Prevention Agenda

Building Capacity

___________• Website TA and

Training

• Training

• Connecting to resources

4

HealtheCNY Website – Launch and Promotion

• Pre-launch feedback

• Regional Advisory Committee, topic area experts, key stakeholders, beta testers

• Planned promotion efforts:

• Targeted announcements to intended audience/press release

• County based introduction events - in coordination with County Agents

• Ongoing activities

• Website work group

• Ongoing additions and improvements

5

Next MeetingWednesday, November 18, 2015

Thank you!


Regional Advisory Committee MeetingNovember 18, 2015

Agenda

• Welcome

• PHIP Updates

• Promotion of HealtheCNY

• Health Equity and Health Disparities Activities

• Prevention Agenda Planning Activities

• NEW Local IMPACT Initiative

• Next Steps

• Next meeting: February 23, 2015

2

HealtheCNY Analytics: 9/14/15 – 11/11/15

4

HealtheCNY traffic sources

Half of all HealtheCNY visitors were “direct traffic” (typed in the URL, or clicked on a URL in an email)

Most other visitors were referred from another website linking to HealtheCNY

• HealtheConnections• CNY Vitals.org• Madison County

Department of Health• Auburn Citizen

Direct50%

Referral39%

Organic Search

9%

Social Media2%

5

HealtheCNY Analytics: 9/14/15 – 11/11/15

Page Title Unique PageviewsHealtheCNY Homepage 1156Community Dashboard (All CNY Data) 192Health Priorities 166Promising Practices Database 146Explore Data 122County Landing Page 121Disparities Dashboard 115SocioNeeds Index 99Onondaga County Priorities 93About Us 82NYS Prevention Agenda 2013-2017: Progress Tracker 80

6

Health Equity and Health Disparities

• Cultural Competency and Health Literacy Workgroup• Culturally and Linguistically Appropriate Services

(CLAS) Standards Assessment

7

Prevention Agenda Planning Activities

• Plans are due December 30, 2016• Community Health Assessment (CHA)• Community Health Improvement Plan (CHIP)• Community Service Plan (CSP)

• PHIP Assistance Highlighted• HealtheCNY: data, best practices, activities, posting report,

engaging partners, tracking progress• County agents participation at each county• Where can PHIP resources be most useful?

8

Central New York Local Initiatives for Multi-Sector Public Health Action

(Local IMPACT)

Regional Advisory Committee MeetingNovember 18, 2015

• Describe the Local IMPACT Grant

• Share the Goals and Intent of the Project

• Convey the Local IMPACT Implementation Plan

• Discuss the 15 Associated Strategies

• Explore Collaboration Opportunities

Today’s Objectives

10

• HealtheConnections selected as one of three large area awardees

• $2.05 million grant over the next 3 years

• Administered by the NYSDOH with funding from the CDC

• Partially funded by the ACA (2014 Prevention and Public Health Fund DP14-1422)

Local IMPACT Overview

11

Presenter

Presentation Notes

State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health (DP13-1305) – All states Epi and Surveillance Making Healthy Choices Easy Improve Health Systems Community-Clinical Linkages 1422 there are 21 awards – mostly states to fund local but also 4 cities (NYC) directly funded.

Local IMPACT Goals

• Prevent obesity, prevent and control diabetes, heart disease and stroke, with a focus on reducing health disparities among adults

• Support high-need counties in implementing intensive, general and location-specific strategies in community and health system settings

Local IMPACT

12

• Package of policies and programs to strengthen communities and health systems

• We are testing• Dual Approach• Addressing risk factors and conditions

simultaneously• Local implementation of whole-population and

priority population strategies

Local IMPACT Intent

13

• Four Local IMPACT Partnerships are required to

• Serve counties identified in application• Identify and target high-need areas within these

counties - Bundled strategies• Partner with community entities and health

systems that serve low-income populations (e.g. Federally Qualified Health Centers)

Target Population

14

CNY Local IMPACT Region

15

CNY Local IMPACT Region –Population Distribution

County Percentage

Onondaga 46%

Oneida 23%

Oswego 12%

Cayuga 8%

Herkimer 6%

Cortland 5%

6 Counties - 1,017,894 People Source: ACS 2010

16

CNY Local IMPACT County Agents

Onondaga County Health Department

17

CNY Local IMPACT Partners

18

Thank you!

