Stakeholders Compare and Contrast Essay

The

Evidence-Based Available data can drive successful community benefit programs

by Susan Birk

In the current environment of increasing accountability, the use of evidence-based decision making, an approach that is rapidly permeating virtually every aspect of medicine, is steadily working its way into every facet of healthcare management as well. The community benefit arena is no exception.

"The government is asking health- care organizations to document what they're doing and why, which means providers are becoming

evidence driven in all dimensions," says Connie J. Evashwick, ScD, FACHE, professor, department of health management and policy antl department of community health. Saint Louis University School of Public Health. "Community bene- fit is one of these dimensions. If we have health fairs, how do these health fairs help the community in a meaningful way? We need to get to the 'so what' of our efforts." Getting to the "so what"—demon- strating value—requires healthcare

providers and public health agencies to

step out of their separate silos and join

forces to reach underserved popula-

tions, Evashwick contends. 1 he two

disciplines have long existed in parallel

universes, and the need to forge a

closer bond has never been more

important, particularly now that non-

profit hospitals and health systems are

being asked to demonstrate with more

rigor and clarity than ever before

through 1RS Form 990 Schedule H

their efforts to benefit the communi-

ties they serve. As the point at which

healthcare management and public

health intersect, "community benefit

is a place where the two fields can

really come together nicely," she says.

Fortunately for healthcare providers,

public health itself has already become

a much more evidence-driven discipline

during the past 15 to 20 years, amass-

ing a solid body of data on how com-

munity health can be measured and

the strategies and interventions that do

and do not work, Evashwick notes.

Healthcare organizations can harness

this data to develop effective programs

tailored to their communities" most

pressing needs and allocate community

benefit dollars and resources where

they will do the most good.

If hospitals and health systems are to

be truly systematic about contribut-

ing to their communities in the ways

that their communities most need,

and if they are to effectively show

that they have done so, they need to

know what those needs are,

Evashwick says.

Healthcare r.Ntcutivc 2 9 JULY/M'C^OIO

The Evidence-Based Road Available data can drive successfulcommunity benefit programs However, she stresses that infusing

evidence-based substance into com-

munity benefit initiatives does not

necessarily demand a major invest-

ment of resources in the form of an

original community needs assess-

ment. Instead, "you need to ask

what has been done and tap into

that learning. If obesity is a prob-

lem in your community, and you

produce meaningful results, Evashwick

says. But the most efficient strategy

for doing so is to take advantage of

the abundance of information that

already exists. "Why spend time and

money that have already been spent?"

she says. "Hospitals should tap into

the existing data first and use the

money saved for focus groups on spe-

cial subpopulations."

"Why spend time and money that have already been spent?

Hospitals should tap into the existing data first and use the

money saved for focus groups on special subpopulations."

—Connie J. Evashwick, ScD, FACHE

Saint Louis University School of Public Health

want to do something about it,

rather than pick an arbitrary pro-

gram or continue with a program of

questionable value that youVe been

doing for 50 years, look at the evi-

dence about what works in your

type of community, and use those

interventions," she urges. "Let's go

with what we know."

"Coing with what we know" not only

can save hospitals energy and resotirces,

but it can also help to ensure that their

efforts will not be wasted. "Of course,

we should be able to identify the prob-

lem and the measures that will make a

difference" in order to shift from the

random acts of kindness that have

characterized some community benefit

efforts in the past to programs that

Michael Bilton, co-founder and execu-

tive director of the Association for

Community Health Improvement of

the American Hospital Association,

agrees with Evashwick that providers

can begin to gain valuable insight into

their communities' needs without the

expense of an independent needs

assessment, which can cost anywhere

from $5,000 to $150,000. "Before

spending funds on new data collec-

tion, you might check with the local

public health department. United

Way, community clinics association,

school district and other related orga-

nizations. They almost always will

have health data and may be willing to

share," says Bilton, who has also served

as director of community health pro-

grams for the American Hospital

Association's Health Research and

Educational Trust.

Armed with this information, a hospi-

tal will be better able to plan its own

data collection to fill in the blanks

about the health issues and local pop-

tilations most relevant to its mission.

"Since we're talking about community

health needs, a hospital's community

partners frequently hold important

pieces of the puzzle," he says.

An important new factor recently has

entered the community health assess-

ment equation, Bilton notes. The

national health reform legislation

passed this year requires tax-exempt

hospitals to conduct a community

health needs assessment at least once

every three years. What's more, "hos-

pitals will also have to demonstrate

they have a strategy to meet the needs

identified by the assessment," he says.

All of this makes a stronger case than

ever for programs grounded on hard

data with respect to both the needs

being served and measurable results,

he says. Making use of existing

resources can help greatly in this

regard and allow providers to spend

their community benefit resources

more wisely.

Profiles in Evidence Spectrum Health Spectrum Health, a nonprofit, seven-

hospital healthcare system in western

Michigan, taps regularly into a com-

prehensive storehouse oi community

3 0 Healthcare Executive JULY/AUG 2010

The Evidence-Based Road Available data can drive successfulcommunity benefit programs data to plan, implement and evaluate its community benefit programs.

This data, compiled from a wide range of public and private sources and refined to create more detailed profiles of specific communities throughout western Michigan, is available through the Community Research Institute of the Johnson Center for Philanthropy at Crand Valley State University. The insti- tute provides Spectrum Health with an excellent source for the evidence-based backing it needs to justify and develop new programs, allocate resources, and identify and target the populations that are most in need. "We can slice apart the data as we look at the dispari- ties," says Erin Inman, PharmD, director of Spectrum Health's Healthier Communities depart- ment, which oversees the system's 27 programs targeted to under- served populations.

