Dubuque County HIP 6-26-18HIP...Dubuque County Health Improvement Plan June 26, 2018 Page 5 of 22 The same day we also had the prepacked boxes of Dry Foods from the John Deere special

Dubuque County Health Improvement Plan Date Updated: June 26, 2018

For additional information, CONTACT:

Name Organization Phone Email

Patrice Lambert 6/18 Dubuque County Health Department 563-557-7396 [email protected]

Page 2 of 22 Health Improvement PlanDubuque County June 26, 2018

Community Priority

Goal #1 Healthy Behaviors: Reduce obesity among Dubuque County adults to 27% by June 30, 2020.

National Alignment

Healthy People 2020 Goal Improve health-related quality of life and well-being for all individuals.

State Alignment

Healthy Iowans 6-5 An increase in the proportion of adults who get the recommended levels of aerobic physical activity.

Objective 1-1 Establish policies to address adult and childhood obesity in various sectors in Dubuque County; i.e., Municipal ordinances, workplace, schools, etc. ANTICIPATED IMPACT OF THESE ACTIONS: • Implementation of community and organizational-wide policy that contribute to a culture of wellness. PLAN TO EVALUATE THE IMPACT: Measurement of policies and environmental change actions in the community.

Baseline Year2015

Baseline ValueTBD

Target Year2020

Target ValueTBD

increase from

baseline.

Report Date

May 31, 2017Year

2017

Value

Progress on Objective

Met, trend in right directionMet, no trend

Met, trend in wrong direction

Not met, trend in right direction✔

Not met, no trend

Not met, trend in wrong direction

Progress notes:

Strategy 1-1.1 Broaden the scope of the Dubuque County Wellness Coalition to include organizational representation capable of implementing strategic policies and environmental change in their organizations, and including organizations that represent the cultural and economic diversity of the community and geographic areas of the county.

Strategy TypeEnvironmental / Policy / Systems Change

Who's ResponsibleDubuque County CHNA HIP Steering Committee

Target DateJan 1, 2020

Report DateMay 31, 2017

Progress on Strategy

Complete On track✔ Off track No progress

Progress notes: The Dubuque Wellness Coalition consists of community members and organizations working to impact policy and infrastructure, identify gaps and duplication of efforts and utilize data to influence individual and community health. Members consist of City Health , Leisure Service Department, Dubuque County Health Department, IDPH, Dubuque Community & Holy Family Schools, Live Health Dubuque, Hy-Vee, Multi-Cultural FC, Mercy, Finley, Hillcrest, Iowa State University Extension, VNA, Crescent CHC, Tri-State Trail Vision, St. Stephen's Food Bank, Dubuque Community Y, Helping Services, and other local business. Although membership has expanded and represents more sectors and organizations, cultural diversity has not changed. Dubuque Eats Well is a network of community members and organization working to transform the local food system.

Report DateJune 26, 2018



Progress notes: Mercy Dubuque On the Move May 2017-June 2018


Update Goal Provide health and wellness information and resources to the business community through outreach and engagement at minimal or no cost Target audiences 1. Business leaders focusing on corporate wellness programming 2. Wellness professionals 3. Individuals in the workforce Forums to connect target audiences 1. Well Café a. Networking opportunity with one-hour presentation on specific topic for business leaders and wellness professionals to connect and share resources - Free i. June 2017 – Wellness Regulatory Update – 40 registrants ii. October 2017 – Nutritional Resources – 18 registrants iii. March 2018 – Creating a Company Culture of Wellness – 48 registrants 2. Du it in 2 a. Informal opportunity for business leaders to connect their workforce with wellness professionals and resources in the community as well as engage in physical activity - Free i. May 2017 – 142 registrants ii. May 2018 – 250 registrants 3. FITPass a. Opportunity for business leaders to connect their workforce with wellness and fitness professionals and resources in the community - Free i. June 2017 – 731 registrants ii. June 2018 – 430 registrants as of 06/01/2018 4. Employer Wellness Forum a. Formal, half-day educational and networking opportunity for business leaders with the focus on corporate wellness programming - $25 per person i. December 2017 – 85 participants 1. Conference Theme – Aligning People, Place, and Purpose Volunteers Dubuque on the move consists of approximately 30 individual members representing over 25 businesses in the Dubuque community.

Strategy 1-1.2 Involve the Local Food Systems Working Group and other community-based organizations that have a specific interest in nutrition, weight loss, and physical activity in the process.