Population Health ImprovementRegional Advisory Committee Meeting

February 23, 2016

Central New York PHIP: 2015 Highlights

Established infrastructure to support regional health priorities• County Agents and Advisory Groups• Engaged 600+ stakeholders• Listening Forum on clinic-to-community linkages

• Collaboration with YMCA, St. Joseph’s and Lerner Center

Compiled, shared and promoted data and best practices• www.HealtheCNY.org• Over 1800 unique users since September 2015• Best practices around Health Equity and Site Based Work• Promoted Monday Mile expansion, CDSMP, NDPP

Supported NYSDOH efforts• DSRIP, SHIP and Prevention Agenda

Capacity to apply for other grants• Local IMPACT• NACDD: Reaching People With Disabilities Through Healthy

Communities (RPDTHC)• Others in process

2

http://www.healthecny.org/

Held Cooking Matters workshop in partnership with Cornell Cooperative Extension

Provided monthly Diabetes Support Group

Cayuga County:Cayuga Community Health Network

3

Coordinated Renter’s Rights & Landlord Rights workshops with Human Services Coalition

Cayuga County:Cayuga Community Health Network

4

Started National Diabetes Prevention Program

Cortland County:Seven Valleys Health Coalition

5

Supported local Prevention Agenda groups

Supported Cortland Counts

Cortland County:Seven Valleys Health Coalition

6

Established Live Well Committee to address obesity in children

Madison County:Madison County Rural Health Council

7

Supported National Diabetes Prevention Program in collaboration with Herkimer County HealthNet

Madison County:Madison County Rural Health Council

8

Launched Baby Café with Mohawk Valley Perinatal Network and Oneida County Breastfeeding Workgroup

Offered Fresh Start tobacco cessation curriculum with multiple partners

Oneida County:Central New York Health Home, Inc.

9

Restructured the Oneida County Health Coalition to enhance Prevention Agenda efforts

Oneida County:Central New York Health Home, Inc.

ONEIDA COUNTY HEALTH COALITION

Partnership of stakeholders from a broad cross section of sectors convene to network, increase

awareness of programs, initiatives, and/or community health issues related to the NYS

Prevention Agenda (PA)

Representatives of agencies, groups or initiatives supporting

Prevention Agenda #1 Prevent Chronic Disease:

Obesity in Children and Adults Illness, Disability and Death Related to Tobacco Use and Secondhand Smoke

Access to High Quality Chronic Disease Preventive Care and Management


Prevention Agenda #4-Promote Mental Health and Prevent Substance Abuse:

Mental, emotional and behavioral (MEB) well-being

Substance Abuse and other Mental Emotional Behavioral Disorders

Strengthening Infrastructure across Systems


Prevention Agenda #3 - Promote Healthy Women, Infants, and Children:

Maternal and Infant Health Child Health

Reproductive, Preconception and Inter-Conception Health


Prevention Agenda #2 Promote Healthy and Safe Environments:

Outdoor Air Quality Water Quality

Built EnvironmentInjuries, Violence and Occupational Health

Representatives of agencies, groups or initiatives supporting Prevention Agenda #5 - Prevent HIV, STDs,

Vaccine Preventable Diseases, and Healthcare-Associated Infections:

Prevent HIV and STDsPrevent Vaccine-Preventable Diseases

Prevent Healthcare-Associated Infections

PHIP GrantProvide funding resources to support

community agencies, groups or initiatives doing evidence-based interventions in the

Prevention Agenda focus areas

HealtheConnectionsProvide technical support, data and/or

expertise to support the work of the AAA Team

STEERING COMMITTEE A subgroup of OCHC members

working with OCHD to: Monitor PA health status indicators Recruit representatives to the OCHC Report on access to care and health issues and

trends, vulnerable populations Recommend evidence-based interventions Support health assessment activities

Community Initiatives (Example: Stop ACEs, DSRIP

Projects)

Community Initiatives (Examples: Immunization

Consortium, DSRIP Projects)

Community Initiatives (Examples: IMPACT Grant, CHIP – Tobacco Cessation

Workgroup, DSRIP Projects)

Community Initiatives (Example: Creating Health Schools and Communities

Grant)

Community Initiatives (Examples: CHIP Breastfeeding Workgroup, Teenage Pregnancy

Prevention Network, DSRIP Projects)

10

Created life expectancy tables using Onondaga County Health Department Vital Statistics data

Onondaga County:Onondaga County Health Department

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Perc

ent S

urvi

ving

Age (Years)

Onondaga (excl. of Syracuse), Male

Onondaga (excl. of Syracuse),FemaleSyracuse, Male

Syracuse, Female

Survivorship for residents of Syracuse, New York compared to residents of Onondaga County, New York (exclusive of Syracuse), 2011-2014

