A planning framework moves you through the process of setting overall health goals for targeted populations, selecting proven strategies to reach those goals, and assessing progress. By plugging expert resources into your plan (e.g., the Guide to Community Preventive Services and Guide to Clinical Preventive Services) you are more likely to achieve real health improvements.
A Six-step Plan to Improve Health
- Identify health issues of concern to your health plan, medical group, community or state, and collect the data necessary to evaluate these issues.Resources For Health Plan/Medical Group PlannersMeasures of clinical performance may come from a quality improvement initiative, HEDIS report card, a recent accreditation survey, and/or service utilization reviews that compare performance with state or regional benchmarks.Resources For Community Planners
The National Association of County and City Health Officials and the CDC’s Public Health Practice Program Office have developed a community-wide strategic planning tool called Mobilizing for Action through Planning and Partnerships(MAPP) . MAPP helps communities identify health issues and the resources to address them. The MAPP process begins with recruitment of community partners and initiation of four simultaneous assessments:
- Community Themes and Strengths Assessment: To identify community health assets and issues of concern.
- Local Public Health System Assessment: To measure the capacity and performance of the local public health system.
- Community Health Assessment: To collect data about health status, quality of life, and risk factors in the community.
- Forces of Change Assessment: To identify forces that are or will be affecting the community or the local public health system.
- Using the information collected in step #1 above, establish and prioritize objectives for community health or health plan or medical group performance.That is, identify gaps between actual and achievable health status of targeted populations or between actual and achievable performance for health plans or medical groups. Refer to Healthy People 2010 to compare local and national health objectives.For example, health plans may aim to:
Increase the proportion of adults aged 65+ who receive an annual influenza vaccine.
Increase the proportion of pregnant women who are assessed for tobacco use and receive cessation counseling or referrals for counseling.When setting objectives, consider forces for change: What new or growing health influences will affect communities and/or health plan cachement areas? How will these affect health or performance targets? (Local and/or state public health agencies are a valuable resource for this kind of information.)
Resource for community planners
The Healthy People 2010 Tool Library is a useful planning instrument and also has links to other planning resources. The Department of Health and Human Services also maintains a database of regional Healthy People 2010 events and priorities.
Remember, the most effective objectives are realistic, unambiguous, time-limited, and worded so that it is easy to evaluate progress.
- Use proven strategies to achieve health objectives.Recommended clinical interventions are presented in the Guide to Clinical Preventive Services . These interventions can be incorporated into health plan, medical group, and public health clinic practice, as well as training programs for healthcare professionals.Proven ways to improve the overall delivery of clinical preventive services are identified in the Guide to Community Preventive Services . Many of these strategies can be employed in state-sponsored health plans, such as Medicaid managed care plans and the State Child Health Insurance Program, in addition to private health plans and medical groups. Effective strategies include:
- Reducing or eliminating co-pays for key services.
- Holding providers accountable for service delivery.
- Instituting administrative systems to support service delivery.
- Using financial incentives to improve the performance of medical groups
- Working with quality improvement consortia.
- Working with medical associations and health agencies to provide continuing medical education for clinical staff.
The Community Guide also discusses valuable strategies to create a community environment that promotes and protects health.
Remember, use of multiple strategies to achieve individual health goals is most likely to be successful. For example, underage smoking may be addressed by lobbying for an increase in the unit price for tobacco products, supporting an anti-smoking mass media campaign, delivering smoking cessation services to adolescents, and taking other steps.
- Use the best tools available to implement your strategies.Many good implementation tools exist, including the MAPP Field Guide and other MAPP products (available from NACCHO) and Put Prevention Into Practice , a comprehensive program to increase the appropriate use of clinical preventive services, available from the Agency for Healthcare Research and Quality (AHRQ). Other tools include medical record reminders, at-a-glance protocols that fit into a lab coat pocket, and many others available from trade or industry associations, voluntary associations, relevant federal agencies (e.g., the Food and Drug Administration, Environmental Protection Agency, and CDC) and (sometimes) state and local public health agencies.Often the best tools are simply leadership and adequate funding.
- Measure progress.A good evaluation is not an afterthought, but is built into the planning process and budget. Ideally it uses information to examine both how well an activity is working (process measures) and whether or not it is achieving expected results (outcome measures). Here are a few evaluation resources:
- AHRQ’s Put Prevention Into Practice devotes a chapter to the evaluation of systems to deliver clinical preventive services in medical practice.
- The Centers for Disease Control and Prevention has developed a comprehensive framework for program evaluation in public health whose principles are integrated into all CDC program operations and may serve as a useful guide for others as well.
- The Outreach Evaluation Research Center of the National Network/Libraries of Medicine provides access to a number of resources to help health educators plan health information outreach programs and measure their success.
- CDC’s Physical Activity Evaluation Handbook outlines the basic steps of program evaluation using physical activity examples.
- CDC’s Guidance for Comprehensive Cancer Control Planning is useful to help plan and evaluate programs that address risk factors for cancer, such as tobacco use and physical inactivity.
- Modify activities as needed.Disease and injury prevention guidelines are not static, but change along with the evolving science base. As guidelines are updated to reflect current knowledge, specific strategies should be updated as well. (To keep on top of current research, health planners and others can receive a free online subscription to CDC’s Morbidity and Mortality Weekly Report . They can also take advantage of AHRQ’s User Liaison Program , which disseminates health services research findings to state and local health policymakers in easily understandable and usable formats through interactive on-site workshops, teleconferences, distance learning programs, and research syntheses.)Program evaluation data also provides crucial information to guide ongoing program changes. Are all activities being implemented as planned? If not, what additional steps should be taken to assure implementation? Perhaps the plan was unrealistically ambitious and should be implemented in stages. Perhaps adequate community support and involvement are lacking. Perhaps incentives and/or other support systems are insufficient to prompt changes in provider practices. Any number of factors may be in play.If all activities have been fully implemented, have they produced the desired outcomes? If not, perhaps a more comprehensive approach should be adopted. Or perhaps program goals are unrealistic given the resources available.