Strategy TypeAddress Social Determinant / Health Inequity






Progress notes: Dubuque Eats Well is a network of community members and organizations working together to transform the local food system. Local food systems group representative a member of the Coalition and reported out/received coalition input on local foods assessment, local food activities etc. Established Double Up Food Bucks program which distributed $4,100 DUFB dollars to SNAP recipients attending the Dubuque Farmers Market (DFM). Over 50 vendors were engaged redeeming DUFB in 2016, and recorded over 200 NEW SNAP market goers. Weekly offerings of Snap-Ed friendly recipes are through #MealMonday social media series, as well as a recipe on the back of the DFM Market Map.


The Agricultural Urbanism Toolkit is a three year (2015-2017), three phase process through which stakeholders in the greater Dubuque area are coming together to evaluate the local food system, identify assets and gaps, and create a shared vision and goals, leading towards the implementation of tactics to move the local food system forward. Current projects addressing the social determents include The , Double Up Food Bucks and Sinsinawa Collaborative Farms. In addition, there is progressive work around numerous community gardens including Dubuque Rescue Mission, Washington Neighborhood, Four Mounds, Dr Viner, Jaycess, St Lukes, West Minster Presbyterian. Other projects include: Farm to Institution, Convivium Urban Farmstead, Kids at Market, Chefs at Market, 3rd Annual Tristate Local Food Summit, Bee Branch Project, 2016 Driftless Farm and Food Fest, Community Supported Agriculture connecting with businesses.

Report DateJun 26, 2018



Progress notes: Upon the recommendation of the Dubuque Eats Well Coalition, the Dubuque County Board of Supervisors has passed a resolution creating a Dubuque County Food Policy Council (see attached). The Board has also budgeted $5,000 for administration and start-up of the Council, as well as $20,000 for a Community Food System Development Fund. The Policy Council will recommend guidelines for use of the fund.

Strategy 1-1.3 Research model policies/best practices that are working in other communities and replicate them in Dubuque County.







Progress notes: Wellness Coalition exploring Healthy Hometown model with Mary Lawyer, Wellmark

Strategy 1-1.4 Secure commitments from participating partner organizations and coalition members to assist in implementing and supporting environmental change.







Progress notes: Mercy partnered with the Iowa SNAP Incentive Project proposed by the Iowa’s Healthiest State Initiative to increase fresh fruits and vegetable access to low income residents. Mercy also assisted through community grant the Sinsinawa Collaborative farms to purchase equipment.




Progress notes: 5210 Grant—Kathy Hutton, Food Pantry The full grant was approved for half going to the Eleanor Roosevelt Middle School greenhouse and half to the Lincoln Elementary School Pantry. The pantry is going well from the 5-2-1-0 grant at Lincoln Elementary School. On April 11th we served 51 families with fresh produce including, potatoes, tomatoes both big boy and cherry, heads of lettuce and grapes. With the signage we have at Lincoln and the literature sent to the parents from the school we are able to reach many families.


The same day we also had the prepacked boxes of Dry Foods from the John Deere special Serving Our Community Grant. This grant allowed us to distribute at Audubon Elementary, Fulton Elementary, Prescott Elementary, Lincoln Elementary and Jefferson Middle School. These are all the 100% free and reduced lunch schools. This made a huge impact at feeding the needy thanks to John Deere for the dry nonperishable food box. Ground breaking happened June 2018 for the Green House at Eleanor Roosevelt Middle School.

Objective 1-2 Implement environmental changes throughout the county to improve physical activity and nutrition. ANTICIPATED IMPACT OF THESE ACTIONS: • Reduction in overall obesity rate. • Improvement in chronic disease and other health conditions affected by obesity. PLAN TO EVALUATE THE IMPACT: Outcome indicator: Actual measurement of the percentage of obese adults in Dubuque County using the same metrics used in this assessment (County Health Rankings.) Process indicators: Success in broadening the scope and strengthening the authority of the Dubuque County Wellness Coalition; success in securing necessary funding through grants or partner funding; development of a published strategy which will include milestone assessments.

Baseline Year2015

Baseline ValueTBD

Target Year2020

Target ValueTBD

increase from

baseline.

Report Date

May 31, 2017Year

2017

Value


Met, trend in right directionMet, no trend✔


Not met, trend in right directionNot met, no trend


Progress notes: Mercy Medical Center is a member of Dubuque Wellness coalition and a member of Dubuque on the Move which it spearheads. Mercy Medical Center is also a member of Dubuque Eats Well. All of these work with community members and organizations to improve individual and community health. Events sponsored by Dubuque on the Move include: Well-Cafe meetings, Du It In 2, Fit Pass and Employee Forum. Mercy Health Strides also sends out a monthly wellness e-new letter and Mercy sends out a quarterly Health Watch Wellness Magazine. Epworth added new park on east side of town and also a dog park to promote increased activity. New park built in Asbury to meet needs of increased population.