75.9 76.874.6

72.6

78.777.5 77.2

78.579.8

65

70

75

80

85

90

95

100

13202* 13203* 13204* 13205* 13206 13207 13208 13210* 13224

Life

Exp

ecta

ncy

at B

irth

(Yea

rs)

Age (Years)

Life Expectancy at Birth by Zip Codefor Residents of Syracuse, New York, 2011-2014

*Zip codes containing nursing homes or assisted living facilities

Onondaga County:Onondaga County Health Department

Partnered with Cornell Cooperative Extension to hire AmeriCorps worker for community garden

Built Chronic Disease Self-Management Program (CDSMP) infrastructure

Oswego County:Rural Health Network of Oswego County

13

Central New York PHIP: 2016+

NYSDOH’s Population Health Improvement Program• 11 regions• Broad boundaries/flexible program• Common framework

Funding for 2016 and beyond• PHIP in Executive Budget for 2016• Possibility of renewal years

CNY PHIP work going forward• Continue: stakeholder engagement, HealtheCNY, supporting

NYSDOH initiatives, supporting other funded activities• What else?

PHIP work across the state

14

Thank you

Next Meeting: Wednesday, May 18, 2016

Population Health ImprovementRegional Advisory Committee

August 24th, 2016

Chronic Disease Prevention and Self-Management Programs

in Central New York

PHIP & Local IMPACT: Our Charge

2

Population Health Improvement Program

• Engaging stakeholders• Providing data,

resources, best practices• Capacity building/support

for PHI & Prevention Agenda priorities

Local Initiatives for Multi-Sector Public Health

Action

Preventing and controlling obesity, diabetes, heart

disease, and stroke through 15 mutually reinforcing

strategiesSupporting, scaling up, and

sustaining Chronic Disease Prevention and

Self-Management Programs

3

• By 2050, 1 out of 3 adults in U.S. could have diabetes if current trends continue

SOURCE: Centers for Disease Control and Prevention

Prevalence of Diagnosed Diabetes in NYS

4

Herkimer, Cayuga and Cortland are among five counties with highest prevalence in state.

NYS = 8.6%US = 9.3%

Prevalence of Diagnosed Diabetes in CNY

5

SOURCE: 2013-2014 NYS Expanded Behavioral Risk Factor Surveillance System. Accessed via www.HealtheCNY.org.

Age-Adjusted Hospitalization Rate Due to Diabetes by Zip Code

6

Hospitalizations per 10,000 population aged 18 and over.SOURCE: 2012-2014 New York Statewide Planning and Research Cooperative (SPARCS).

Accessed via www.HealtheCNY.org

National Diabetes Prevention Program

7

• Endorsed/recognized by the CDC

• Evidence-based program includes:

• NDPP, Prevent T2, YDPP, Omada

• In-person, virtual, online, combination

• 12 month standard curriculum

• “Lifestyle change” focus: Eating healthy and increasing physical activity for weight loss

Chronic Disease Self-Management Program

8

• Supported by Stanford University Patient Education Research Center

• Evidence-based program

• Six week standard curriculum for all chronic diseases

• “Self-management” focus: Techniques for improving daily functioning, communicating effectively, and making decisions.

Diabetes Self-Management Program

9

• Supported by Stanford University Patient Education Research Center

• Evidence-based program

• 16 week standard curriculum specific to diabetes

• “Self-management” focus: Techniques for improving daily functioning, communicating effectively, and making decisions specific to diabetes.

Regional Progress

10

• Forming CDSMP Workgroup

• Building NDPP Infrastructure

• Training NDPP Coaches via QTAC-NY

• Increasing enrollment in NDPP

• Working with diverse partners including employers

• Evaluating challenges/opportunities with focus groups and subject matter experts

• Tracking policy changes

Guest Speaker Presentations

11

• Organization’s role in relation to NDPP, CDSMP, DSMP

• County(s) served

• Specific population(s) served

• Setting(s)

• Key points relating to guest speakers’ unique perspectives, experiences

Central New York Examples

Oswego County Health Department

13

• Diane Oldenburg, Senior Public Health Educator• Organization’s Role: Provider of CDSMP, NDPP;

Partner with and support other organizations that provide CDSMP, NDPP; hold the MOU with QTAC in Albany

• County served: Oswego County


14

Populations Served:• Since 2012, we have offered 15 workshops, with

176 participants and 124 completers

• Participants are from 20 different zip codes

• 65-69 years is most common participant age

• Hypertension is most often listed chronic condition


15

Host Workshops at:• Senior Nutrition Sites

• Senior Housing

• Step-By-Step Clubhouse

• Bishop’s Commons

• Health Centers


16

Key Points:• Local health department perspective on

delivery of CDSMP, NDPP

• Collaboration in Oswego County around marketing, recruitment, delivery

• Roles of health department, hospital, rural health network, not-for-profit organizations


17

Key Points:• Lessons learned from serving people of low

socio-economic status, rural populations

• In Oswego County, partnerships are key!

