What Makes a Healthy Community | Measurement | Investment | Policy This resource from the Build Healthy Places Network guides community developers toward partnerships with hospitals and They are residents and patients . When you are part of an organized caring community network, your group Build a network that will be there for you when you need it. connection and support; Navigating health and community resources; Pet care; Yard care; Social events. Whether through questionnaires to parents or networking through colleagues, you can build a resource pool from the wide range of expertise.
of Patients Resources for Creating and Network a Community Building
CHCs did not want to be singled out in the analysis and reporting process. Most importantly, CHCs needed to be part of the design process to see value in this effort, in contrast to prior, imbalanced research relationships with academic partners. The collaborative model for development of a centralized data warehouse enabled CHCs with less experience in warehouse development to learn from more experienced members of the CHARN network.
Local CHCs and Nodes now have a standardized data warehouse and can use data queries already created for local data cleaning to investigate local QI or research questions using this shared data structure.
Another benefit to the CHCs is that having access to a local copy of the data warehouse made it possible for the CHCs to more easily answer questions about their local data and to conduct their own analysis on their specific populations.
It was important to set up a multiple-layer query process for data validation to ensure better data quality by identifying and resolving problems along a continuum of local and central checks. The validation queries and processes developed among the network to facilitate the goal of standardized data that can be used for research are critical to conducting research within and across CHCs. Partners within a data network need to come to a shared understanding of the context of the CHC data.
This will enable them to create and implement appropriate data validation processes before using and publishing CHC data. A benefit of the data warehouse from the CHC perspective was that clinics could participate in research without having their primary functions disrupted. The main deterrent to clinic participation in practice-based research is the time that it takes away from patient care.
As a result, our project paved the way for low impact but active clinic engagement in research. The centralized data warehouse currently supports CHARN working groups, research proposals, and prep-to-research requests. Examples include investigations of the impact of insurance transitions among diabetics, screening for HIV, viral hepatitis and tuberculosis, and providing preliminary data for proposals to study the impact of a team-care model in safety net diabetes patients and the impact of Meaningful Use on documentation and delivery of smoking cessation counseling.
For example, we could combine census data on socioeconomic status with our warehouse data to study patient mobility and migration systematically.
It will also be important to add new Meaningful Use data as standardized data fields are rolled out across EHRs. There is also the possibility of adding web-based query tools to facilitate easier access to the information contained in the warehouse and to help researchers create and prepare new research studies.
In particular, concerns about data quality and the suitability of EHR data for research have significant potential to have an impact on research because clinical data are not captured with the same rigor as are research data. For example, some lab results are being recorded in discrete fields, while others are recorded in difficult-to-capture open-text fields. Also, some fields had a large percentage of missing data due to either the complexity of extracting and formatting the individual elements or to the data not being collected or codified at some of the CHCs.
Another limitation was the inability to link different but related events e. These issues point to the complexities of using EHR data for research. As the movement to conduct more research using EHR data continues, improvements in methodology to increase the quality of EHR data, similar to those used for classical clinical trials, can be implemented. For example, the use of more standardized intake forms—requiring field completion, standardizing medications, labs tests, and diagnosis lists—as well as standardizing clinician documentation, can improve the accuracy and completeness of these data.
These types of requirements could have similar impacts on data collection of other clinical measures.
Furthermore, the potential uses of the data warehouse were limited regarding conditions that were not explicitly defined. Finally, even relatively complete EHR data only provide a partial picture of the health and health care experience in a safety net population—emergency visits and hospitalization are typically not documented and the most vulnerable patients often change locations and health providers frequently.
As the focus of the warehouse expanded through the development of Version 2 V2 , we developed additional procedures to address some of the limitations encountered with V1. V2 has been implemented and includes patients seen through December 31, , as well as additional clinical data; for example, we have expanded the warehouse to accommodate data on vital signs, procedures, tobacco use, problem list, enabling services, and referrals for other clinical services.
A key change to the data warehouse design was to include the full population of patients from each CHC. It also facilitates interpretation of results and understanding regarding generalizability of those results to a diverse safety net population. Another improvement for V2 was to have the DCC manage the standardization of coding for lab results and medications rather than having separate efforts at each Node.
Furthermore, CHARN working groups outline specific queries and targeted chart reviews relevant to their subject in order to understand the quality and appropriate uses of the data, e.
With regard to the variable encounter structures, linking events via dates rather through a common encounter ID is a feasible, standardized alternative. Working groups are currently using or planning to use the data warehouse for the following: In addition, de-identified data sets will be released to the Nodes and their CHCs, enabling them to carry out additional local- or network-wide projects.