Report Date

Jun 26, 2018Year

2018

Value


Met, trend in right direction✔

Met, no trend




Progress notes: Updates from Mercy Hospital "Dubuque On the Move" (Member of the Dubuque County Wellness Coalition) Live Healthy Iowa statistics as of June 2018 Robert Wood Johnson data: OB - Obesity - 32% to 28% IN - Inactivity - 23% to 24% AC – Access to Exercise - 49% TO 87% HB – Healthy Behaviors - #21/99 Live Healthy Iowa data:


WG (Winter Games) - #1/99 w 673 10WC (10- week wellness challenge) - #8/99 w 212 AI (Active Index) - #10/99 to date (2016= #74, 2017 #50) 5k (5k) - pending 2018 10 Week Wellness Challenge Dubuque County • 212 participants • Activity Minutes o 210 participants o 552,980 total minutes o 2,633.2 minutes per participant • Weight Loss o 147 participants o 546 total pounds lost o 2.5% weight loss for the county • Organizations represented* o A.Y. McDonald Mfg. Co. o Change Healthcare o Crescent Community Health Center o Divine World College o Hillcrest Family Services o Iowa Legal Aid o John Deere Dubuque Works o John Deere World Headquarters o Lauridsen Group, Inc. o Lutheran Services in Iowa o Maquoketa Community Schools o Penn Center o Rapids Reproductions o Sacred Heart Schools-Maquoketa o Sisters of Charity, BVM o State of Iowa Employee Challenge

Strategy 1-2.1 Support local food system development. Strategy TypeEnvironmental / Policy / Systems Change






Progress notes: Dubuque has a local Farmers Market in spring, summer, fall. Mercy Medical Center supports the Dubuque Mission "Mission Preservation", allowing the mission to grow and preserve their fresh vegetables and produce. Mercy Medical Center supports St. Stephen's food bank allowing the ability to buy fresh produce from local farmers for those in need. Mercy Medical Center also partnered with Iowa SNAP Incentive Project making it easier for low income to eat fresh fruits and vegetables while supporting local farmers. Peosta started a food pantry assisting with food access. Farm to Institution: a team that looks to understand the potential the benefit for local institutions to buy from local farmers. Mercy Medical Center supported Sinsinawa Collaborative Farms assists beginning farmers in their quest to access land and dream to become farmers.

Strategy 1-2.2 Expand sidewalks, trails, and bike routes to increase physical activity and facilitate alternative forms of transportation.








Progress notes: Trails have been extended on the NW Arterial and the Bee Branch/North End trail. Bike lanes/complete street completed on Key West Dr. see http://www.cityofdubuque.org/1589/Trail-Maps for trails map Epworth expanded their walking trail around the town. Heritage trail replaced old bridges allowing continued use of trail. Dyersville added sidewalks around Westside park. Dubuque expanded sidewalk along northwest arterial.

Strategy 1-2.3 Encourage policy development for monitoring and tracking pesticide and nutrient use.







Progress notes: City of Dubuque developed a Pesticide Free Parks policy, designating 9 parks as pesticide free, and limiting certain pesticide use and amounts in parks and public places. The City of Dubuque has adopted an Integrated Pest Management Plan (IPM) that will be evaluated annually.




Progress notes: The city of Dubuque is compiling data on their first year of reducing pesticide use and the results of weed growth. this data will be evaluated annually to determine future reductions, eliminations or use of pesticide use and other IPM stategies. some pesticide use was reduced. Alternative IPM strategies employed received mixed results. Full report will be released in July.

Strategy 1-2.4 Preserve/increase number of acres for fruit and vegetable production for human consumption.







Progress notes: Bee Branch Project allowing fruit/vegetable bearing trees as landscaping. Gardening for a Healthier Community, allowing space for Crescent neighbors to have a garden.




Progress notes: 18 fruit trees have been planted in the Bee Branch Parkway (apple, pear, cherry)


Goal #2 Preventing the Spread of Disease: Improve communication and education of communicable diseases between public health and health care providers.

National Alignment

Healthy People 2020 Goal Increase immunization rates and reduce preventable infectious diseases.

State Alignment

Healthy Iowans 2-1.2Increase the use of the Iowa Health Information Network 4 to report disease records.

