SAN FRANCISCO’S COMMUNITY HEALTH IMPROVEMENT PROCESS

San Francisco Health Commission ▪ February 5, 2013

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A comprehensive assessment and action plan to improve population health through partnership and collective impact.

Community Health Improvement Process 2

Overview

18-month process (Jul 2011–Dec 2012)

Engaged close to 700 community residents + local public health system partners

Key Partners San Francisco Hospitals +

Community Benefit Partnership UCSF + San Francisco Health

Improvement Partnerships Residents Community-based

organizations

SF’s Health Priorities Ensure Safe + Healthy

Living Environments Increase Healthy Eating +

Physical Activity Increase Access to High

Quality Health Care + Services

Foundational Values Alignment

Health Equity Community Connections

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Overview (cont.)

Two Key Products 4

Impetus

Improve community health

National trends Alignment of multiple

related initiatives Public health

accreditation Health Care Services

Master Plan Hospital community

health needs assessment SFHIP

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Process

Mobilizing for Action through Planning + Partnerships (MAPP)

Considered the gold standard in assessment, planning, and community health improvement by the National Association of County + City Health Officials

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Foundation 7

Foundation 8

A process that engages with community members and local public health system partners to systematically collect and analyze qualitative and quantitative health-related data from a variety of sources.

Community Health Assessment (CHA) 9

Health Equity Focus

To more easily identify health inequities, the CHA collected data on the social determinants of health through:

Indicator selection Data disaggregation Focus groups with vulnerable

populations HCSMP Task Force discussions

=

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Approach 11

Community Health Status Assessment

Key Findings SF’s population is aging Income inequality ↑ Certain neighborhoods and

subpopulations experience significant health disparities and inequities

Safety = key concern in SF; disparities exist by race/ethnicity and neighborhood

Mirroring the nation, cardiovascular diseases = among leading causes of death in SF

Many Health Care Resources Available in SF

For example: 94% residents insured or

enrolled in Healthy SF High rates of health care

providers to population But: Availability ≠ Accessibility Reported barriers

particularly for low-income populations

Community Health Status Assessment

(CHSA)

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Forces of Change Assessment

Sample Findings Health Reform will place

greater demand on SF’s health care resources

Many uninsured already access care through a “medical home” thanks to Healthy San Francisco

Limited cultural competence negatively impacts patient experience and health outcomes, a particular concern for SF’s diverse population

30,000

Estimated number of new Medi-Cal beneficiaries in San Francisco following

Health Reform implementation

Source: SF Human Services Agency estimate based on SF’s current General Assistance, food stamp, and Healthy Families recipients compared to new Medi-Cal eligibility criteria.

Forces of Change

Assessment (FCA)

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Local Public Health System Assessment Local Public

Health System (LPHSA)

Essential Public Health Services Activity Rating

1 Monitor health status to identify community health problems. Minimal

2 Diagnose and investigate health problems and health hazards. Moderate

3 Inform, educate, and empower individuals and communities about health issues.

Moderate

4 Mobilize community partnerships to identify and solve health problems.

Minimal

5 Develop policies and plans that support individual and community health efforts.

Moderate

6 Enforce laws and regulations that protect health and ensure safety. Significant

7 Link people to needed personal and health services and assure provision of health care when otherwise unavailable.

Moderate

8 Assures a competent public and personal health care workforce. Moderate

9 Evaluate the effectiveness, accessibility, and quality of personal and population-based health services.

Moderate

10 Research for new insights and innovative solutions to health problems. Minimal

Overall Performance Score Moderate

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Community Themes + Strengths

Sample Themes Healthy eating + active

living Clean, accessible natural

environment Community engagement +

partnerships “Learning + earning”

opportunities Location + transportation Cultural competency +

language access Safety Need for affordable

dental + vision services

Community Themes & Strengths

Assessment (CTSA)

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Data Synthesis: Cross-Cutting Themes

Ensure safe + healthy living environments

Improve behavioral health Increase access to high

quality health care + services

Increase physical activity + healthy eating

Reduce the spread of infectious disease

Support early childhood development

Support seniors and persons with disabilities

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A 3- to 5-year action-oriented plan outlining the priority health issues identified in the community health assessment and how these issues will be addressed, including strategies and measures, to ultimately improve community health.

Community Health Improvement Plan (CHIP)

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SF’s Health Priorities for Action

Priority 1

Ensure Safe + Healthy Living Environments

Priority 2

Increase Healthy Eating + Physical Activity

Priority 3

Increase Access to High Quality Health Care + Services

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Health Priority Components + Health Equity 19

Priority 1: Ensure Safe + Healthy Living Environments

Goals + Objectives a. Improve safety and crime prevention

i. ↓ violent injury ii. ↑ feelings of safety at night iii. ↓ severe and fatal pedestrian injuries

b. Reduce exposure to environmental hazards i. ↓ exposure to air pollution ii. ↓ exposure to traffic noise iii. ↓ housing violations iv. ↓ exposure to second-hand smoke

c. Foster safe, green, “active” public spaces i. ↑ park/playground safety ii. ↑ access to open spaces and natural areas

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Priority 2: Increase Healthy Eating + Physical Activity

Goals + Objectives a. Increase physical activity

i. ↑ fitness in children ii. ↑ time spent walking and/or biking daily

b. Increase healthy eating i. ↑ access to healthy, diverse food resources ii. ↑ daily consumption of fruits and vegetables iii. ↓ consumption of sugar-sweetened beverages

c. Increase number of residents who maintain a healthy weight

i. ↓ youth obesity ii. ↓ adult obesity

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Priority 3: Increase Access to High Quality Care + Services

Goals + Objectives a. Improve integration and coordination of services across the

continuum of care i. 100% of San Franciscans enrolled in either health insurance of

Healthy SF b. Increase connection of individuals to the health services they

need i. ↓ barriers to medical care ii. ↓ preventable hospital stays among seniors and persons with

disabilities c. Ensure services are culturally and linguistically appropriate

i. ↓ cultural and linguistic barriers to care d. Ensure San Franciscans have access to a health care home

i. ↑ number of residents with a primary care provider

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Committed Partners (Sample)

American Heart Association Boys and Girls Clubs of SF California Pacific Medical Center Children’s Council of SF Chinese Hospital Community Benefit Partnership Community Transformation Grant Team Dignity Health HOPE SF Kaiser Permanente Mayor’s Office SF Bike Coalition SF Department of Children, Youth and their

Families SF Department of Environment SF Health Improvement Partnerships

SF Health Plan Human Services Agency- Department of

Aging & Adult Services SF Medical Society SF Municipal Transportation Authority SF Planning Dept. SF Recreation & Parks SF Unified School District Shape Up SF, including HEAL Zone Southeast Food Access Work Group Tenderloin Healthy Corner Store Coalition UC, Berkeley UCSF Medical Center UCSF-SF Health Improvement Partnerships YMCA of SF

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Connecting the CHIP to Health Outcomes 24

Implementation of CHIP strategies and evaluation of CHIP impact to improve community health.

Action Phase 25

Next Steps

CHA/CHIP distribution SFDPH website www.healthmattersinsf.org SF Public Library Community presentations

Post/track CHIP objectives on Community Vital Signs Assign “Champions” to priorities Develop CHIP-based SFDPH Strategic Plan Apply for public health department accreditation Repeat process in 3-5 years

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THANK YOU QUESTIONS?

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