health care question

Good start!! Please read the directions and Rubric carefully. Your mentioned that your topic is reducing infant mortality. Therefore, you need to develop an infant mortality program in a COMMUNITY not the state.

Your entire paper should be based on goals related to developing a community program that works toward reducing infant mortality. Read more in the class sources about population health.

Also, please format correctly (see how your paper is changed). Please develop paragraphs and do not use lists unless they are complete sentences that are substantively written about your topic.

Please let me know if you have questions.

Many thanks

Healthcare Disparities in Maryland

Maryland state is one of the smallest states geographically but a home to a diverse community that includes Non-Hispanic Whites, Blacks, American Indian and Alaska Native, Asians and Hispanic or Latino (Malley, Brown, & Sharfstein, 2014). It has over six million people with a remarkable thirty nine percent comprising of the minority population (Hogan, Rutherford, & Schrader, 2016). Nationally, in the United States, affordable modern health care is relatively available to citizens in most states; however, notable health disparities exist between states. Health disparity refers to variation in disease occurrence, extension, deaths and economic implications that exist among different communities in the United States ( Baquet & Colgan, 2013) The subject of this discussion is focused on health disparities in Maryland State when compared to the United States in general. Comment by miriam ross: Good but actually the subject of your paper is infant mortality

Indicators

Infant Mortality Rate

The number of infant deaths per 1000 live births in Maryland for the period between 2007-2016 was higher than the national average in the United States (Hogan, Rutherford, & Schrader, 2016).

Poor Health Insurance Coverage

The state of Maryland has one of the poorest enrollment to health insurance compared to other states in the United States. Data from Medicare enrollees in 2015 shows that Maryland has between 1.0%-15.4% of her residents covered compared to the national average of 31.3% all over the United States ( Price, Schuchat, & Rothwell, 2017). As of 2013, about 730,000 ( 14%) of Maryland’s 5.8 million people were not insured ( Baquet & Colgan, 2013). Comment by miriam ross: You have described the priority community but you also need to have good paragraph development

Prenatal Care in First Trimester

Research shows that the number of women getting prenatal care in first trimester was 69% in Maryland compared to 73.1% in the United States (Martin, J. A., 2012). In addition, the percentage of women delivering after receiving late or no prenatal care in 2016 was 8.5% in Maryland compared to 6.2% in the United States (Hogan, Rutherford, & Schrader, 2016). Comment by miriam ross: Reminder there are no initials in citations Comment by miriam ross: Good points about infant mortality – well done There should be additional information about summarizing and expanding on this data

Differences in Mortality for the Top Causes of Death

Deaths due to cardiovascular diseases tops all over the United States, however, studies conducted between 2007-2016 show a higher rate of age adjusted death rate for cardiovascular diseases in Maryland as compared to the national average in the United States; in 2013 for example, this rate was 171.7 per 100000 in Maryland compared to 169.8 nationally in the US (Hogan, Rutherford, & Schrader, 2016). Comment by miriam ross: It would be good to put your statistics in a table and then narrow down how you have chosen infant mortality as your topic

Death Rate Due to Pneumonia and Influenza

For the study carried out between 2007-2016, age adjusted death rate as a result of these two infectious conditions was higher in Maryland than in the United States (Hogan, Rutherford, & Schrader, 2016). Comment by miriam ross: Not sure what this is referring to in relation to your topic – again good paragraph development is needed

Stakeholders

Maryland State Government

A key partner in formulating health policies that will address the health needs within the state. It’s also key in ensuring that federal health policies such as Affordable Care Act, 2010 are implemented within Maryland ( Baquet & Colgan, 2013). Another key thing is proper representation especially for minority population to bridge the gap in access to healthcare.

Maryland State Department of Health

An important stakeholder in collection of data concerning health trends and forwarding necessary recommendations to the state government.