Objective 2-1 Develop regular communicable diseases information dissemination mechanisms to Health Care Providers. ANTICIPATED IMPACT OF THESE ACTIONS: • Increased communication between hospitals, labs local epidemiologists, community partners. Process indicators: Success in providing resource and education support to PCP.

Baseline Year2015

Baseline ValueTBD

Target Year2020

Target ValueTBD

increase from

baseline.

Report Date

May 31, 2017Year

2017

Value





Not met, no trend


Progress notes:

Report Date

June 26, 2018Year

2018

Value





Not met, no trend


Progress notes: Regular meetings at the "Bi-Hospital Infection Control" meetings with hospital Infection Control Nurses and Doctors and lab personnel.

Strategy 2-1.1 Provide relevant information through social media to include hospitals, clinics, physicians, Long Term Care (LTC) facilities, schools/daycares, and public health.







Progress notes: "Blasts" of Health Alerts are sent as needed to appropriate locations thorugh the Dubuque County Health Department.




Progress notes: Blasts of Health Alerts were sent to appropriate locations 11 times last year.

Strategy 2-1.2 Research developing new and improved communication methods such as listservs, twitter, etc.








Progress notes:




Progress notes: Facebook and Twitter have been established but have had little usage as of yet.

Strategy 2-1.3 Develop a local system for reporting that will reduce redundancy.







Progress notes:

Objective 2-2 Improve communicable disease knowledge and reporting between local epidemiologists, lab partners, community partners and healthcare providers who report as required by Iowa Code. Outcome indicators: ANTICIPATED IMPACT OF THESE ACTIONS: • Increased awareness of infectious diseases and the importance of reporting those diseases. • Increased timely disease investigation and reporting. • Implementation of educational programs to assist in learning about diseases and the way diseases are spread. Actual percentage of individuals in Dubuque County receiving recommended vaccinations and incidence of infectious diseases, utilizing in ED for non-emergent services, actual measurement of the percentage of individuals enrolled in a PCP, actual measurement of the number of developmental screenings provided by pediatric offices.

Baseline Year2015

Baseline ValueTBD

Target Year2020

Target ValueTBD

increase from

baseline.

Report Date

May 31, 2017Year

2017

Value



Met, no trend




Progress notes: With recent communicable disease outbreaks, providers have been educated and have been reporting timely on communicable diseases.

Strategy 2-2.1 Develop a community committee that will annually review and update the County Communicable Disease CQI Plan. This committee will also develop a local system for reporting.








Progress notes:

Strategy 2-2.2 Annually update county preparedness plan so provider contact information is correct and current.







Progress notes: Reviewed by the Executive Members of the Dubuque County Healthcare Preparedness Coalition.




Progress notes: Dubuque County Public Health Emergency Preparedness Response Plan Annual Update Board Of Health approval March 14, 2018.

Strategy 2-2.3 Explore funding opportunities for communicable disease educational program.







Progress notes: Funding found to provide Healthcare Providers with a new Communicable Disease Book. Some funding to send a few people to the IDPH Communicable Disease Update meetings.

Goal #3 Transitions of Care: Reduce non-emergent Emergency Department (ED) use by 2% each year.

National Alignment

Healthy People 2020 Goal Improve access to comprehensive, quality health care services.

State Alignment

Healthy Iowans 1-3 An increase in the proportion of people who have one person as a health provider.

Objective 3-1 Educate and provide alternatives to individuals and families about primary care access when using the ED (Emergency Department) for non-emergent reasons. Outcome indicator: Actual measurement of the percentage of individuals in Dubuque County utilizing in ED for non-emergent services, actual measurement of the percentage of individuals enrolled in a PCP, actual measurement of the number of developmental screenings provided by pediatric offices. Process indicators: Success in providing resource and education support to PCP.

Baseline Year2015

Baseline ValueTBD

Target Year2020

Target ValueTBD

increase from

baseline.

Report Date

May 31, 2017Year

2017

Value



Met, no trend




Progress notes: *UnityPoint Finley have opened several new urgent care and PCP offices, all patients being


treated in urgent care and ER are referred to a PCP *UnityPoint Finley has increased marketing community wide related to appropriate use of ER *VNA has met with UnityPoint ER Director and set up an informal referral system for any patient utilizing ER with additional needs (ie no insurance, oral health, no PCP, specialized care needed, home health. *Marshall Island Health Project assists and educates the Marshallese community how to reconnect with healthcare and assist them through the healthcare system. Mercy Medical Center has a case manager in the ER to assist patients in finding primary care for non-emergent use. *As part of the Mercy Medical Center’s Outreach and Enrollment efforts at Crescent Community Health Care Center, when clients are approved for Iowa Medicaid they return to the Outreach Office to schedule wellness exams, dental exams and review the benefit booklet-Info on how and when to access the ED, their PCP and other services. *Crescent Community Health Center has several staff members and workflow processes to help educate patients about insurance coverage, preventive care, using a medical/dental home, services provided by Crescent and others within the confines of the clinic.

