Engage Your Community in Quality Improvement to “Move the Needle” for Positive Health Outcomes

By March 1, 2011, the Washington County Health Department QI team will improve community engagement and health improvement planning processes as evidenced by an increase in commitment of team membership resources from 0% to 30%; an increase in average score from 0 to 4.2 on the Meeting Effectiveness survey tool; an improvement from 0 to 1 community vision, and from 0 to 3 assessments completed from the MAPP process demonstrating progress towards CHIP; and an improvement from 0% to 100% of a local strategic plan through the Step UP performance management web-based program.

• Need up-to-date data and re-assessment of community. • Use systematic process data in planning and engagement. • Increase community involvement and resources for health improvement planning process. • No standardized process for county-level community engagement and health improvement planning. • WCWI actively works on goals set from 2005 health assessment with subcommittees formed.

In order to decide on a specific QI project, Washington County used the previous 2005 Community Health Assessment and the 2010 State of the County’s Health for Washington County to identify problem focus areas for its population of 51,976. The results showed stress/depression and tobacco use were among the highest rated health concerns. In addition, heart disease and diabetes were listed among the top 10 causes of death in Washington County for 2010. The cost of health care averaged $395 more for a person under the age of 65 who is obese than someone of the same age who is not. The estimated health care costs related to obesity for Washington County soared to almost $3.7 million, and these costs only go up when the 65-and-over population is included. The most serious problem area was youth drug and alcohol abuse (60% of respondents reported), and 46% of those surveyed thought adult drug and alcohol abuse were the next most serious health problems. The leading cause of death for 15- to 24-year-olds living in Washington County continues to be suicide, and the rate is double that of the national average. The State of the County report also showed that 32.4% of individuals lack health insurance and live at 200% of the Federal Poverty Level. Many of the same issues found on the 2005 assessment continued to be problems in 2010; therefore, Washington County decided to use a systematic, standardized process to gain county-level community engagement and create much-needed health improvement.

Issue #1: Is Washington County Health Department and Turning Point engaged with the community and addressing its needs? Background: Turning Point is an initiative to transform and strengthen the public health system in Oklahoma by making it more community-based and collaborative. Washington County has had a Wellness Initiative (WCWI/Turning Point Coalition) since 2004. This Coalition was developed on the idea that diverse groups working together can better identify and influence the determinants of health. In 2005, Washington County Health Department administered a Community Health Assessment. Paths Through Root Cause Map: Through that 2005 assessment, analysis of data revealed areas that the community identified as a priority and/or need. They are as follows: Access to Health Care, Poverty, Access to Mental Health Care, Child/Adolescent Preventative Care and Adult Preventative Care. Recommendations: Committees and subcommittees were formed and work groups prioritized from those priority areas: Suicide Prevention, Anti-Drug Network, Transportation, Affordable Housing, and the Hispanic Outreach Center. Issue #2: Have the need and priority areas changed in Washington County from 2005 to 2010 based on the Community Health Assessment? Background: In December 2010, the Wellness Initiative (Turning Point Coalition) began a strategy to improve the county’s health through a formalized process leading to accreditation called MAPP. Another Community Health Assessment was delivered to the community in 2010. Paths Through Root Cause Map: Through that 2010 assessment, analysis of data revealed areas that the community identified as a priority and/or need. They are as follows: Poverty, Transportation, Access to Mental Health Care, Access to Health Care, low-cost Dental Care and affordable Prescription Medications, and Housing. The 2005 and 2010 surveys both represented priority needs in common, which included: Poverty, Access to Health Care, and Access to Mental Health Care. New priority areas were identified: low-cost Dental Care and Prescription Medications. Recommendations: Washington County has active coalitions and subcommittees addressing the priority needs of the community. Through this QI Plan, there has been more of an emphasis placed on a collaborative approach with the existing coalitions and committees. Current projects include: (1) Access to Health Care Committee and the Preventative Health Partnership are looking for strategies to improve the current Health Care System and improve Preventative Health measures. (2) Transportation Coalition has created a low-cost transit system to address the community’s transportation needs. (3) Affordable Housing Coalition is looking into avenues and solutions for access to housing at low cost. (4) Suicide Prevention Coalition, Mental Health Association, and the Anti-Drug Network are providing actions to improve Access to Mental Health. (5) Many other subcommittees and Coalitions have contributed in these efforts. Washington County Health Department and the Wellness Initiative will continue to monitor the needs of the community and foster a collaborative effort from our community partners.