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2017 Update Missouri Health Improvement Plan 2013-2018 PDF

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Missouri Health Improvement Plan 2013 - 2018 Revised 2017 Missouri Department of Health and Senior Services TABLE OF CONTENTS EXECUTIVE SUMMARY 3 INTRODUCTION 4 VISION AND VALUES 7 PRIORITY HEALTH ISSUES 8 Priority Issue 1 Access to Health Care 11 Priority Issue 2 Modifiable Risk Factors 13 Priority Issue 3 Infrastructure 15 APPENDICES 17 A. Summary - State Health Assessment Findings 17 B. Summary - State Public Health System Assessment Findings 20 C. Summary - Community Themes and Strengths Assessment Findings 23 D. Summary - Forces of Change Assessment Findings 27 E. State Health Assessment/State Health Improvement Plan Partners 31 REFERENCES 32 Executive Summary Background The Assessments Summary of Outcomes Key Issues The Missouri Department The SHA utilized a case Place matters when it Strategic issues reveal the of Health and Senior study design to determine comes to both health changes that must occur in Services (DHSS), through the health status of the determinants and order for the vision of the its vision, mission, and residents in the state of health outcomes. In the health improvement plan values, serves the citizens Missouri. Two theoretical 2012 America’s Health to be achieved. The results of the state. The health frames for public health Ranking Report, the of the MAPP assessments department’s vision is planning guided the rankings for Missouri’s offer important contextual healthy Missourians for assessment activities; health determinants information and the life. The organizational Mobilizing for Action range from 23rd (low foundation for creation mission is to be the leader through Planning and birth weight) to 46th of Missouri’s statewide in promoting, protecting Partnership (MAPP) and (immunization coverage), health improvement plan. and partnering for health. the PRECEDE-PROCEED while the health outcome Using the outcomes of the DHSS is seeking national Model. Four assessments indicators range from 29th four MAPP assessments, accreditation and in form the foundation of the (geographic disparity) to the Public Health System January 2013 initiated a MAPP process (Community 41st (premature deaths). Partners Group identified joint effort involving the Themes and Strengths, In Missouri, as in many 10 key issues–uninsured, development of a State Local Public Health System, states, health varies from smoking, economics, Health Assessment (SHA) Community Health Status one region to another. The mental health and and a process to develop a and Forces of Change). worst burden of risks and substance abuse, health State Health Improvement From January through June adverse outcomes in the services access and Plan (SHIP). To assure that of 2013, DHSS completed State of Missouri are with costs, modifiable risk the process included input activities using all four citizens in the Southeast factors, commitment from key stakeholders, assessments. region. Across the state, and collaboration a diverse group (sector citizens’ and stakeholders’ through partnerships, and geography) of over perceptions about the assure workforce, and 30 public health system impact of economics and performance management partners and stakeholders lack of insurance converge and quality improvement. from across the state was with the health status The 10 key issues identified to support the indicators that show converged into three assessment activities. the decline in insurance overarching areas that This Public Health System and increase in persons shaped the development Partners Group offered living below the poverty of the state health valuable efforts and time level. Both citizens and improvement plan. in the completion of stakeholders shared MAPP multiple assessments, as their concerns about ASSESSMENTS well as the development of fiscal challenges in strategic priority issues. their households, organizations and communities and the Health Care impact on the health Public Health Access & of Missourians. Infrastructure Costs Modifiable Risk • Factors HEALTH.MO.GOV/MOHEALTHIMPROVEMENTPLAN 3 MISSOURI HEALTH IMPROVEMENT PLAN Introduction State of Missouri Profile Missouri is located in the Midwestern portion of the organized by a society to protect, promote, and restore United States, sharing borders with eight other states. the people’s health.7 Health is not merely the absence of Missouri is known for its mixture of large urban areas disease but a complete stat of physical, mental, and social with rural regions and an extensive farming culture. The well-being.8 The public health infrastructure carries out 2010 population density of the state was 87.1 people per the majority of public health activities in partnership with square mile. Based on 2010-2012 Census reports, Missouri non-governmental agencies, coalitions, and individuals. has a population of approximately six million people.1 DHSS’s vision is healthy Missourians for life. The The state’s capitol is in Jefferson City and the most organizational mission is to be the leader in promoting, populated cities are Kansas City, St. Louis, Springfield, protecting and partnering for health. The goals, which Independence and Columbia. The demographic make- were updated in 2012, are to: up of the population is 1.43 million children under 18; • Ensure Missourians are healthy, safe, and informed. 