Strategy 3-1.1 Provide resources to ED staff to educate patients about the importance of and access to a routine medical and dental home.

Strategy TypeCounseling & Education






Progress notes: *VNA provides written information to both Mercy and Finley ER highlighting all local medical and dental providers accepting new patients. Forms updated annually and distributed. *When a new or continuing patient enters Crescent Community Healthcare Center, the staff reviews demographic and insurance information. If the patient’s insurance has lapsed or the individual has never had insurance, the patient is given information about consulting with the Outreach and Enrollment Coordinator if they so desire. After the patient’s medical or dental visit, they may be able to meet with the Coordinator at that time or later. The Coordinator is able to assist in completing a Medicaid or Marketplace insurance application. The individual will be asked to return after they receive an answer on their application to assist them in choosing an MCO and discuss the services Crescent is able to provide. *Crescent Community Health Care Center’s Care Coordinator provides patient packet information including health insurance options to the Mercy Medical Center’s ER.

Strategy 3-1.2 Educate patients as they become insured about when to utilize ED, access to after-hours nurse triage through their PCP (Primary Care Providers).







Progress notes: *VNA case manages all children 0-21 enrolled in Medicaid. In 2016 VNA provided informing services to over 3000 children, highlighting insurance coverage, and available providers, importance of PCP and routine preventive exams, and available benefits. *VNA case managers also provide services to all high risk families born through UnityPoint Finley Birthing Suites. Case managers meet with families discuss PCP,


health insurance, preventive exams, assistance is offered in scheduling appointments, and identifying any social concerns. *As part of the Mercy Medical Center’s Outreach and Enrollment efforts at Crescent Community Health Care Center, when clients are approved for Iowa Medicaid they return to the Outreach Office to schedule wellness exams, dental exams and review the benefit booklet-Info on how and when to access the ED, their PCP and other services. *A Crescent Care Coordinator tracks all inpatient and emergency department admissions. Once the Coordinator receives all documentation of the patient’s care, updates the medication reconciliation, and appoints the patient for the PCP follow-up within 3-7 days. The Coordinator also describes what services are available at Crescent, including, mental health counseling by a Hillcrest Community Mental Health Center at Crescent. This information is all available in the Patient’s electronic medical record for the PCP to review. The provider also addresses the need for patients to get regular follow-up by the PCP rather than in the ED or to prevent hospitalization. The Coordinator also tracks those patients with excessive ED use and those with multiple hospitalizations. Out of these efforts, a pilot project was developed to address overuse by Marshallese patients.

Strategy 3-1.3 Implement a care coordination team to include Public Health, hospitals, FQHC, physician offices and others to holistically address patient needs to break down barriers and improve access to primary medical and dental homes.

Strategy TypeClinical Intervention






Progress notes: *UnityPoint Finley has working on a C.A.R.E. Model with population based services incorporating ACO members, local providers, and Public Health. * This is currently in place with multiple providers. Crescent Community Health Care Center coordinates accessing information exploring options for health insurance pre and post the visit. This process is replicated with multiple agencies; transitional housing, Dept. of Corrections, Dept. of Housing, Circles Initiatives, SASC, VNA, Rescue Mission, non-profits, churches, LGBTQ+, Latino community, African American communities and many more. The implementation of the Marshall Island program also has multiple agencies involved. The focus is to engage patients, dismissed from care at Crescent, re-engage them with a community health worker/interpreter and a nurse to educate, support and triage services necessary to enhance the patient’s knowledge and participation in their care.

Strategy 3-1.4 Develop a Health Information Exchange with hospitals to create a database to track patient care pre and post hospitalizations. Create a team of providers to work within the exchange to assist in overall patient care.







Progress notes: Crescent, along with most other health centers in Iowa, are members of the statewide Health Information Exchange, or HIE. Other physician practices and hospitals are not members at this time. However, Crescent has direct relationships with the hospitals and medical and dental practices, so Care Coordinators receive patient information directly from the EMRs.


Strategy 3-1.5 Investigate the ability to develop local paramedicine options for patients.






Complete On track Off track No progress✔

Progress notes:




Progress notes: On local college is looking at a telehealth program for students.