The data warehouse will also be used in prep-to-research activities to develop new research proposals. It is feasible, but time intensive, to create a centralized data warehouse with multiple CHC partners using different EHR systems. It is essential to allow sufficient time 1 to develop collaborative, trusting relationships among new partners with varied backgrounds, experiences, and interests; 2 to complete institutional and regulatory review processes; 3 to identify and address technical challenges associated with diverse data environments, practices and resources; and 4 to provide continuing data quality assessments to ensure data accuracy.
The authors gratefully acknowledge the CHARN community health centers CHCs , research node centers and the data coordinating center for contributing the time and data used in preparation of this article. Erie Family Health Center, Inc. There are no competing interests. National Center for Biotechnology Information , U. Published online Oct Find articles by Jon Puro.
Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC.
Open in a separate window. Subject Area Types of Data Included Patient Demographics Birth and death dates, birth and current gender, transgender status, race, ethnicity, primary language, and CHC enrollment date Encounter Data Encounter start and end dates, encounter type, department, location, provider, insurance for encounter, and smoking status Diagnosis Data Diagnosis code, coding system, diagnosis descriptive name, and where data was collected from patient reported, provider coded, billing data Laboratory Results Lab code, coding system, lab descriptive name, collection and results dates, lab result, reference units including high and low values , interpretation Medications Ordered Medication names generic and brand names , medication code and coding system, form, total dose, units, route, frequency, start and end dates, stop reason, diagnosis associated with medication.
Warehouse Design and Implementation The CHARN DS was established to provide feedback to researchers on the content of the warehouse, to develop a database schema and methods to facilitate the extraction of data from CHCs, as well as creating the processes for transferring those data to the DCC. A lack of standardized data classification systems for labs and medications, which made it more difficult to clearly define our populations for analysis based on either labs or medications;.
Implementation of an EHR system not being done at the time of the data warehouse development One participating CHC had its data entered into an internal database structure and was able to provide most of the V1 data, but this required additional CHC effort to extract the data into the CHARN data model.
Impossibility of linking encounters visits to medication orders and lab orders for some CHCs because of differing EHR structures and workflows; and. A need for additional time to compile all required data because of multiple data sources at the CHC level.
Discussion The three-year funding period for this infrastructure development project supported the development of a robust data warehouse. Limitations and Challenges In particular, concerns about data quality and the suitability of EHR data for research have significant potential to have an impact on research because clinical data are not captured with the same rigor as are research data.
Progress in Version 2. The effectiveness of physical activity interventions in socio-economically disadvantaged communities: A rapid-learning health system. Health Aff Millwood Mar; 26 2: Achieving a nationwide learning health system. A survey of informatics platforms that enable distributed comparative effectiveness research using multi-institutional heterogenous clinical data.
Building a research consortium of large health systems: J Natl Cancer Inst Monogr. Bauck A, Gillespie S. Integrating layered data validation for multi-site clinical trials.
Diagnosis code, coding system, diagnosis descriptive name, and where data was collected from patient reported, provider coded, billing data. Lab code, coding system, lab descriptive name, collection and results dates, lab result, reference units including high and low values , interpretation. Medication names generic and brand names , medication code and coding system, form, total dose, units, route, frequency, start and end dates, stop reason, diagnosis associated with medication.
Confirming that all data conformed to the defined SQL server field data types. All records loaded into the tables conformed to the primary key constraints. Required fields no missing data in required fields. In fact, the more you can use the words of the community members who contributed their concerns and experiences, the more powerful your report will be. How will you communicate the results to the community? With the availability of PowerPoint and similar programs, you have the opportunity to create a professional-looking presentation that you can use in a number of ways.
It could be presented as a slide show in one or more public meetings or smaller gatherings, posted along with a narrative on one or more social media sites Facebook, YouTube, etc.
Furthermore, it could be used by a number of people without each having to fetch and carry large and cumbersome equipment or signboards and the like. The group should make sure everyone has a role that fits her skills, talents, and, to the extent possible, preferences. It should also make sure that all necessary tasks are covered. If more people need to be recruited -- as data gatherers, survey mailers, phone callers, etc.
The point of having a plan is to try to anticipate everything that's needed -- as well as everything that might go wrong -- and make sure that it has been arranged for. Assigning tasks appropriately is perhaps the most important part of that anticipation. Work out what should happen by when. How long will you gather information? How long will you take to analyze the data and write up a report? Each phase of the assessment should have a deadline.
That creates benchmarks -- checkpoints along the way that tell you you're moving in the right direction and have gotten far enough along so that you'll finish the assessment on time with the information you need. Once the plan is done, it should be presented to at least a sample of those who will be asked for information and those who will have responsibilities for parts of the assessment.
This will allow them to consider whether the plan takes the culture of the community into account, and is likely to make data collection and analysis as easy as possible. As a result of their feedback, you can adjust parts of the plan to make them more acceptable to the community or more workable for the assessment team. Now you can celebrate the completion of the plan, but it's not an occasion for resting on your laurels.