Insurance Agencies

Medicare, for example, should come up with friendly policies that will see to it that more people enroll for health cover. Another example is Maryland Insurance Administration ( Baquet & Colgan, 2013).

Health Care Workers

Key in eliminating the disease burden. Comment by miriam ross: You need paragraphs and organizations in the community where infant mortality is being addressed This is not even a complete sentence

Health Need: Access to Health Care

Looking at the data derived from health trends in Maryland and the United States, it’s no doubt that access to health care is a top health need. Infant mortality rate is at an alarming high rate when compared to the national average. In 2015 for example, the rate was 6.7 per 1000 live births in Maryland compared to 5.9 in the United States (Hogan, Rutherford, & Schrader, 2016). It does not stop there; a look at the neonatal mortality is quite disturbing- 4.9 per 1000 live births in Maryland compared to 3.9 in US. These findings combined with low prenatal care and poor health insurance cover paints the picture of poor healthcare access in Maryland.

Sources Comment by miriam ross: Sources related to what – did you use these when you gathered your data?

· Maryland State department of health reports

· U.S. Department of Health and Human Services

· Centers for Disease Control and Prevention

· National Center for Health Statistics

· Journals and articles from United States National Library of Medicine

Resources and Programs in Maryland

Medicaid health insurance covers children under the age of 21 years (Maryland Department of Health, 2017). Maryland Children’s Health Program provides affordable health cover to children from low income families (Maryland Department of Health, 2017). Human resources include doctors, dentists, and other health workers.

Health Initiative: The Big 3 Health Priorities for Maryland

Goal

To bridge the gaps that exists in the healthcare system in Maryland.

Objectives

· Lower infant mortality rate. Comment by miriam ross: You need complete sentences

· Improve prenatal care

· Expand health insurance coverage in Maryland with a focus on minority population

Planning Model: State Health Improvement Plan

State Health Improvement Plan (SHIP) is a health planning model developed by the Association of State and Territorial Health Officials and Centers For Disease Control and Prevention (CDC) in 2011 (CDC, 2018). It consists of seven key components that are crucial in its implementation (Association of State and Territorial Health Officials, 2015). In a nutshell, identifying partners for planning and execution is the first step, this is followed by data sampling from the population of interest; the data focuses on the observed health trends and the system capacity (Association of State and Territorial Health Officials, 2015). The data is analyzed and priorities picked with solutions and strategies, it’s then communicated to stakeholders who eventually come up with a working plan for SHIP (Association of State and Territorial Health Officials, 2015). Comment by miriam ross: good

Rationale for choosing SHIP

This planning model is the most effective for the health initiative in Maryland because it involves all the relevant stakeholders. Through this model, the community of Maryland is actively involved in the process by providing relevant data, therefore, the issues highlighted in health initiative (the big 3 health priorities for Maryland) will come out clearly in the SHIP. It is therefore the best planning model for my program because of its emphasis on community engagement and collaboration for system-level planning after identifying assets and need (CDC, 2018).

Specific Aspects of the Health Initiative (The big 3 health priorities for Maryland)

Inputs

To achieve this initiative, a number of resources will come into play. Healthcare is influenced by many factors and medical attention is only one of them. Social classes, work environment, employment, income, housing, education level, diet and lifestyle among other things are resources affecting healthcare. However, more specific resources for this program would include financial resources, human resources and material resources. Finances in form of money is the first resource and this is where government, both federal and state government of Maryland lend a helping hand. Money will see to it that human resources are recruited, family health care workers, obstetrics and gynaecologists, physicians, pediatricians will go a long way in ensuring that the objectives of this program are met. Material resources in form of hospitals and modern medical equipment will help eliminate the health disparities in Maryland. Medicaid, state department of health Maryland and other public health agencies should partner closely with community based programs in Maryland such as Division of Community Support Services to ensure that proper service delivery to all citizens of Maryland. Other additional resources could include deployment of more emergency services, special fund to cater infants, introduction of universal health coverage and adoption of necessary health legislations such as Maryland Health Improvement and Disparities Reduction Act of 2012 (SB 234) ( Baquet & Colgan, 2013). Comment by miriam ross: this is general and rambling – you need specific goals related to a program – this is why you need a community and not a state