Objective 3-2 Provide data to PCP's regarding ED use in which PCP's could increase effectiveness within the medical home, e.g. asthma, mental health. Partner with a minimum of 1 provider office per year to implement a plan.

Baseline Year2015

Baseline ValueTBD

Target Year2020

Target ValueTBD

increase from

baseline.

Report Date

May 31, 2017Year

2017

Value





Not met, no trend


Progress notes: • Through UnityPoint Finley all ED information is now being transmitted to patient PCP electronically through EPIC or more traditional ways. • Mercy Medical Center in collaboration with Medical Associates hired health coaches to assist in hospital and ED transition to home.

Strategy 3-2.1 Develop a data dashboard regarding ED use for certain conditions which could be managed more efficient and cost-effective through treatment provided within the medical home.







Progress notes:

Strategy 3-2.2 Collaborate with PCP's to develop care plans and triage system for certain non-emergent conditions.







Progress notes: • UnityPoint Finley has developed a Nurse Call system between hospital and UnityPoint Clinics.

Strategy 3-2.3 Identify ED overuse by certain patients and formulate plans to redirect these patients to PCP.








Progress notes: *UnityPoint Finley has developed ED CCP program. *Mercy Medical Center developed Complex Care Maps to help identify and ensure appropriate treatment. Once a patient is discharged from ED care, a designated person reviews appointments needed and if no insurance directs the patient to the Outreach and Enrollment Coordinator to explore health insurance options.

Goal #4 Transitions of Care: Increase access to care for mental health services.

National Alignment

Healthy People 2020 Goal Improve access to comprehensive, quality health care services.

State Alignment

Healthy Iowans 8-1.4Increase access to services and supports for individuals experiencing a mental health crisis.

Objective 4-1 Provide education to PCP's to bridge medications for mental health patients until they can obtain an appointment with a psychiatrist. ANTICIPATED IMPACT OF THESE ACTIONS: • Increased early intervention mental health services. Process indicators: Development of collaboration with local school district to identify and provide resources to young children displaying mental health behaviors.

Baseline Year2015

Baseline ValueTBD

Target Year2020

Target ValueTBD

increase from

baseline.

Report Date

May 31, 2017Year

2017

Value





Not met, no trend


Progress notes: Crescent providers will bridge some medications for mental health patients until they are able to access the prescriber at the mental health center. Typically, these are patients with depression or anxiety, not the more complex diagnoses such as schizophrenia, emotional intensity disorder or bipolar disorder.

Strategy 4-1.1 Establish early intervention services in primary care offices by increasing pediatric developmental screenings.







Progress notes: • Through VNA 1st Five program developmental testing for children 0-5 increased 8% from 2015 to 2016. 2017 is on track to increase testing by 37%. All tests completed are sent to pediatric physician for review. • 2017 VNA Child Care Nurse Consultant will work with 2 child care providers to begin developmental testing on all children in their care, results will be forwarded to pediatric physician.

Strategy 4-1.2 Provide education and consultation to PCP's regarding types of pharmacotherapy which could bridge patient's medications until the patient can obtain a


psychiatry appointment. Strategy TypeCounseling & Education






Progress notes: Crescent has a Clinical Pharmacy Director on staff that is available to providers to educate and provide guidance on medications and medication interactions. Crescent also has a contract with Mercy Family Pharmacy for Pharm D staff to conduct a twice weekly anticoagulation monitoring clinic, diabetes education, medication reconciliation and other patient services to supplement the visit to the PCP.

Strategy 4-1.3 Provide easily accessible community mental health resources (therapists, psychiatric prescribers, telehealth to ED's and PCP's in order to potentially avoid a patient ED visit.







Progress notes: *UnityPoint clinics and Hillcrest are partnering together to have on site mental health services. *Telemedicine is being planned for expanded Crescent CHC space available in mid-2018. *The Care Coordination team addresses the need for specialty care and follow-up and regular mental health care in addition to counseling e.g. appointments with prescribers at the mental health center, enrollment in the Integrated Health Home, substance abuse counseling and other resources.

Strategy 4-1.4 Increase avenues for outpatient and inpatient treatment for substance abuse issues.







Progress notes: Mercy Medical Center in collaboration with Medical Associates has established an outpatient medication assisted treatment program for opioid use disorder. Mercy Medical Center also offers training on the use of Naloxone as well as offers the medication free of charge to those unable to afford in addition to local law enforcement and EMS. Substance Abuse Service Center and Turning Point added additional substance use disorder assessments. Mercy Medical Center spearheaded the formation of Opioid Response Team. Mercy Medical Center also provides continuing education to staff and community. Substance Abuse Service Center and the Outreach and Enrollment department work collaboratively to explore health insurance options so that treatment for substance abuse issues is not delayed due to lack of payment. County funding options are explored while waiting for insurance applications to be processed and approved in efforts to speed up the scheduling of appointments.

