Primary Care and Public Health Exploring Integration to Improve Population Health (2012) / Chapter Skim
Currently Skimming:
3 Potential for Interagency Collaboration
3 Potential for Interagency Collaboration
Pages 79-104
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 79... ...
The term "health center" is used here to refer to organizations that receive grants under the Health Center Program as authorized under section 330 of the Public Health Service Act, as amended, and federally qualified health center look-alike organizations, which meet all the Health Center Program requirements but do not receive Health Center Program grants. The term does not refer to federally qualified health centers that are sponsored by tribal or urban Indian health organizations, except for those that receive Health Center Program grants.
|
From page 80... ...
is directed to make grants to early childhood home visiting programs to promote improvements in health and socioeconomic status and reduce community and family risks. The Home Visiting Program represents a strong opportunity for integration of primary care and public health because the health care service delivered is not based on an illness or in response to a person seeking care, but instead is aimed at prevention and wellness for all members of a community.
|
From page 81... ...
The grant application requires a detailed needs and resources assessment of a targeted community and specifies the selection of a home visiting program that responds directly to the community's identified needs. Linking at-risk families to local health centers strengthens (or in some cases creates)
|
From page 82... ...
Linkages could be explored between communities selected for Home Visiting Program grants and those selected for Community Transformation capacitybuilding grants. For example, groups that received grants from CDC to disseminate and amplify lessons learned from Community Transformation Grant programs could work with HRSA to include strategies learned from the Home Visiting Program.
|
From page 83... ...
Finally, as programs mature and are evaluated, health departments and implementing partners will have an opportunity to coalesce around strong programs and advocate for the adoption and dissemination of promising results. Sustainability As part of the Home Visiting Program, states must create a resource plan and discuss how the program will fit into existing programs within the community.
|
From page 84... ...
Healthy Start, another program administered by HRSA's Bureau on Maternal and Child Health, requires that grant recipients report data on the characteristics of their program participants, as well as the services they provide. Finally, data collection is a core component of the Home Visiting Program.
|
From page 85... ...
However, it traditionally has not paid for a home visitor to spend time on community health issues or on coordination with such entities as social service agencies, housing services, and WIC; these are deemed to be public or community health services not focused on individual patients, and therefore not reimbursable. The Home Visiting Program provides HRSA and CDC with an opportunity to reposition the discussion about funding and promote population health by working with state Medicaid directors to sustain this program.
|
From page 86... ...
Providing a staff person who could work directly with the MCH staff provided by HRSA in the regional offices offers an opportunity to align goals around MCH. In addition, directly involving local health centers in the Home Visiting Program would foster relationships between primary care providers and families.
|
From page 87... ...
Cardiovascular disease also is an important example of health disparities. African Americans experience significantly higher mortality rates from cardiovascular disease than whites: in 2007, the overall cardiovascular disease death rate per 100,000 was 251.2; the rate was 405.9 and 286.1 for African American males and females, respectively, versus 294.0 and 205.7 for their white counterparts.
|
From page 88... ...
Principles of Integration Shared Goal of Population Health Improvement The Million Hearts initiative suggests that the HHS agencies have a shared goal of population health improvement. Achieving the reduction in strokes and heart attacks targeted by the initiative -- which is a population health goal -- will require contributions from all of the agencies involved.
|
From page 89... ...
Community Engagement In addition to the Healthy Weight Collaborative and the Community Transformation Grants, the portfolios of HRSA and CDC include other programs that involve local communities in the prevention of cardiovascular disease. For example, CDC's Division for Heart Disease and Stroke Prevention administers the WISEWOMAN program, which focuses on reducing the burden of cardiovascular disease among women aged 40 to 64 who are financially disadvantaged.
|
From page 90... ...
Thus, the experience of health centers with successful strategies to achieve better outcomes in blood pressure and cholesterol control could be used to advise the WISEWOMAN program and Community Transformation Grants. In many cases, health centers have been pioneers in employing culturally relevant outreach and educational methodologies and bilingual modalities that could be used more effectively in public health activities aimed at cardiovascular disease prevention.
|
From page 91... ...
These maps could then be tracked over time, making visible the efficacy of integrated primary care and public health efforts. Since health centers are identified largely as providing care for medically underserved areas, mapping patterns of clinical efficacy against Community Transformation Grants and other CDC efforts should promote collaborative activity and accountability.
|
From page 92... ...
Finance HRSA and CDC could provide some flexibility for grantees that are pursuing the goals of the Million Hearts initiative. For example, the agencies could permit some grantees to set requirements around screening or outreach that would give health departments and health centers added flexibility in their fight against cardiovascular disease.
|
From page 93... ...
As primary care providers working with underserved populations, officers of the NHSC are well positioned to provide clinical services, including those that promote cardiovascular health, to vulnerable community members. EIS officers based in state and local health departments likewise are well positioned to use public health approaches to address cardiovascular disease.
|
From page 94... ...
. Unfortunately, significant disparities exist in the colorectal cancer screening rates for a number of populations.
|
From page 95... ...
Several states have made these links. And by including the new proposed performance measure on colorectal cancer screening, HRSA has positioned health centers to work with health departments in identifying members of the population who should be screened.
|
From page 96... ...
Requiring a needs assessment as part of the Colorectal Cancer Control Program to identify activities already taking place in the state -- similar to the needs assessment required by the Home Visiting Program discussed above -- would enable states to identify and link with primary care delivery sites, such as health centers, early on. Similarly, encouraging states and tribes to use patient navigators who can link patients to health centers would create an opportunity for partnership.
|
From page 97... ...
To have a lasting impact on the incidence of colorectal cancer, however, the delivery of screening services also must be sustainable. With the proposed colorectal cancer screening measure, providers at health centers may have an added incentive to provide screening; if approved, this measure will require them to report their screening rates.
|
From page 98... ...
As with cardiovascular disease prevention, the coordination of these two data systems is key to integrating activities in colorectal cancer screening. Potential Actions, Needs, and Barriers CDC is well positioned to assist health centers in meeting the needs of their at-risk populations.
|
From page 99... ...
Patient navigators offer an opportunity for integration by linking the community to primary care. These positions could be funded either by health centers or by health departments (or jointly)
|
From page 100... ...
From the committee's in-depth examination of the Home Visiting Program, cardiovascular disease prevention, and colorectal cancer screening, some key points emerged. They include the value of using community health workers, the opportunities provided by data sharing, the potential to use the NHSC and the EIS to create linkages in communities, and the possibility of using a third party to foster integration.
|
From page 101... ...
CDC, in particular, could play a role in facilitating this access by encouraging state health departments to involve local health departments and health centers in the design of surveillance systems, data hubs, and other data collection activities. The NHSC and the EIS, respectively, are HRSA's and CDC's primary workforce programs.
|
From page 102... ...
2000. Hawaii's healthy start program of home visiting for at-risk families: Evaluation of family identification, family engagement, and service delivery.
|
From page 103... ...
2011. Options for increasing colorectal cancer screening rates in North Carolina community health centers.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.