There's a lot of work ahead as you conduct the assessment, analyze the data you get from it, and make and implement action plans based on that analysis. It's important to have benchmarks built into the assessment plan and the action plans that follow, so you can keep track of your progress.
But it's also important to hold your long-term vision in view, and to keep moving toward it until the community becomes what all its members want it to be. Needs and resources are really two sides of the same coin.
In order to get a comprehensive view of your community, it is important to look at what you have and what you need. With these things in mind, you can have a positive impact on the problem you wish to address. Understanding the community's needs and assets will also help your organization clarify where it would like to go and how it can get there.
The Action Catalogue is an online decision support tool that is intended to enable researchers, policy-makers and others wanting to conduct inclusive research, to find the method best suited for their specific project needs. Ranking the health of nearly every county in the nation, the County Health Rankings help us see how where we live, learn, work, and play influences how healthy we are and how long we live.
The health of a community depends on many different factors — ranging from individual health behaviors, education and jobs, to quality of health care, to the environment, therefore we all have a stake in creating a healthier community. A companion piece to Communities in Action: A Guide to Effective Service Projects. Publication by Rotary International. Nutrition and Physical Activit y.
A Tool kit to help with community assessment on a specific topic from the Vermont Dept. A Capacity Builder's Resource Library.
Preparing for a Collaborative Community Assessment. From the Iowa State University Extension. Planning for community health. An action planning guide for community-based initiatives. Healthier communities action kit. Michigan Community Health Assessment. Defining and organizing the community. Community organizing and community building for health. Children, Youth and Families Department. Planning and conducting needs assessments: Skip to main content. Chapter 3 Sections Section 1.
Understanding and Describing the Community Section 3. Collecting Information About the Problem Section 5. Analyzing Community Problems Section 6. Conducting Focus Groups Section 7. Conducting Needs Assessment Surveys Section 8. Identifying Community Assets and Resources Section 9. Developing Baseline Measures Section Conducting Concerns Surveys Section Determining Service Utilization Section Conducting Interviews Section Conducting Surveys Section Strengths, Weaknesses, Opportunities, and Threats Section Tools for Community Mapping Section Implementing Photovoice in Your Community Section Windshield and Walking Surveys Section Arranging Assessments That Span Jurisdictions.
The Tool Box needs your help to remain available. Toggle navigation Chapter Sections. Learn how to develop a plan for community assessment to guide efforts to better understand community needs and resources. What do we mean by needs and resources? Why develop a plan for assessing local needs and resources? Who should be involved in developing a plan for assessing local needs and resources?
When should needs and assets be identified? How do you develop a plan for assessing local needs and resources? It will help you gain a deeper understanding of the community. Each community has its own needs and assets, as well as its own culture and social structure -- a unique web of relationships, history, strengths, and conflicts that defines it. A community assessment helps to uncover not only needs and resources, but the underlying culture and social structure that will help you understand how to address the community's needs and utilize its resources.
An assessment will encourage community members to consider the community's assets and how to use them, as well as the community's needs and how to address them. That consideration can and should be the first step in their learning how to use their own resources to solve problems and improve community life. It will help you make decisions about priorities for program or system improvement. It would obviously be foolhardy to try to address community issues without fully understanding what they are and how they arose.
By the same token, failing to take advantage of community resources not only represents taking on a problem without using all the tools at your disposal to solve it, but misses an opportunity to increase the community's capacity for solving its own problems and creating its own change. It goes a long way toward eliminating unpleasant surprises down the road. Identifying needs and resources before starting a program or initiative means that you know from the beginning what you're dealing with, and are less likely to be blindsided later by something you didn't expect.
It allows you to involve community members from the very beginning of the process. This encourages both trust in the process and community buy-in and support, not only of the assessment, but of whatever actions are taken as a result of it.
Full community participation in planning and carrying out an assessment also promotes leadership from within the community and gives voice to those who may feel they have none. An assessment is a great opportunity to use community-based participatory research , further involving community members and increasing community capacity. A good plan will provide an easy-to-follow road map for conducting an accurate assessment. Planning ahead will save time and effort in carrying out the process. A planning process will give community members the opportunity to voice their opinions, hopes, and fears about the community.
Their idea of priorities might be different from those of professionals, but they shouldn't be ignored. Among those who should be involved: Those experiencing needs that should be addressed. It's both fair and logical to involve those who are most directly affected by adverse conditions. They know best what effects those conditions have on their lives, and including them in the planning process is more likely to produce a plan that actually speaks to their needs.
Health and human service providers. These individuals and organizations, especially those that are community-based, often have both a deep understanding of the community and a strong empathic connection with the populations they serve. They can be helpful both by sharing their knowledge and by recruiting people from marginalized populations to contribute to the assessment.
