Maps help organizations identify how best to spend community benefit dollars
Community benefit experts now can be more precise and judicious in how they assess and address community needs, with a free online tool that San Francisco's Catholic Healthcare West launched recently.
The Community Need Index uses socioeconomic data for every ZIP code in the U.S. to identify which communities are most in need of targeted community benefit programs. By pinpointing the areas of greatest need, hospitals, health systems and other organizations can ensure they are spending scarce community benefit and public health resources wisely.
"This tool is an expression of mission and of our commitment to ensuring that all people have access to the care they need, when they need it," said Richard Roth, CHW senior director of innovation.
The tool is available at www.chwhealth.org/cni. Website visitors can click on the "Launch CNI" button and then select a state and city or county to generate a needs map. A color code indicates the ZIP codes with the greatest public health needs. The colors are keyed to Community Need Index scores, a number that is based on the prevalence of certain socioeconomic factors that are barriers to health care access.
The CNI goes beyond public health data to derive these scores, and uses proxy measurements to account for the underlying economic and structural barriers that affect overall health. The five barriers weighted in the score are income, culture, education level, insurance status and whether people own their homes or rent. A community with a large elderly population living in poverty, for instance, will have a high CNI score, while one with high incomes and high insurance levels will have a low score.
Research, scientific literature and CHW's experience have shown a correlation between those five factors and health status. For example, people with limited incomes are less likely to visit the doctor's office. People with language and cultural barriers may not understand medical instructions, and their health may suffer as a result.
The website can pinpoint community resources, including hospitals, shelters and clinics, making it easier for community benefit staff to identify potential partners for their initiatives.
CHW worked with consulting company Thomson Reuters to develop the CNI tool, and the system has been using it internally since 2005. "Prior to our development of this tool, the allocation of resources for community benefit work was loosely defined," said Roth. Now, he said, CHW uses the tool "to bring more scientific rigor to our community benefit work."
The CNI tool helped CHW to put in place disease management programs for people most at risk for hospital readmission. CHW project teams identified areas of greatest need and then created programs there for patients who had been hospitalized for asthma, diabetes or congestive heart failure and then released. Nearly 9,000 patients participated in the programs. CHW saw an 86 percent reduction in readmissions for these patients.
Such well-targeted programs can help reduce the $261 million-plus that CHW hospitals spend annually treating conditions on an inpatient basis that could have been prevented with proper outpatient care.
CHW plans to update the data that feeds into the CNI calculation annually. It will enhance the resource by working with others to collect additional data.
CHW President and Chief Executive Lloyd Dean said the tool will be particularly useful in adapting to health reform. Providers will need to continue reducing the cost of care while improving quality, he said. The CNI will help them to do so by locating preventive services in the communities that need them most.
Julie Trocchio, CHA senior director of community benefit and continuing care, said the purpose of the CNI resource is directly related to the Catholic health mission. "Persons who are vulnerable — because of poverty and other factors captured by the CNI — are our priority population," she said. "The CNI can help us focus community benefit resources where they can have the maximum impact for these populations."
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