838,000 seniors 65 years and over; and 3.73 million • Maximize health and safety outcomes. adults between the ages of 18 and 64.2 African Americans represent the state’s largest racial population at 11.7 • Engage and invest in our staff. percent. From 2000 to 2009, Missouri’s population • Position resources to ensure maximize returns. grew by seven percent. Of all racial and ethnic groups, Hispanics had the fastest growth rate at 70 percent.3 The number of Missourians age 55 – 64 years increased by 35 percent. Thirty-seven percent of Missouri’s population is rural, equating to approximately 2.22 million people in rural areas.4 The median age of 37.9 years is slightly higher than the national median age of 37.2 years. The median household income was approximately $45,231.00 in 2011 while the national median household income was $50,502.00. In Missouri, 15.9 percent of the people live below the federal poverty level, which is almost comparable to the national rate. Each year the United Health Foundation, along with the American Public Health Association (APHA) and the Partnership for Prevention present a state-by-state analysis and report of health in the United States. The report focuses on both determinants of health (e.g., smoking, drinking, obesity, sedentary lifestyle) and outcomes (e.g., physical health, mental health, mortality). According to the 2012 report, Missouri ranked 42nd; the lowest ranking for the state since 1990 when the reports were initiated. In Missouri, more than 1.1 million adults smoke. In the past ten years, the rate of uninsured population increased from 9.4 percent to 14.4 percent. Sedentary lifestyle and obesity are prevalent.5 The Institute of Medicine defines public health as what society does collectively to assure conditions for people to be healthy.6 More specifically it is one of many efforts • HEALTH.MO.GOV/MOHEALTHIMPROVEMENTPLAN 4 MISSOURI HEALTH IMPROVEMENT PLAN Journey to Improvement After more than six years of exploration and investigation, identification of a preliminary set of priority issues for the Centers for Disease Control and Prevention (CDC), in improvement. The activities included receiving input and collaboration with the Robert Wood Johnson Foundation, feedback from a cross–section of citizens and key public is supporting a national voluntary accreditation program health stakeholders in the state. for public health agencies. Formed in May 2007, the To assure that the assessment process included input from Public Health Accreditation Board (PHAB) is a non-profit key stakeholders, a diverse group (sector and geography) entity that oversees the accreditation process. PHAB is of over 30 public health system stakeholders from working to promote and protect the health of the public across the state were identified to assist throughout the by advancing the quality and performance of all public assessment process. This Public Health System Partners health departments in the U.S. through national public Group was critical in two of the assessments, the forces health department accreditation.9 PHAB’s vision is a high- of change assessment and the public health system performing governmental public health system that leads assessment, as well as the development of strategic to a healthier nation. For a public health department to be priority issues to be addressed in the State Health accredited, it must meet stringent requirements for the 10 Improvement Plan.  essential services of the core public health functions and demonstrate a commitment to constant improvement. Figure 1 depicts the 10 essential public health services. In its efforts to become nationally accredited, in January 2013 DHSS initiated a joint effort involving the development of a State Health Assessment (SHA) and a process to develop a State Health Improvement Plan (SHIP). The purpose of the State Health Assessment was to learn about the health status of the population that DHSS serves. It describes the health status of the population, identified areas for health improvement, determines factors that contribute to health issues and identifies assets and resources that can be mobilized to address population health improvement. DHSS engaged a consulting firm (Research and Evaluation Solutions, Inc.–REESSI) to facilitate and support the development of the state health assessment and the Figure 1 – The 1•0 Esse ntial Public Health Services HEALTH.MO.GOV/MOHEALTHIMPROVEMENTPLAN 5 MISSOURI HEALTH IMPROVEMENT PLAN Assessment Process The development of the state health assessment utilized The MAPP process is designed to lead to development a case study design to determine the health status of and implementation of a strategic plan for public health the residents in the state of Missouri. Two theoretical improvement. The plan requires the engagement of both frames for public health planning guided the assessment citizens and professional stakeholders who hold strong activities–Mobilizing for Action through Planning and commitments to the community’s health and overall Partnership (MAPP) and the PRECEDE-PROCEED Model. well-being. MAPP focuses on strengthening the whole system rather than separate pieces, consequently bringing MAPP is a comprehensive, community-based approach together diverse interests to collaboratively determine to community health improvement. Through MAPP, the most effective way to conduct public health activities. stakeholders in States and local communities seek to Figure 2 illustrates the MAPP process. achieve optimal health by identifying and using their resources wisely, taking into account their unique Four major assessments are key elements of the MAPP–1) circumstances and needs, and forming effective Community Themes and Strengths Assessment, 2) partnerships for strategic action. Local Public