YMCA of Greater Syracuse

18

• Jessica DesRosiers, Senior Healthy Living Director

• Organization’s Role: YMCA of Greater Syracuse provides Y-DPP program, as well as: Fall Prevention, Arthritis Management, Blood Pressure Monitoring, Cancer Survivor Programming, Orthopedic/Physical Therapy Step Down Program

• Counties served:• Onondaga County

• Cayuga & Oswego Counties


19

• Serves various populations including: low income, rural, suburban, Hispanic, African American

• Estimated annual reach is on average 75-100 participants with the Y-DPP

• Y-DPP can be delivered in versatile locations, since it is a classroom based program. We have offered it at the workplace, church, schools, health centers, and YMCAs.


20

Key Points• How Y-DPP relates to national NDPP effort

• YMCA of Greater Syracuse has been offering the program since 2009

• Y-DPP infrastructure: We have 18 Lifestyle Coaches (16 Female, 2 Male, 1 Female is Bi-Lingual)

• Y-DPP at worksites: Cayuga County Health Department, CENTRO, SCHC, Say Yes Parent University


21

Key Points• Lessons learned from serving people of low socio-

economic status

• Childcare Needed

• Transportation - Hold class in community

• Language barrier

• Attendance struggle

• Preparation for Medicare reimbursement

• Compliance Officer

• Keeping relationships active

22

• Tom Curnow, Executive Director• Elyse Enea, Program Coordinator• Organization’s Role: NDPP classes represent one

component of core service area focused on chronic disease prevention; other future components to include CDSM & DSM

• Counties served: • Herkimer County• Madison County

(Collaboration)

Herkimer County Health Net


23

• Population served: NDPP classes currently serving 47 individuals (Herkimer - 29, Madison - 18)

• Characteristics:• Avg. age – 58 (range: 32 – 84)• Avg. weight – 223 (range: 143 – 362)• Other diseases: hypertension, high cholesterol,

heart disease• Setting: Hospitals, non-profit agency, Chamber of

Commerce, primary care clinics

24

Key Points:• Unique model that separates administrative and

coaching components of NDPP

• Coaches work under an independent contractoragreement.

• HCHN assumes primary responsibility for marketing (recruitment concept dropped)

• HCHN manages class data and QTAC input

• Marketing: Newspaper block ads, website, Facebook, radio advertisements, community flyers, Chamber of Commerce newsletter



25

Key Points:• Lessons learned during expansion of NDPP:

Relationship with coaches, share resources for most impact, shift to marketing.

• Lessons learned in achieving “pending” recognition from CDC, moving towards “full:” “Manage your coaches”, consistently review & assess your data, outcomes are somewhat “out of your control.”


26

Key Points:• QTAC-NY’s support role: Training & data support

• Cross-county collaboration: Leverage resources

• Requirements for class size can be a barrier

• Impact of Medicare & Medicaid: BIP demonstration project


27

• Bonnie Slocum, Executive Director• Victoria Brown, Program Assistant• Organization’s Role: Madison County Rural Health

Council coordinates NDPP/CDSMP facilitator training,markets & promotes classes, patient referral process (except Hamilton), schedules classes, completes datarecording & evaluation as required by Herkimer Health Net

• County served: Madison County• Open to Oneida & Chenango Counties


28

• Population Served: • Anyone over the age of 18 with prediabetes, also those

without if more than 50% in class have prediabetes

• 2015- 21 people; 2016 - 18 people so far, potential for 20 more in Sept. 2016.

• Reaching out to obstetric practices for those with gestational diabetes

• Characteristics: • Ages 30 – 83, weights from 140 – approx. 300, heart

disease, arthritis, high cholesterol, hypertension, about 1/3 employed, 2/3 retired, most live within 12 miles of class location.


