2017 Update Missouri Health Improvement Plan 2013-2018

2017·21.7 MB·English

by  Missouri Department of Health and Senior Services, Office of Performance Management, Research and Evaluation Solutions, Inc.

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
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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
•
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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
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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
•
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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•.
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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.
•
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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.
•
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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
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