Health System Assessment, 3) Community Health Status Assessment, and the 4) Forces of Change Assessment. Each of these assessments provides a critical foundation and contextual information to develop a realistic and feasible health improvement plan. Summaries of the four assessments are located in the Appendices. unity The The PRECEDE-PROCEED frame uses an ecological and educational approach that respects context. The assessment team used elements of the PRECEDE- rganize : Partnership PROCEED model that focus on social and epidemiological- i for Success Development behavioral-environmental assessments and situational Visioning analysis. The complete report of the state health ' assessment process, Missouri State Health Assessment Four MAPP Assessments ' 2013 can be found at: health.mo.gov. Identify Stra•teg ic Issues formulate Goals and Strategies 1 ._.. Evaluate Plan J rE!ZfJ lement . a,\\'(\ Figure 2 – MAPP Process • HEALTH.MO.GOV/MOHEALTHIMPROVEMENTPLAN 6 MISSOURI HEALTH IMPROVEMENT PLAN Vision and Values The second phase of the MAPP process involves the development of a vision and set of values for the health Supporting Values Statements*: improvement plan. The shared vision and values offer 1. We are committed to assuring that the Missouri purpose, direction and focus for the process. Moreover, public health system is inclusive of, and sensitive to, the values help to mobilize the stakeholders to achieve all populations and communities in meeting their the shared vision. diverse health needs. On June 19, 2013, 22 members of the Missouri Public 2. We support and encourage equitable access to and Health System Partner Group engaged in activities that led the quality of the public health system. to the creation of a shared vision and eight core values. 3. We promote influential leadership in the public The group emphasized the need for the vision and values health system to advocate for a healthy Missouri. to have a broad appeal to the existing stakeholders, 4. We are committed to collaborating for shared nontraditional partners (e.g., economic development goals, risks, rewards, resources, and leadership. entities, businesses) that will join the group in the future, residents, and visitors to the state. 5. We value integration and collaboration with partners to generate ongoing discovery to translate and implement new information and technology for public health practice. 6. We are committed to informing citizens and policymakers about health issues to encourage healthy behaviors and impact policy decisions. 7. We support and advance programs and policies that are data driven and based on the best available evidence or contribute to the research base of best practices. 8. We engage in responsible stewardship of public Vision and private resources, transparency, and timely action to achieve accountability. *The original statements were edited for clarity and grammar. Statement Missouri is a state of health: Top 10 in 10 The byline demonstrates the partners’ desire and commitment to the state being rated in the top 10 for health outcomes within 10 years•. HEALTH.MO.GOV/MOHEALTHIMPROVEMENTPLAN 7 MISSOURI HEALTH IMPROVEMENT PLAN Priority Health Issues The four MAPP Assessments (community themes The results of the MAPP assessments offer important and strengths assessment, state public health system contextual information and the foundation for creation of assessment, forces of change assessment, and state the state health improvement plan. The state surveillance health status assessment) led to the identification of areas data on health determinants and health outcomes reveal of weakness that formed common themes from which the the health status of citizens and often show disparities strategic issues were identified. To assure that issues in based on region, race, age and gender. Moreover, the each of the assessment categories received consideration, health status data point to possible health goals, and priority issues from each of the four assessments were issues that require responses and action. The community identified. These strategic issues reveal the changes themes and strengths assessment gives meaning and that must occur in order for the vision of the health context to the indicators data and offer the opinions and improvement plan to be achieved. Strategic issues have experiences of the citizens and stakeholders. The public several characteristics that separate them from findings health system assessment reveals both the strengths and identified earlier in the planning process. weaknesses of the public health infrastructure. The quality and effective functioning of this system is integral to the 1) They represent a fundamental choice to be made at the health and well-being of those being served. Plans for highest levels of the community and local public addressing health issues must be realistic and considerate health system. They focus on what will be done, who of the threats and opportunities that may impact both will be served, and by whom services will be provided. the public health system and the health of the public. The forces of change assessment guides public health 2) Strategic issues usually center around a tension or partners through the careful exploration of external forces conflict to be resolved. Such tensions or conflicts that may influence the implementation of the health may be related to differences between: past ways improvement plan. Using the outcomes of the four MAPP of doing things and future demands, current capacities assessments, the Public Health System Partners Group and capacities necessary for delivering the