29

• Setting where program is delivered: 3 locations• Classrooms on 2 hospital campuses

• Community Based Organization meeting room


30

Key Points:• Goals: Increasing number of referrals; Letting

physicians know of NDPP resource; Streamliningreferral process from physicians to RHC, Getting information back to physicians about patient participation.

• Need better identification by physicians of prediabetics

• Rural health network perspective on delivery of these programs: A way to shift thinking from treatment to prevention and self-management


31

Key Points:• Cross-county partnerships:

• Herkimer Health Net – Grant recipient for both Herkimer & Madison Counties

• Facilitators from Onondaga and Cortland counties engaged to conduct classes in 2016

• Residents from Oneida County have attended

• Open to Chenango County residents


32

Key Points:• QTAC- NY – Training for ALED and DMP to develop

capacity for full spectrum of preventive and self management programs. QTAC & CDC class requirements challenging for rural areas

• Sustainability – w/ Herkimer, larger region?• Will it be feasible as a rural health council to continue with heavy

Medicaid/Medicare data and record requirements for reimbursement?

• How do the preventive and self management programs fit with DSRIP over the long term?

• No cost to participants at present. Will that be possible to continue

• NDPP will be included in CHA/CHIP/CSP strategies for Healthy weight priority

ARISE, Inc.

33

• Shane Hoey, Habilitation Coordinator • Jim Karasek, Manager of Independent Living• Organization’s Role: ARISE, Inc. is a provider of

CDSMP, DSMP, NDPP

• Counties served:• Cayuga

• Madison

• Onondaga

• Oswego

• Seneca

ARISE, Inc.

34

• ARISE is a non-profit Independent Living Center that provides disability services for people of all ages and abilities in Syracuse and Central New York.

• 1 in 10 adults in Oswego County is diabetic which is higher than the state average (9.0%)

• Currently approx. 50 individuals per year are completing the course in Oswego County.

• We deliver these classes throughout the community where needed, our office, nursing homes, homeless shelters, schools, etc.

ARISE, Inc.

35

Key Points • DSMP differs from previously mentioned

programs by specifically providing information for diabetics to help manage their disease with topics such as monitoring your blood sugar as well as skin and foot care.

ARISE, Inc.

36

Key Points - What did we learn?• Lessons learned from serving specific

subpopulations with CDSMP, DSMP, NDPP

• We were part of an original BIP grant that asked us to specifically target individuals with disabilities to help adapt the program as needed.

• In Oswego County approximately 61% of the population lives in the rural area compared with 12% for the state and 19% nationwide.

Group Discussion

37

Possible themes to consider:• Reaching high-risk subpopulations

• Marketing & recruitment

• Collaborating with other agencies

• Linking community-based programs with health systems

• Paying for program by charging participants, billing insurance


November 10, 2016

Follow Up From Summer Meeting

Theme: Scaling and Sustaining Chronic Disease Prevention and Self-Management Programs in CNY

Areas of Action:

1. Improve awareness and coordination of current programs

2. Provide local feedback to the national level about implementation challenges

2

Awareness and Coordination

Improve awareness and coordination of current programs

Created and distributed a list of programs – see handouts

Launched a map of programs on HealtheCNY: http://www.healthecny.org/ChronicDiseasePrograms

Piloting a multi-directional referral system on HIE, using Direct Mail to refer patients with prediabetes to NDPP and share information back with provider for participants in NDPP

3

http://www.healthecny.org/ChronicDiseasePrograms

Feedback to the National Level

Provide local feedback to the national level about implementation challenges

Participated in NYSDOH meeting on EBSMPs• Feedback on facilitators and barriers to EBSMP adoption• HeC plus Onondaga, Madison, Cayuga, Herkimer, Oswego

and Cortland attended• NYSDOH will submit white paper with feedback to the CDC

4

Today’s Agenda

Theme: Using data from multiple sources to plan and monitor population health improvement work in CNY

Sources of Data to Inform Population Health Improvement Work

County Initiatives Using Data to Guide Population Health Improvement Work

Opportunities for Action

5

Central New York PHIP Scope of Work

6

Convening Stakeholders

Data and Best Practices

Building Capacity

Opportunities for Action - Ideas

Convening Stakeholders• Convene a regional Work Group around using data

Data and Best Practices• Arrange for access/purchase specific data sources• Enhance HealtheCNY with new data or functionality• Products: printable county profiles, custom dashboards,

snapshots of data or health topics• Communications messaging about data (e.g., for social media)

Building Capacity• Contract with consultant to offer technical assistance• Trainings (e.g., qualitative data, communicating about data)• Resources that help people understand and use data.