Strategy 4-1.5 Collaborate with school system to set up resource packets and support systems for children transitioning


between inpatient mental health care and home. Strategy TypeCounseling & Education






Progress notes: Mercy Medical Center psychiatric Case Managers collaborates on the plan of care with schools if signed release of information is obtained.

Goal #5 Environmental Health: Improve water quality.

National Alignment

Healthy People 2020 Goal Promote health for all through a healthy environment.

State Alignment

Healthy Iowans Water Quality 5-1.8

Objective 5-1 Improve adequate wastewater treatment to unsewered communities.

Baseline Year2015

Baseline ValueTBD

Target Year2020

Target ValueTBD

increase from

baseline.

Report Date

May 31, 2017Year

2017

Value




Not met, trend in right directionNot met, no trend✔


Progress notes:

Strategy 5-1.1 Identify and prioritize unsewered communities according to environmental impact, in Dubuque County.







Progress notes:

Strategy 5-1.2 Educate affected citizens on the importance of proper wastewater treatment, the environmental impact and health outcomes.







Progress notes:




Progress notes: As new septic permits are issued education is given to the home owners.


Strategy 5-1.3 Identify funding sources for individual and community sewer systems.







Progress notes: Some funding sources for private septic systems with low income and low interest loans available through local banks. No funding for community sewer systems available at this time.

Objective 5-2 Provide clean drinking water through private water supplies for those not served by public water systems.

Baseline Year2015

Baseline ValueTBD

Target Year2020

Target ValueTBD

increase from

baseline.

Report Date

May 31, 2017Year

2017

Value





Not met, no trend


Progress notes: Offering limited number of free water tests each fiscal year through our Grants to Counties Program.

Report Date

June 26, 2018Year

2018

Value





Not met, no trend


Progress notes: 150 free water tests were completed under the Grants to Counties.

Strategy 5-2.1 Educate on health and environmental impacts of unsafe drinking water i.e., annual report, social/multi-media on current well water testing.







Progress notes:




Progress notes: Numerous brochures distributed to local county residents on clean and safe drinking water.

Strategy 5-2.2 Create materials to encourage testing, publicize website for stream water monitoring testing results.








Progress notes:

Strategy 5-2.3 Establish baseline/inventory of private wells in Dubuque County.







Progress notes: Baseline established.

Strategy 5-2.4 Increase the number of private well recommended tests performed by city and county labs.







Progress notes: Increase in testing under our Grants to Counties Program.




Progress notes: Continuing to increase testing under Grants to Counties Program.

Goal #6 Environmental Health: Reduce residential and neighborhood environmental health risks.

National Alignment


State Alignment

Healthy Iowans Air Quality 5-1.1

Objective 6-1 Maintain compliance with Air Quality standards. Baseline Year2015

Baseline ValueTBD

Target Year2020

Target ValueTBD

increase from

baseline.

Report Date

Jun 26, 2018Year

Value



Met, no trend




Progress notes: the air quality measurement data from the Potosi monitor matched with the trend shown in National Emissions Inventory data for Dubuque County. Since 2011, the Potosi monitor indicates levels below the EPA Annual Design values. Measurements from the Potosi monitor are falling steadily each year. The graphs below provide hourly and annual design from the the Potosi monitor from 2008-2016 and both show a downward trend from 2012-2016.

Strategy 6-1.1 Support the development and implementation of the EPA PM Advance Path Forward Plan.







Complete✔ On track Off track No progress

Progress notes: EPA PM Advance Path Forward Plan was approved by City Council and DMATS in July, 2015 and submitted to EPA. An EPA education grant focused on air quality was submitted by and awarded to the University of Iowa with the City of Dubuque as a sub-award/partner. City staff is assisting U of Iowa staff in finalizing the work plan for the air quality education activities. The EPA education grant with the University of Iowa worked with schools and community groups to create learning opportunities using hand held air quality monitors. This grant also provided Education to Dubuque Community School teachers. Community partners are utilizing the handheld air quality monitors. See the web site dedicated to this project http://www.iihr.uiowa.edu/clear4/ .