Essential defined the three top strategic issues as follows: Services, the role of the local health agency and the roles of other community agencies, and the 1. Access to health care needs of the community and the resources available to • Health care access, high cost of health care meet those needs. and high rate of uninsured 3) Strategic issues have no obvious best solution. If • Economy – access to resources necessary to there is an obvious immediate solution to an issue, be healthy including affordable options then question why it has not been implemented for good nutrition, physical activity and before. Such issues are likely to be operational preventive health care services concerns for individual organizational participants 2. Modifiable risk factors rather than strategic issues for the public health • Obesity system. • Smoking 4) A strategic issue must be something the local public • Mental health/substance abuse health system can address. If an issue cannot be addressed by the local public health system, it may be 3. Infrastructure issues strategic, but not at the community level. Issues such as • Mobilizing partnerships universal health insurance coverage, poverty cessation, • Performance Management/Quality Improvement or eradicating a wide spread disease may be seen as strategic on a national level, however, few localities • Workforce development would have the means to take them on. • HEALTH.MO.GOV/MOHEALTHIMPROVEMENTPLAN 8 MISSOURI HEALTH IMPROVEMENT PLAN These issues serve as the foundation of this health DHSS is only one part of the public health system. Other improvement plan. The Partners Group enlisted additional agencies, organizations, institutions and coalitions play subject matter experts to help address all the issues vital roles in the health of Missourians. The ongoing identified for inclusion in the plan and to develop goals health improvement processes and the plan itself each and objectives that encompassed these issues. Over reflect efforts of many of the key partners in the public the next few months, the partners worked in groups health system to promote collaboration, coordination and based on the priority health issues to develop goals and efficiency. Future actions will include reports based on objectives around each using processes and tools from progress related to the goals and objectives resulting from the University of Kansas, The Community Tool Box and the efforts of the public health system working together. MAPP Clearinghouse tools from the National Association Figure 3 illustrates how the Missouri process linked the of County and City Health Officials. To align their work four MAPP assessments to the three overarching strategic with national objectives, workgroups referred to Healthy issues of health care access and costs, modifiable risk People 2020, the National Prevention Strategy, and factors, and public health infrastructure which then led the Health and Human Services Action Plan to Reduce to the development of goals and objectives for the state Disparities and adopted or aligned with objectives where health improvement plan. applicable. When choosing strategies for each issue, workgroups considered the Centers for Disease Control and Prevention (CDC) Winnable Battles (known effective strategies for improving outcomes within five years) and the recommendations from the CDC’s Community Guide. In addition, work groups considered other state and local plans and those related goals and objectives to align work whenever feasible. These efforts culminated in this Missouri Health Improvement Plan 2013 - 2018. Improvement strategies and outcome indicators are located in the Missouri Health Improvement Implementation Plan and are reviewed and updated as needed. These documents make up a long- term, systematic effort to address public health problems based on the results of community health assessment activities and the community health improvement process. This plan will be used by health and other governmental education and human service agencies, in collaboration with community partners, to set priorities, coordinate efforts, and acquire resources. The plan will also be important for the development of policies and defining actions for directing efforts that promote health. • HEALTH.MO.GOV/MOHEALTHIMPROVEMENTPLAN 9 MISSOURI HEALTH IMPROVEMENT PLAN Figure 3: MAPP Assessments Linked to Priority Health Issues and to the SHIP Figure 3: MAPP Assessments Linked to Priority Health Issues and to the SHIP Community Public Health Health Status Themes and System Assessment Strengths Assessment Assessment Forces of Change Assessment Areas of Concern: Areas for Opportunity:  Economy  Local Public Health Agencies  Uncertain Political  Missouri Foundation for Environment Health  Lack of Resources  Interagency Collaboration  Accreditation Areas of Weakness: Areas of Weakness: Areas of Weakness:  Obesity  Economy (jobs)  Performance Management/QI  Smoking  Health Care Access  Workforce  Mental Health  Mental Health Development  Substance Abuse  Healthy Lifestyles  Partnership  High Number of  Partnerships/ Development Uninsured Collaboration Common Themes:  Partnership Development  Health Care Access (uninsured, access. cost)  Mental Health  Healthy Lifestyles (obesity, smoking, substance abuse) Forces of Change Access to Modifiable Public Health Health Care Risk Factors Infrastructure and Costs State Health Improvement Plan:  Goals / Objectives / Strategies  Measures / Outcome Indicators • 10 | Page HEALTH.MO.GOV/MOHEALTHIMPROVEMENTPLAN 10 MISSOURI HEALTH IMPROVEMENT PLAN

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