Other ideas7

Thank you

Connecting You To Better Care and Health

Karen Romano and Gary Krudys

HealtheConnections

HealtheConnections is a not-for-profit corporation that supports the meaningful use of health information exchange and technology adoption, and the use of community health data and best practices, to enable Central New York stakeholders to transform and improve patient care, improve the health of populations and lower health care costs.

3

Health Information Exchange

Population Health

Improvement

Value Based Solutions & Analytics

Participant Engagement &

Provider Advisory

“Supporting the Triple Aim”


1111


1212

HealtheConnections By The Numbers

7,000+ Active Users

1.87 Million Patients in the HIE

2.4 Million Consents (1.1 Unique)

2.5 Million Results Delivered

93,000+ Alerts Sent

750,000,000+ Patient Clinical Items Available and Growing

13

14


Data Warehouse

• Data to support HIE functions

• Organized for look up efficiency

• Data to support reporting and analytic functions

• Organized for reporting and analysis efficiency

Information Flow

15

Data Warehouse

Clinical Information Areas

Labs - Results

Diagnosis

Encounter

Procedures

Provider

Patients

Medications

Conditions

Vitals

Allergy

Consent

What’s in the Data Warehouse ??

16

Data Warehouse

Use Case Examples

Brief Overview

www.HealtheCNY.org

Mary Carney and Debbie Gordon-Messer

http://www.healthecny.org/

2-1-1 Counts

http://ny.211counts.org

Mary Shaheen

http://ny.211counts.org/

Cortland Counts

Susan Williams

A Picture of Cortland County:Assessment of Health and Well-Being

The Community Assessment Team (CAT)

Cortland Counts Reports:

* Demographics

I. Health and Safety

II. Social Cohesion, Recreation, and Culture

III. Employment, Economy and Welfare

IV. Housing and Environment

V. Positive Development Through the Life Stages

Annual Report Card, yearly, 8 pages

Comprehensive Report, every 4 - 5 years (CHA cycle), 180 pages

PROCESS

• mothersandbabies.org

• cdc.gov

• nyskwic.org

• health.data.ny.gov

• health.ny.gov

• seer.cancer.gov

• mchb.hrsa.gov

• childhealthdata.org

• jamanetwork.com

• criminaljustice.ny.gov

• ucr.fbi.gov

• elections.ny.gov

• labor.ny.gov

• bls.gov

• census.gov

• data.guttmacher.org

• data.nysed.gov

• healthecny.org• Calls or emails to specific agencies

Sources

Housing: 2008

Sustainability: 2016

SUCCESSES

Oneida County Health Coalition’s Health Report Cards

Phyllis Ellis

Data

Perceptions

Trends

Best practices

Issues

Improve the way we monitor health status by:

Analyzing data and health trends during “off” CHA years.

Providing up-to-date information on and data trends.

Using the OCHC as a means to capture and compile qualitative data (potential underlying causes, influences, trends, gaps in services, vulnerable populations, etc.)

OCHC restructuring and sustaining engagement

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=imgres&cd=&cad=rja&uact=8&ved=0ahUKEwi1uKiqppfQAhXI6yYKHWiqAtQQjRwIBw&url=http://gethealthycarsoncity.org/about-us/the-10-essential-public-health-services/&psig=AFQjCNEwNJ22SAxo_uHLjTK93B8x9tBa3w&ust=1478630590230694

Initially: PHIP Agent, HealtheConnections (OCHC web page), OCHC

Steering Committee

Thereafter: Broad engagement of all stakeholders, actively solicit for

involvement.


Identify topic and facilitator to lead discussion/analysis.

Collect and disseminate preliminary quantitative data for advance review

Quarterly Meeting Discussion Format:

Summarize quantitative data. Gather qualitative feedback - Why do we have this issue? What are some of the underlying

causes (social, environmental, economical)? Gaps in resources? Community’s perception, concerns? Vulnerable populations? Existing community partnerships/coalitions doing work in this area?

Compile and organize data into Quarterly Health Status Report Card (Review Sample)

Report distributed to general membership and posted on OCHC web page.


NYSDOH

HealtheConnections

Survey membership for:o Community Agency and Program Data

o Community Surveys


Too early to determine how they have been used (assess after 1 yr)

Expectations:o Increase education, awareness

o Set priorities

o Initiate new or strengthen existing partnerships

o Monitor change

o Leverage grant opportunities


Challenges: Partners still learning the process Keeping focus on issues and areas for improvement (understanding

population health) Identifying programs and services vs. collaborations/partnerships Structuring qualitative feedback Facilitator selection

Successes: Strong partner interest in the Report Card and high engagement Increasing awareness and identifying collaborative opportunities One source for local quantitative and qualitative data on specific issues.