Progress notes: 1) The CLEAR4 project with the University of Iowa will end January 2018. To date, accomplishments include: Website with blogs, current air quality conditions and events, social media (Facebook, Twitter), Community education day long workshop for educators and CLEAR4 partners, booth and presentation at 2016 Growing Sustainable Communities Conference, presentations, and use of low cost air monitor trainings to school and community groups. The City revised its Open Burning Permitting process, expanding Fire Department approval requirements to include public health and sustainability staff review and input. Through December 22, 2017, 2,397 people were reached in air quality education actives, including students, citizens, and staff working on the CLEAR4 project. University of Iowa students and staff have presented posters on the project to the American Association for Aerosol Research meeting and the American Geophysical Union Meeting. Also, University of Iowa is assisting with an application programming interface (API) code to automate air quality summary reports. During fall 2017, the CLEAR4 team worked with the City to develop visualizations showing long-term improvement in air quality and also a process that will automatically update air quality statistics on the SOCRATA data portal. City staff is working on a plan for the AIR Beam air quality monitor use at the conclusion of the CLEAR4 project.



Complete On track Off track No progress

Progress notes:

Strategy 6-1.2 Research local PM air quality monitoring. Strategy TypeEnvironmental / Policy / Systems Change







Progress notes: Air Quality Task Force members, including Health Services Department, Sustainability Coordinator, Greater Dubuque Development Corporation, and East Central Intergovernmental Association will review any new available Air Quality data from EPA/DNR with a focus on PM 2.5 and ozone. The most recent Iowa Department of Natural Resources (IDNR) research and findings presented at a business community forum hosted by Greater Dubuque Development Corporation in April, 2016 confirms that Dubuque has improved significantly as it relates to both PM 2.5 and Ozone, although additional action on Ozone may be called for if the Federal Government follows through on plans to reduce allowable levels. We are awaiting release of new data from IDNR. IDNR does not indicate local monitoring is needed in the Dubuque area. No resources, expertise exist for establishing local monitoring.

Strategy 6-1.3 Monitor health indicators related to air quality. Strategy TypeEnvironmental / Policy / Systems Change






Progress notes:

Goal #7 Environmental Health: Improve residential living environments.

National Alignment


State Alignment

Healthy Iowans Healthy Homes 5-1.2

Objective 7-1 Implement healthy homes principles in residential living environments. Number of homes referred into Healthy Homes Program. Asthma Hospitalization rates. Outcome indicators: Lead poisoning rates Process indicators: Monitor number of lead level tests.

Baseline Year2015

Baseline ValueTBD

Target Year2020

Target ValueTBD

increase from

baseline.

Report Date

May 31, 2017Year

2017

Value



Met, no trend




Progress notes: Childhood lead poisoning rates are decreasing, and testing/screening rates are increasing. See attached charts.

Report Date

Jun 26, 2018Year

Value



Met, no trend




Progress notes: Homes having healthy homes interventions and being Pb safe continues to increase- see chart

Strategy 7-1.1 Implement and educate about healthy homes principles.








Progress notes: In January 2016, the HUD National Disaster Resiliency Competition grant awarded the State of Iowa $95.7 million. The City of Dubuque received $31.5 million of this award in disaster resiliency funds for the Bee Branch Healthy Homes Resiliency Program and storm water infrastructure improvements. Performing repairs to homes that were damaged in the 2011 flood that includes but not limited to: Remediation of mold and mildew; replacement of equipment such as hot water heaters, furnaces and electrical panels; basic basement waterproofing; and making a home resilient to run off water and future flooding. We plan to make resilient 320 housing units, which will affect approximately 1,120 individuals.




Progress notes: Bee Branch Healthy Homes has completed 28 HH projects and has 23 in progress

Strategy 7-1.2 Reduce incidents of illegal dumping (get baseline data) and accidental hazardous material releases.







Progress notes:

Strategy 7-1.3 Increase childhood blood lead testing rates. Strategy TypeClinical Intervention






Progress notes: Awaiting 2016 data from IDPH, but trend is increasing.

Strategy 7-1.4 Provide education and resources for reducing lead hazards.







Progress notes: Bee Branch Healthy Homes has completed 28 homes with 23 in progress

Strategy 7-1.5 Encourage radon testing and CO monitoring. Strategy TypeAddress Social Determinant / Health Inequity







Progress notes: City of Dubuque Healthy Homes Program and Bee Branch Health Homes Program is conducting Radon screening on homes, and promoting testing through community education and outreach as a result of a grant received from the Iowa Cancer Consortium.

Dubuque County HIP 6-26-18HIP...Dubuque County Health Improvement Plan June 26, 2018 Page 5 of 22 The same day we also had the prepacked boxes of Dry Foods from the John Deere special

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