Activities

Early planning and assessment

This is the first activity that will bring together all stakeholders to generate goals and objectives. A timeline is also set at this point so that time is accounted for. The health need and he subsequent health initiative is also communicated at this point. Ideas on how to reach the community of interest are brought to light early during the planning. Comment by miriam ross: you need better sentence structure and specific goals and activities – what are the activities classes – discuss clinics – discuss education material – discuss food bank – discuss counseling – discuss these are some suggestions

Workshops and meetings

This is basically reaching out to Marylanders for their engagements. Public places are the most ideal for this endeavor, these include market places, school gatherings, churches, sport events among others. Data collection is done this way.

Volunteer services

These include free medical camps that target the health needs of the community. Civic education is done with a focus on pregnant and breastfeeding mothers in a bid to ensure the welfare of their infants.

Social media

This is done through television adverts, social media campaign. A popular way in the world today is use of twitter, Facebook and Instagram to try and reach as many people as possible. Public figure personalities can especially those within Maryland. Comment by miriam ross: again very general – see my suggestions above that are program specific – others?

Outcomes

These are defined changes resulting from objectives, i.e. the specified knowledge, behavior change, or the change in a risk factor, community norm, health status, among other things (Association of State and Territorial Health Officials, 2015). Comment by miriam ross: Paragraph development and more specifics

Short term outcomes

People will start talking about the health situation in Maryland which will create awareness. These conversations surrounding high infant mortality rate, low prenatal care and poor health insurance; will trigger a public interest that will see the government being put to task by her citizens. It will the very first positive outcome towards the program. With everyone in Maryland asking themselves these hard questions, the process of data collection and picking priorities is happening so that stakeholders can present recommendations to the public. Nevertheless, resistance may be encountered from the political class who may see this as a venture to undermine them. Comment by miriam ross: Very general – need community specific information

Intermediate outcomes

The relevant stakeholders have already received possible solutions from the taskforce and implementation is ongoing. Resources are harmonized to address the big 3 health priorities and hence working towards the health initiative.

Long term outcomes

With proper implementation of the plan, objectives will be realized in the long term. Infant mortality rate will come down and probably rank below the national average in the United States. This will be as a result of improved prenatal care and health insurance policies. The heath need for Marylanders which is access to healthcare will have been achieved.

Budget Proposal

Staff expenses

Staff here comprises the executive committee who are permanent for the entire duration of one year. Their role is to help in administration and logistics such as facilitating the process when workgroups meet (Association of State and Territorial Health Officials, 2015). A minimum of five staff members is necessary for this program with a stipend of $3460 per month for 12 months each. Staff working in priority workgroups will be needed for 12 months to ensure continuity, a minimum of 2 each with a monthly stipend of $3460 for 12 months was budgeted.

Data collection

Tools such as laptops and printers will be needed, an estimated cost of 5 laptops and 5 printers was budgeted at $5000. Transport during the process is budgeted at $10000. Additional staff will be needed in the field during data collection, costs of at least 3 members for 3months amounts to $31140.

Publicity

This will involve social media campaigns for four months during which data collection and public participation is needed, budget of $50000 was deemed necessary to ensure proper coverage by television stations, radio stations, Facebook, Twitter, Instagram among others. Entertainment is crucial to attract members of the public and it will involve both local and national artists for the 4 months of active public participation. A cost of $30000 was budgeted for that. Public gatherings will be done both in open air places and rented conference halls at an estimated cost of $30000. There is need to invite panelists with special knowledge in the priority areas of the health initiative, this was budgeted at $25000. Flyers will aid in publicity at cost of $5000.

