SAN FRANCISCO’S COMMUNITY HEALTH IMPROVEMENT PROCESS San Francisco Health Commission ▪ February 5, 2013 1
SAN FRANCISCO’S COMMUNITY HEALTH IMPROVEMENT PROCESS
San Francisco Health Commission ▪ February 5, 2013
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A comprehensive assessment and action plan to improve population health through partnership and collective impact.
Community Health Improvement Process 2
Overview
18-month process (Jul 2011–Dec 2012)
Engaged close to 700 community residents + local public health system partners
Key Partners San Francisco Hospitals +
Community Benefit Partnership UCSF + San Francisco Health
Improvement Partnerships Residents Community-based
organizations
SF’s Health Priorities Ensure Safe + Healthy
Living Environments Increase Healthy Eating +
Physical Activity Increase Access to High
Quality Health Care + Services
Foundational Values Alignment
Health Equity Community Connections
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Overview (cont.)
Two Key Products 4
Impetus
Improve community health
National trends Alignment of multiple
related initiatives Public health
accreditation Health Care Services
Master Plan Hospital community
health needs assessment SFHIP
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Process
Mobilizing for Action through Planning + Partnerships (MAPP)
Considered the gold standard in assessment, planning, and community health improvement by the National Association of County + City Health Officials
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Foundation 7
Foundation 8
A process that engages with community members and local public health system partners to systematically collect and analyze qualitative and quantitative health-related data from a variety of sources.
Community Health Assessment (CHA) 9
Health Equity Focus
To more easily identify health inequities, the CHA collected data on the social determinants of health through:
Indicator selection Data disaggregation Focus groups with vulnerable
populations HCSMP Task Force discussions
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Approach 11
Community Health Status Assessment
Key Findings SF’s population is aging Income inequality ↑ Certain neighborhoods and
subpopulations experience significant health disparities and inequities
Safety = key concern in SF; disparities exist by race/ethnicity and neighborhood
Mirroring the nation, cardiovascular diseases = among leading causes of death in SF
Many Health Care Resources Available in SF
For example: 94% residents insured or
enrolled in Healthy SF High rates of health care
providers to population But: Availability ≠ Accessibility Reported barriers
particularly for low-income populations
Community Health Status Assessment
(CHSA)
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Forces of Change Assessment
Sample Findings Health Reform will place
greater demand on SF’s health care resources
Many uninsured already access care through a “medical home” thanks to Healthy San Francisco
Limited cultural competence negatively impacts patient experience and health outcomes, a particular concern for SF’s diverse population
30,000
Estimated number of new Medi-Cal beneficiaries in San Francisco following
Health Reform implementation
Source: SF Human Services Agency estimate based on SF’s current General Assistance, food stamp, and Healthy Families recipients compared to new Medi-Cal eligibility criteria.
Forces of Change
Assessment (FCA)
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Local Public Health System Assessment Local Public
Health System (LPHSA)
Essential Public Health Services Activity Rating
1 Monitor health status to identify community health problems. Minimal
2 Diagnose and investigate health problems and health hazards. Moderate
3 Inform, educate, and empower individuals and communities about health issues.
Moderate
4 Mobilize community partnerships to identify and solve health problems.
Minimal
5 Develop policies and plans that support individual and community health efforts.
Moderate
6 Enforce laws and regulations that protect health and ensure safety. Significant
7 Link people to needed personal and health services and assure provision of health care when otherwise unavailable.
Moderate
8 Assures a competent public and personal health care workforce. Moderate
9 Evaluate the effectiveness, accessibility, and quality of personal and population-based health services.
Moderate
10 Research for new insights and innovative solutions to health problems. Minimal
Overall Performance Score Moderate
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Community Themes + Strengths
Sample Themes Healthy eating + active
living Clean, accessible natural
environment Community engagement +
partnerships “Learning + earning”
opportunities Location + transportation Cultural competency +
language access Safety Need for affordable
dental + vision services
Community Themes & Strengths
Assessment (CTSA)
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Data Synthesis: Cross-Cutting Themes
Ensure safe + healthy living environments
Improve behavioral health Increase access to high
quality health care + services
Increase physical activity + healthy eating
Reduce the spread of infectious disease
Support early childhood development
Support seniors and persons with disabilities
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A 3- to 5-year action-oriented plan outlining the priority health issues identified in the community health assessment and how these issues will be addressed, including strategies and measures, to ultimately improve community health.
Community Health Improvement Plan (CHIP)
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SF’s Health Priorities for Action
Priority 1
Ensure Safe + Healthy Living Environments
Priority 2
Increase Healthy Eating + Physical Activity
Priority 3
Increase Access to High Quality Health Care + Services
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Health Priority Components + Health Equity 19
Priority 1: Ensure Safe + Healthy Living Environments
Goals + Objectives a. Improve safety and crime prevention
i. ↓ violent injury ii. ↑ feelings of safety at night iii. ↓ severe and fatal pedestrian injuries
b. Reduce exposure to environmental hazards i. ↓ exposure to air pollution ii. ↓ exposure to traffic noise iii. ↓ housing violations iv. ↓ exposure to second-hand smoke
c. Foster safe, green, “active” public spaces i. ↑ park/playground safety ii. ↑ access to open spaces and natural areas
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Priority 2: Increase Healthy Eating + Physical Activity
Goals + Objectives a. Increase physical activity
i. ↑ fitness in children ii. ↑ time spent walking and/or biking daily
b. Increase healthy eating i. ↑ access to healthy, diverse food resources ii. ↑ daily consumption of fruits and vegetables iii. ↓ consumption of sugar-sweetened beverages
c. Increase number of residents who maintain a healthy weight
i. ↓ youth obesity ii. ↓ adult obesity
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Priority 3: Increase Access to High Quality Care + Services
Goals + Objectives a. Improve integration and coordination of services across the
continuum of care i. 100% of San Franciscans enrolled in either health insurance of
Healthy SF b. Increase connection of individuals to the health services they
need i. ↓ barriers to medical care ii. ↓ preventable hospital stays among seniors and persons with
disabilities c. Ensure services are culturally and linguistically appropriate
i. ↓ cultural and linguistic barriers to care d. Ensure San Franciscans have access to a health care home
i. ↑ number of residents with a primary care provider
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Committed Partners (Sample)
American Heart Association Boys and Girls Clubs of SF California Pacific Medical Center Children’s Council of SF Chinese Hospital Community Benefit Partnership Community Transformation Grant Team Dignity Health HOPE SF Kaiser Permanente Mayor’s Office SF Bike Coalition SF Department of Children, Youth and their
Families SF Department of Environment SF Health Improvement Partnerships
SF Health Plan Human Services Agency- Department of
Aging & Adult Services SF Medical Society SF Municipal Transportation Authority SF Planning Dept. SF Recreation & Parks SF Unified School District Shape Up SF, including HEAL Zone Southeast Food Access Work Group Tenderloin Healthy Corner Store Coalition UC, Berkeley UCSF Medical Center UCSF-SF Health Improvement Partnerships YMCA of SF
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Connecting the CHIP to Health Outcomes 24
Implementation of CHIP strategies and evaluation of CHIP impact to improve community health.
Action Phase 25
Next Steps
CHA/CHIP distribution SFDPH website www.healthmattersinsf.org SF Public Library Community presentations
Post/track CHIP objectives on Community Vital Signs Assign “Champions” to priorities Develop CHIP-based SFDPH Strategic Plan Apply for public health department accreditation Repeat process in 3-5 years
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THANK YOU QUESTIONS?
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