Kahn Building Working Cities Challenge 3.12.2015

8/21/2019 Kahn Building Working Cities Challenge 3.12.2015

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Working Cities Challenge

Learning Community

Robert Kahn, MD MPH Associate Chair for Community Child Health,

Cincinnati Children’s Hospital Medical Center

March 12, 2015

Lifting People and Places Out of Poverty:

Strategies for Linking Human Capital andNeighborhood Development


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Overcoming Obstacles to Health, Robert Wood Johnson Foundation, 2008


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Changing the Outcome, Closing the Gap

Population health work

• Asthma and housing

• Community agency - health care collaborations

• Beyond collaborations to networked production

• Moving beyond health care

• Hospital level• Clinic level


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VisionBe the leader in improving child health

Purpose

Lead, advocate and collaborate to measurably improve the health of

local children and reduce disparities in targeted populations

High Level MeasuresBy June 30 2015,

• Reduce the use of the ED and inpatient services by 20% in children

with asthma covered by Medicaid

Goal and Initiatives

Population Health Init iative Hamilton County: 190,000 children age 0-17yrs

Cincinnati 66,000 children 0-17 yrs


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CCHMC


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Children from RED neighborhood:

5x more likely to live in poverty

5x more likely to lack reliable transportation

8x more likely to be substandard housing

Asthma admission rate per 1,000 children (by neighborhood)

Quintile 1:

• 18 admits among 29,000 kids

• 0.6 per 1000

Quintile 5:

• 299 admits among 17,900 kids

• 16.7 per 1000


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Who are the critical partners?

• Pharmacies

• Cincinnati Public Schools• Cincinnati Health Department

• Community Development Corp

• Community health workers

• Legal Aid Society


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Attacking social determinants directly


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181 total utilizations – 130 ED visits, 51 admissions

0

2

4

6

8

10

12

14

0 1 / 0 1

0 1 / 1 0

0 1 / 2 0

0 2 / 0 8

0 2 / 1 5

0 2 / 2 4

0 2 / 2 9

0 3 / 1 2

0 3 / 1 5

0 3 / 2 1

0 3 / 2 5

0 4 / 0 4

0 4 / 1 1

0 4 / 1 5

0 4 / 2 5

0 5 / 1 0

0 5 / 2 2

0 5 / 2 8

0 6 / 1 5

0 6 / 3 0

0 7 / 1 0

0 7 / 1 7

0 7 / 2 5

0 8 / 0 8

0 8 / 1 8

0 8 / 2 8

0 9 / 0 1

0 9 / 0 4

0 9 / 1 1

0 9 / 1 3

0 9 / 2 4

1 0 / 0 2

1 0 / 0 8

1 0 / 1 1

1 0 / 1 6

1 0 / 2 1

1 0 / 2 9

1 1 / 0 6

1 1 / 0 9

1 1 / 1 8

1 1 / 2 6

1 2 / 1 0

1 2 / 1 2

1 2 / 1 7

1 2 / 2 3

1 2 / 2 9

2012 D a y s S i n c e P r e v i o u

s U t i l i z a t i o n

Date of Util izationDays Since Previous Utilization Average Days Between Utilizations Control Limits

Beck (2014)

Engaging Legal Aid: Child-Health Law PartnershipAvondale and Asthma – Neighborhood approach


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Avondale

Beck (2014)


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Avondale

Beck & D. Jones (2014

“ Heat map”

of building

code

violations


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Avondale

CHOICE Buildings

to be refurbished byThe Community

Builders

Beck (2014)


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Avondale

Beck (2014)


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Asthma admissions (Medicaid)

0

2

4

6

8

10

12

14

A d m i s s i o n

R a t e

Month

Rolling 12 Month Average Number of Admiss ionsper 10,000 Hamilton Co. Medicaid Patients age 2 through 17 years old

CL Control Limits Moving Average Special Cause

Last update: 09-19-14 by T. Cole Data source: Epic

Baseline – 7.2

20% reduction – 5.8

Current – 4.7

Meds In-hand

for hospitalized

children

Enhanced inpatient and

outpatient screening &

Connections to Health

Department and Legal Aid

Care coordination

Expanded home

health care

Primary care asthma

follow up visit redesign

School-based health

2014: 185 patients NOT admitted

Move further upstream,

neighborhood deep dive


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Purpose

Lead, advocate and collaborate to measurably improve the health of

local children and reduce disparities in targeted populations

By June 30 2015,

• Reduce the use of the ED and inpatient services by 20% in children with

asthma covered by Medicaid

• Reduce infant mortality by 15%, 20 infant deaths per year

• Reduce the occurrence of unintentional pediatric injuries 30%

• Reverse the trend of increasing childhood obesity in grades K-3

• Early mental health promotion and intervention

• School readiness and Grade 3 reading

Goal and Initiatives

Population Health Init iative Hamilton County: 190,000 children age birth -17yrs

Moving beyond health care: Hospital


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Other health conditions in Hamilton County


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What A Prepared Clinic

Will Detect Maslow’s Hierarchy of Needs

Hunger;

homelessness; denial

or delay of benefits;

utility shut offs

Domestic violence;

mental health issues;

inadequate education

services

Overwhelmed new

parents; lack of

parenting role models

Unemployment; lack

of high school degree;

higher level job

training

Potential

Collaborations

Achieving

potential

Esteem &

Respect

Belonging

Safety

Basic Human Needs

Henize, Kahn (2013)

Moving beyond health care: Clinics


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Using QI to enhance partnership


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Lessons

• Shared vision – change outcomes, close the gap,

and develop intentionality• Population denominator approach

– Otherwise great silos, lousy outcomes

– Measurement and analytic capacity• Building network of partnerships

– Span missions, but also daily operations, data

• Building innovation and improvement capacity

– community capacity for design thinking, QI,

measurement

• Funding – hospital, foundation, payment reform,

community development


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Thank you!

• [email protected]

• @docrob64

• Cincinnati Children’s Hospital Medical Center

• 513-636-4369

mailto:[email protected]:[email protected]


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Attributes

Adequate funding

Shared vision, goals

Skilled leadership

Mutual respect

Established relationships,

communication

Innovation

Collaboration history

Existing models, best

practices


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Network of care

Figure. Collaborations between agencies serving children with complex chronicconditions Acad Ped 2012

schools

pharmacy

communityhealth worker

CHOICE building

case manager

Legal Aid

Documents

Kahn Building Working Cities Challenge 3.12.2015