Continuously assessing process and making improvements such as: Provide opportunities for add’l feedback at the meeting (comment cards) and after the

discussions (Surveys)

Use Flip Charts with categories of issues (i.e., Social, Economic, Legal, Technological,

etc.) to guide and frame discussions.

Pre-identify topics and speakers for Steering Committee selection

Include links to additional data sources and community resource information(i.e, 2-1-1)


Limitations: Summarizing multiple sources of data Qualitative feedback limited to participants Community feedback not fully represented Managing expectations

Potential: Stronger efforts to recruit input from unrepresented groups Inclusion of community members in qualitative discussion Driver for making decisions about programs and services Snapshot to educate community and policy-makers


Discussion and Opportunities for Action


February 28, 2017

CNY Prevention Agenda Priorities

2* Breastfeeding is being addressed by 1 county under the main goal of "Prevent Chronic Diseases". Oral Health is being addressed by 1 county under the main goal "Promote a Healthy and Safe Environment".

Selected by 4 counties

Follow Up From Fall Meeting

Theme: Using data from multiple sources to plan and monitor population health improvement work in CNY

Areas of Action:

Create Data Products/Customizable Tools (Report Cards)

Offer Training and Technical Assistance (Qualitative Training and Communicating About Data)

3

PHIP Actions

Create Data Products/Customizable Tools• Reached out to Healthy Communities Institute to

request enhanced functionality around generating customizable reports to easily print

Offer Training and Technical Assistance• Scheduling a 2-part training for the spring/early

summer to include:• Visual Communications• Creating infographics

4

Today’s Agenda

Theme: NYS Prevention Agenda 2013-2018: Breastfeeding Initiatives in Central New York

Review of breastfeeding data and evidence based approaches

Breastfeeding activities in NEW CHIPs and CSPs: Cayuga, Cortland, Oneida and Oswego

Discussion of successes, challenges and opportunities for action

5

Review of Breastfeeding Data and Evidence Based Approaches

Data on Breastfeeding in CNY

7


8

30

4040

69

61

0

10

20

30

40

50

60

70

80

Percent of CNY Infants Exclusively Breastfed in the Hospital,By Medicaid Status and Race/Ethnicity, 2012-2014

Black Non-

Hispanic

Hispanic White Non-

Hispanic

Medicaid Non-Medicaid


9

Breastfeeding Best Practices

10

Describes actions to promote breastfeeding for 3 sectors:

1. Hospitals – quality improvement efforts

2. Primary Care providers –become NYS Breastfeeding Friendly Practices

3. Employers – use the Business Case for Breastfeeding

11

Coalition Development

Breastfeeding Friendly Practices

Breastfeeding Friendly Childcare

Worksites Supportive of Breastfeeding Moms

Baby Cafés

Activities from the Creating Breastfeeding Friendly Communities RFA

Summary of Breastfeeding Activities in NEW

CHIPs and CSPs

Cayuga County

Cayuga County Health Department

•Review of 2013-2016 Community Health Improvement Plan findings and accomplishments

•Moving forward: 2016 – 2018 Community Health Improvement Plan

Results from 2013-2016 CHIP

87

32

144 2

69

2011

4 1

2516

3 2 0

112

48

176 2

0

20

40

60

80

100

120

Initial 3 Month 6 Month 9 Month 1 year

Annual Statistics for2016

Call #1 Surveys Completed Yes Breastfeeding Not Breastfeeding Lost to Follow-up Total Clients

Results from 2013-2016 CHIPReasons women stopped breastfeeding

Breakdown of "Other"Difficulty with Latch 6Incorrect Information Provided 4"Not for Me" 2Breast Milk Dried Up 1Maternal Weight Loss 1

02468

1012141618

Painful Developed mastitis Not enough milk Baby wasn't gaining weight Went back to work Other

Reasons Clients Stopped BF2016 Annual Statistics

Sum of Reasons Client Stopped BreastfeedingPainful 4Developed mastitis 0Not enough milk 5Baby wasn't gaining weight 2Went back to work 6Other 16

• Goal #1 – CCHD and Auburn Community Hospital will collaborate to promote breastfeeding to pregnant and post-partum women in an effort to increase the proportion of babies who are breastfed.

