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DNP 825 Topic 7 Discussion Question Two
DNP 825 Topic 7 Discussion Question Two
Provide an analysis of your surveyed community and what health-related community need is present. Define the methodology of the health improvement program you will use to solve this problem also include a time line. Include any higher level of care management and policy decision that APNs who work in the community would need to be partner with either community-based consortiums or health care policy makers.
The committee proposes a community health improvement process (CHIP) 1 as a basis for accountable community collaboration in monitoring overall health matters and in addressing specific health issues. This process can support the development of shared community goals for health improvement and the implementation of a planned and integrated approach for achieving those goals.
A CHIP would operate through two primary interacting cycles, both of which rely on analysis, action, and measurement. The elements of a CHIP are illustrated in Figure 4-1. Briefly, an overarching problem identification and prioritization cycle focuses on bringing
community stakeholders together in a coalition, monitoring community-level health indicators, and identifying specific health issues as community priorities. A community addresses its priority health issues in the second kind of CHIP cycle—an analysis and implementation cycle. The basic components of this cycle are analyzing a health issue, assessing resources, determining how to respond and who should respond, and selecting and using stakeholder-level performance measures together with community-level indicators to assess whether desired outcomes are being achieved. More than one analysis and implementation cycle may be operating at once if a community is responding to multiple health issues.
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The actions undertaken for a CHIP should reflect a broad view of health and its determinants. The committee believes that the field model (Evans and Stoddart, 1994), discussed in Chapter 2, provides a good conceptual basis from which to trace the multifactorial influences on health in a community. A CHIP must also adopt an evidence-based approach to determining how to address a health issue. Evidence is needed not only to make an accurate assessment of the factors influencing health but also to select an appropriate process through which to make changes. For example, immunizations are an effective means of preventing some infectious diseases, but many children and older adults have not received recommended doses. Studies show that efforts to raise immunization rates should target both the barriers that keep people from using available immunization services and the provider practices that result in missed opportunities to administer vaccines (IOM, 1994b).
As envisioned by the committee, a CHIP can be implemented in a variety of community circumstances. Communities can begin working at various points in either cycle and with varying resources in place. The need to develop better data systems, for example, should not deter communities from using the CHIP framework. Using the process can focus attention on data needs and on finding ways in which they can be met. Participation from both the public and private sectors is needed, and leadership to initiate the process might emerge from either sector. The committee notes, however, that The Future of Public Health (IOM, 1988) suggests that public health agencies have a responsibility to assure that something like a health improvement process is in place. Thus, the committee recommends that local and state public health agencies assure that communities have an effective CHIP. At a minimum, these agencies should be CHIP participants, and in some communities they should provide leadership or an organizational home. Strong state-level leadership in places such as Illinois, Massachusetts, and Washington has helped promote progress at the community level.
The ongoing health improvement process must be seen as iterative and evolving rather than linear or short term. One-time activities, briefly assembled coalitions, and isolated solutions will not be adequate. A CHIP should not hinder effective and efficient operation of the accountable entities in the community that are expected to respond to specific health issues, and it must be able to accommodate the dynamic nature of communities and the interdependence of community activities. It should also facilitate the flow of information among accountable entities and other community groups and help them structure complementary efforts. Both community-level monitoring data and more detailed information related to specific health issues must feed back into the system on a continuing basis to guide subsequent analysis and planning. This information loop is also the means by which a CHIP links performance to accountable entities among the community stakeholders.
In emphasizing the community perspective, the committee does not want to overlook the broader state and national contexts for community efforts. For example, health policymakers at the federal and state levels could consider community-level performance indicators when planning and evaluating publicly funded health services programs such as managed care for Medicaid populations. Community performance measures could also contribute to state management of federal block grants (e.g., Maternal and Child Health Title V grants or those under the Community Mental Health Services Block Grant program) and the proposed federal Performance Partnership Grants (PPGs) (USDHHS, no date).
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