Elected and appointed officials are often those who can help or hinder a community change effort. Engaging them in planning and carrying out an assessment helps to ensure that they will take the effort seriously and work to make it successful. These can can include individuals who are identified as leaders because of their positions -- college presidents, directors of hospitals and other major organizations, corporate CEOs -- because of the prestige of their professions -- doctors, professors, judges, clergy -- or because they are known to be people of intelligence, integrity, and good will who care about the community.
People whose jobs or lives could be affected by the eventual actions taken as a result of the assessment. These include teachers, police, emergency room personnel, landlords, and others who might have to react if new community policies or procedures are put in place. People who have been involved in addressing policy or issues that could come up in the course of the assessment have a stake in planning the assessment as well.
Businesses, especially those that employ people from populations of concern. The livelihoods of local business owners could be affected by the results of the assessment, as could the lives of their employees. Assessments of resources and needs should be done regularly throughout your initiative: Prior to planning the initiative.
This gives coalition members, community leaders, and those being served an idea of how to improve their circumstances. During implementation of an initiative. It is important to make sure that you are on target not only at the beginning and the end of a project, but also during its implementation. If car companies only did quality checks on the steel before the parts are constructed and the paint job after it rolled off the line, you might not be inclined to trust the engine.
Identifying needs and assets during the life of the initiative helps you use your own resources well, and ensures that you're addressing the right issues in the right way. On an ongoing basis. During monitoring and evaluation, either ongoing or after the completion of a project, it is important to celebrate successes and to learn from setbacks to further community development. Recruit a planning group that represents all stakeholders and mirrors the diversity of the community Try to be as inclusive as you can, so that the group is diverse and truly representative of the community.
Design an evaluation process for the assessment , including the development of the plan Why is this step here, at the beginning of the planning process, rather than at the end?
Determining how to address the needs of a particular underserved or neglected group. Conducting a community health assessment in order to launch a public health campaign or combat a particular disease or condition. Exploring how to steer the activities of a coalition of service providers or government agencies. Understanding community needs and resources as a guide to advocacy efforts or policy change. You can't make credible policy recommendations without knowing about current conditions and the effects on them of current policy.
Assessing the impact, intensity, and distribution of a particular issue, to inform strategies for approaching it. This may involve breaking the issue down still further, and investigating only a part of it. Rather than looking at the whole issue of violence, for instance, you might want to focus on domestic violence or youth violence or violence among teenage girls.
Determine what data is already available The chances are that a good deal of information about the community already exists. Federal government statistics, such as census and public health data. Assessments or studies conducted by other organizations. Hospitals, human service providers, Chambers of Commerce, and charitable organizations may all conduct community assessments for their own purposes, and may be willing -- or even eager -- to share their results.
Studies conducted by researchers connected to local universities. What you already know about the needs and assets of the community. The caution here is to realize that what you think you know may either be wrong, or may conflict with the opinions of community members. You should be ready to accept the facts if they conflict with your opinion, or to consider, as we've mentioned, the possibility of yielding to the community's perception of its own needs.
Figure out what other information you need This is the time to finalize the questions you'll ask your informants, as well as the questions you hope to answer with the assessment. In addition, it will probably be helpful to look at some community level indicators , such as: The number of and reasons for emergency room or clinic visits.
The number of places to buy fresh produce in various neighborhoods. The percentage of motor vehicle accidents and traffic stops involving alcohol. Decide what methods you'll use for gathering information Much of the rest of this chapter is devoted to methods of gathering assessment data. This is the research you might do to unearth the information in census and other public records, or to find information that's been gathered by others.
Listening sessions and public forums. Listening sessions are forums you can use to learn about the community's perspectives on local issues and options.
They are generally fairly small, with specific questions asked of participants. They can help you get a sense of what community members know and feel about the issue, as well as resources, barriers, and possible solutions. Public forums tend to be both larger in number of participants and broader in scope than listening sessions.
They are gatherings where citizens discuss important issues at a well-publicized location and time. They give people of diverse backgrounds a chance to express their views, and are also a first step toward understanding the community's needs and resources.
A good public forum informs the group of where the community is and where the members would like to go. Interviews and focus groups.
Building and Supporting Improvers
Yet rather than create a nationwide IDS network for its evergrowing array of U.S. The client/server, TCP/IP-based system includes a patient index, which Because Columbia has focused its resources on developing those community- based. All managers need to build good working relationships with the people who can . Or they may achieve new influence within a professional community but fail to Only after some patient coaching from a senior manager did she understand that and resources from one sector of a network to achieve results in another. Building New Theoretical Frameworks Robyn Keast, Myrna P Mandell, the network champions was working with leaders in the community by selling the establishing contractual resources and agreements with the various learning centers.