• Objective #1 – By December 2018, increase the awareness of breastfeeding and breastfeeding resources available in community.

• Breastfeeding Connection Facebook page (seek funding to run a social media campaign on Facebook to promote and encourage breastfeeding)

• Promote breastfeeding resource guide• Educate hospital maternity floor staff and local pediatricians• Offer community workshops on breastfeeding • Promote breastfeeding support groups

• Objective 2-4 are more of planning and timeline for staff.

• Objective #5– By March 2017, CCHD staff will begin conducting well-check calls to obtain information on the health, well-being and safety of mom and baby as well as to assess the mother’s breastfeeding status. Initial calls will be conducted within one week of discharge and those moms that are breastfeeding upon initial call will be followed-up with at different intervals. The follow-up calls will occur at 3 months, at 6 months, at 9 months and at 12 months post discharge. The follow-up calls will only be made to those mothers who are continuing to breastfeed at these later intervals.

Cortland County

Partners:

• Cortland County Health Department• Cortland Regional Medical Center• Dr. Djafari Pediatrics• Family Health Network• Mothers and Babies Perinatal Network • CAPCO WIC• La Leche League• Seven Valleys Health Coalition

Oneida County

Breastfeeding Initiatives

Objectives & Activities- centered around prenatal, inpatient, and beyond and include:

Increase rate of exclusive breastfeeding during hospital stay

Decrease rate of elective supplementation during Hospital stay

Increase the number of babies who receive any breastmilk in the hospital

Increase the number of childcare providers with NYS Breastfeeding-friendly childcare designation

Increase the number of Breastfeed Your Baby Here (BYBH) locations

Increase the number of individuals educated at health department Baby Weigh Station

Increase the number of providers with NYS Breastfeeding Friendly Practice designation

Increase the WIC initiation rate

Establish educational programs with refugee center

Increase number of people utilizing peer support group (Breastfeeding cafes)

CHIP Goal - Increase the proportion of Oneida County babies who are breastfed

Traditional Art work to promote and normalize Breastfeeding for targeted Health Care Providers in Oneida County will be distributed by Eliesa.

Cutouts will contain education message and links for more information on Breastfeeding as overseen by CCE Oneida County

College students will be used by Carpenter and Damsky for 6 months for ongoing placement and use of cut outs. Will include the development of a toolkit for community use after initial kick off. (open access to borrow from CCE Oneida County for community events, college projects, ect.)

Target Date for Kick off Press Event - June 14, 2017

Marketing and EducationSocial Media

#Mohawk Valley BreastfeedsSocial Media and Marketing Breastfeeding Education

Campaign

Example: #MVBreastfeeds under DevelopmentBased on other successful social media campaigns.

Goals:• To change social norms to accept public breastfeeding

as a normal infant feeding practice• Educate on benefits of breastfeeding • Engage community in Breastfeeding Conversations by

using social media platforms such as Facebook, twitter, and Instagram (selfies with cut outs in community)

Media Company: Carpenter and Damsky

Workgroup participants: Mohawk Valley Perinatal Network Mohawk Valley Health System Rome Memorial Hospital Mohawk Valley Breastfeeding Network Neighborhood Center Oneida County Health Department Cornell Cooperative Extension WIC Healthy Families Community Health Worker Program

CHIP workgroup- Local health department, hospitals, and community partners meeting quarterly.

Oswego County

Oswego County

Oswego County selected breast feeding as an outcome measure under the Reduce Obesity in Children and Adults priority area.• Encourage and recruit pediatricians, obstetricians and

gynecologists, and other primary care provider practices and clinical offices to become New York State Breastfeeding Friendly Practices;

• Continue to participate in the Oswego County Breastfeeding Coalition;

• Increase breastfeeding exclusively at discharge as part of Oswego Hospital’s quality improvement efforts.

Goal is to increase the number of breastfeeding mothers in Oswego County to prevent obesity.

Discussion and Opportunities for Action

Discussion Questions

Question 1: For your discussion topic, what have you tried in your county that has worked?• Follow-up Question: What facilitators led to success?

Question 2: For your discussion topic, what have you tried in your county that did not work?• Follow-up Question: What could have helped make the effort

successful?

Question 3: What ideas/strategies from today’s presentations or from other sources, like evidence-based practices, would help move this work forward in your county or the region?

Thank you

Next Meeting: Thursday, May 25, 2017

NEW LOCATION

443 N. Franklin St.Suite 001

Syracuse, NY 13204

population health improvement program kick-off …...population health improvement program kick-off...

Documents