"We're in a data-driven environment in our community," Inman says. "We can drill down and say 'does it make sense to focus our efforts in this area?'" The system's ready access to in-depth information on community demographics and other variables enables its Community Commitment Advisory Council, Healthier Communities' governing body, to make decisions about where and how the system's $6 million community benefit budget (plus an additional $5 million in grants).

expertise and other resources can most efficiently and effectively be deployed.

In addition to internal efforts. Spectrum Health's community ben- efit initiatives include a range of external programs, in which funds are provided to outside community organizations, such as the Asthma Network of West Michigan, to support their community health work. The system asks these orga- nizations to analyze and present community data to support their proposals as well.

To evaluate whether its community benefit efforts are having an impact. Spectrum Health has used the University of Wisconsin's County Health Rankings "to see if we are making any progress and to see where west Michigan falls in the state and nationally," Inman says. "We want to make sure the dollars we are spending are having a posi- tive effect on the community."

The system also gathers evidence to decide when not to fund programs. "Sometimes a program dissolves, and we might need to look at other ave- nues or revamp it," she says. "Historically, we've looked at com- munity benefit as a 'feel good' thing. But we've changed our focus. Not only do we want it to feel good, but we want to prove that we have out- comes. Decisions have to be made with outcomes in mind, because you

want to make sure you can justify

where your dollars are being spent."

To help in this regard. Spectrum Health has begun developing a series of dashboards to monitor the results of six of its key community benefit programs. "A lot of this type of moni- toring has been going on in the inpa- tient and outpatient worlds for over a decade, but this type of tracking is new to the community benefit world," she says, adding that Spectrum Health's community bene- fit dashboard development is only in its "adolescence." "As a large organi- zation, we wanted to find a consistent way to see quickly and articulate to others whether our programs are really beneficial and meeting the needs of the community."

Carondelet Health Network Carondelet Health Network, Tucson, Ariz., has developed, implemented and replicated a sustainable diabetes care continuum for a rural medical center using telemedicine and the evidence-based Chronic Care Model (CCM). (Based on the scientific evidence about what does and does not work in the care of patients with chronic illnesses, CCM focuses on improving the quality of care through ongoing, productive interac- tions between patients and caregivers, stressing the consistent assessments, support for patient self- management and regular follow-up associated with good outcomes. A key goal of CCM is to provide patients

j2, Hcakhcatc hxccutive JULY/AUG 2010

The Evidence-Based Road Available data can drive successfulcommunity benefit programs with the skills, confidence and infor- mation they need to become active participants in their care.)

During the past 20 years, the Carondelet Diabetes Care Center's American Diabetes Association (ADA)-recognized diabetes self-man- agement training program (DSMT) has established seven satellite DSMT centers in rural and community set- tings throughout southern Arizona. Carondelet also provides diabetes out- reach throughout Arizona through the Arizona Telemedicine Network.

"DSMT programs are financially challenged, particularly in rural areas," says Tara Sklar, JD, director of access and community health. "Yet today, with the growing incidence of diabe- tes, DSMT is needed more than ever." Carondelet received a grant from the Arizona Department of Health Services to partner with the Mt. Craham Regional Medical Center, a 59-bed rural hospital in Safford, two and a half hours east of Tucson. The county in which Mt. Craham is located had only one professional dietician. Public health data had indi- cated not only a need but a signifi- cantly growing need for diabetes education in the state, in part because Arizona is primarily rural, Sklar says.

A Community Advisory Board, including Mt. Craham's CEO, chief nursing officer, community health director, two staff nurses, the dieti- cian, the home health director, a nurse

practitioner from the local Federally Qualified Community Health Center, two primary care physicians, a podia- trist and a diabetes patient met quar- terly to monitor progress, in keeping with ADA recommendations. "This partnership is important in improving the health of our community," says Patrick J. Peters, president and CEO of Mt. Craham.

Components of the DSMT program included DSMT training/mentoring for hospital and community nurses, physicians and dieticians by Carondelet staff via telemedicine; a quarterly Diabetes Day Clinic to provide eye examinations, foot examinations, laboratory tests and medical nutrition therapy for patients; and a free monthly com- munity diabetes information session. The program led to the establish- ment of an ADA-recognized DSMT satellite at Mt. Craham, and a diabe- tes nurse educator was trained and placed in the medical center's pri- mary care offices to educate patients in self-management.

"The only way to be reimbursed for diabetes education is if the services are provided by an ADA-recognized center," notes Donna Zazworsky, RN, vice president of community health and continuum care. By com- pleting the health professional train- ing and mentoring, Mt. Craham is now a satellite of the Carondelet ADA-recognized program, and Carondelet reimburses for nursing

and dietician teaching time. Patient volume is sufficient to also cover uninsured diabetes patients. "By cre- ating partnerships, we can create a barrier-free environment and deliver diabetes care and education to every- body," she says.

Carondelet tracks program and behavioral outcomes as well as con- tinuous quality improvement and demographic data related to the pro- gram at Mt. Craham. The informa- tion is reported at joint meetings between the two organizations and at a biannual Carondelet ADA Advisory Board meeting.

The program has reached more than 100 patients with DSMT and 52 patients in the Diabetes Day Clinics, Zazworsky reports. Ten nurses and one dietician continue to receive train- ing/mentoring via telemedicine, and two nurses are planning to become certified diabetes educators. Perhaps most significant, mean Ale blood glu- cose levels have decreased to 7.1 per- cent from 8.8 percent. According to ADA guidelines, a well-controlled patient with diabetes has an Ale of 7 percent. "We started at Mt. Graham with people on their way to kidney disease, heart disease and stroke," says Zazworsky. "Since the program began two years ago, we have been bringing these people into clinical compliance and reducing complications."

Susan Birk is a freelance writer based

in Wheaton, III.

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