Voluntary Services

The voluntary service most ideal for this program is medical camp which will involve purchase of drugs at an estimated cost of $50000, necessary medical equipment at a cost of $50000 and hired labor expenses at $15000. Unbudgeted costs totals to $20000.

Potential Funding Sources

The Maryland state government is the first stakeholder that ought to take the front line in funding this program given the mandate it’s tasked with. It will accomplish this role by channeling adequate to the State Department of Health. Other state agencies like Maryland Institute for Emergency Medical Services Systems and Maryland Insurance Administration are potential donors (Government, 2018). Special funds like Subsequent Injury Fund can be mobilized to target beneficiaries in this program (Government, 2018). Another important state agency is Uninsured Employers’ fund that can help channel resources to this program for the benefit of the undeserved (Government, 2018)

Community Partner Collaboration

A public health agency like the Maryland Health Benefit Exchange in collaboration with community programs like Maryland Special Populations Network will ensure that healthcare inequalities that exist within the state are addressed ( Baquet & Colgan, 2013).

Logic Model

Situation	Inputs	Activities	Outputs
The big 3 health priorities for Maryland: High infant mortality rate, poor health insurance cover, inadequate prenatal care	RESOURCES: 1)Financial-money, grants 2)Human- doctors, medical specialists, nurses, community health workers, dentists, gynaecologists, physicians, pediatricians 3)Material- hospitals, medical technology, 4) Insurance-Medicaid 5)Health legislation 6)Special funds like Uninsured Employers’ Fund 7) Involvement Community based organizations like Division of Community Support Services	1) Planning and assessment 2)Publicity through social media 3)Public participation through listening sessions and gatherings 4) Volunteer Services such as medical camps	Purpose of the Initiative : Comment by miriam ross: these are good but they are not developed clearly in your paper this needs to relate to an actual project in a community NOT state assume your organization is reaching out to the community · Lower infant mortality rate. · Improve prenatal care. · Expand health insurance coverage in Maryland with a focus on minority population 1)Short term: Awareness 2)Intermediate: Initiation of positive steps towards the initiative 3)Long term: Objectives will be realized

References Comment by miriam ross: you need more sources related to infant mortality

Association of State and Territorial Health Officials (2015, June). Developing a State Health Improvement Plan: Guidance and Resources. Retrieved from Associaton of State and Territorial Health Ofcials: http://www.astho.org/Accreditation-and-Performance/Developing-a-State-Health-Improvement-Plan-Guidance-and-Resources/Home/?terms=state+health+improvement+plan

Baquet, C. R., & Colgan, R. (2013). Overview of Health Disparities: Maryland Considerations. US National Library of Medicine, NCBI.

CDC. (2018, May 08). Assessment & Planning Models, Frameworks & Tools. Retrieved from CDC: https://www.cdc.gov/stltpublichealth/cha/assessment.html

Government, M. (2018, May 09). Maryland State Agency Directory. Retrieved from Maryland.gov: http://www.maryland.gov/pages/agency_directory.aspx

Hogan, L., Rutherford, B., & Schrader, D. R. (2016). MARYLAND VITAL STATISTICS ANNUAL REPORT. Baltimore: Maryland Department of Health.

Malley, M. O., Brown, A. G., & Sharfstein, J. M. (2014). A Public Health Needs Assessment. Baltimore: Public Health Services.

Martin, J. A. (2012). Births: final data for 2010. National vital statistics reports. http://www. cdc. gov/nchs/data/nvsr/nvsr61/nvsr61_05. pdf, 61(1).

Maryland Department of Health. (2017, May 07). Am I Eligible for Medicaid? Retrieved from Maryland.gov: https://mmcp.health.maryland.gov/Pages/Apply%20for%20Medicaid.aspx

Price, T. E., Schuchat, A., & Rothwell, C. J. (2017). Health, United States, 2016. Washington: U.S. Government Printing Office.

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