By NANCY FRAZIER O'BRIEN
Hospitals and health systems are constantly assessing the health needs of the communities in which they serve. But in meeting those needs, the perennial question remains — what works?
The Centers for Disease Control and Prevention now offers what Indu Spugnardi, CHA director of advocacy and resource development, calls "a nice, easy one-stop shop" describing 14 nonclinical interventions that have proven to be effective in impacting community health within five years.
The HI-5 (pronounced "high-five") Initiative, which stands for Health Impact in Five Years, debuted Aug. 9 on the CDC website at cdc.gov/policy/hst/hi5/ and has been in development for more than a year, said Elizabeth Skillen, a CDC senior policy advisor who served as lead on the project.
"We know that many of these interventions aren't new," said Skillen. "But with recent changes in the health system we have gotten more requests for a short list of interventions that have the highest evidence rating. This offers a synthesis of existing evidence."
The 14 interventions are divided into projects that "change the context" such as school-based violence prevention, tobacco control interventions and pricing strategies for alcohol products and projects that "address the social determinants of health," such as clean diesel bus fleets, early childhood education, water fluoridation and public transportation introduction or expansion. (See sidebar for full list.)
"The CDC has always worked with our state, tribal and public health agencies to review and share science on what works," Skillen said. And the HI-5 Initiative takes that work a step further by whittling the list to those projects that have shown positive health impact within five years and have demonstrated cost effectiveness and/or cost savings over the lifetime of the population or earlier.
Skillen said the CDC compiled an initial list of about 140 interventions, relying primarily on data from the Community Guide prepared by the federal government's Community Preventive Services Task Force and the County Health Rankings & Roadmaps program of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.
Clinical, patient-oriented interventions were then excluded from the list, as were duplicates, projects already taking place in 85 percent of U.S. communities and states, those with insufficient evidence of impact or evidence of potential harm, and those that were considered components of other interventions.
The 14 HI-5 interventions are designed to complement the CDC's 6/18 Initiative, which targets six costly and common health conditions — tobacco use, high blood pressure, health care-associated infections, asthma, unintended pregnancies and diabetes — with 18 clinical, patient-focused interventions, Skillen said.
The CDC also offers an online Community Health Improvement Navigator at cdc.gov/CHInav to help hospitals and other stakeholders determine which programs would respond most effectively to the information generated by a community health needs assessment.
More than ever with health reform, "hospitals need to look outside their four walls and look at what is going on in the community," Spugnardi said.
The HI-5 Initiatives will require collaboration among a wide variety of groups, including public officials, health care providers and insurers, businesses, schools, faith-based organizations and philanthropists.
"Hospitals and health systems have a role across the spectrum," Skillen said. "Not only are they key leaders in the community, but they are uniquely positioned to see the health outcomes" resulting from the interventions.
Spugnardi said the HI-5 Initiative offers "a good resource for hospitals, because with health reform hospitals and health systems are not just focusing on clinical care. Population health is also really important."
The CDC program provides "a ready-made package of interventions," she said. "It will help (CHA) members to know how to use their resources effectively."
Spugnardi said many Catholic hospitals already are working in many of the areas highlighted by the CDC program and are "very engaged in community coalitions trying to impact broader problems that affect health."
For example, she said, Trinity Health "has a major effort around tobacco control" and Catholic Health Initiatives has "a systemwide initiative to address violence" in various forms.
She said the HI-5 Initiative helps hospitals and health systems respond to two major goals of health reform — cost savings and improved population health.
"Five years is a short time frame in terms of changing community health," Spugnardi said, adding that the CDC initiative will "give public health advocates some tools to convince community leaders to dedicate money" to certain health-related projects.
"If they are already involved with community partners" in responding to a specific issue, "this could make them a more informed advocate," she said.
CHA is featuring information about the HI-5 Initiative on the community benefit section of its website along with a listing of national initiatives and member examples of effective programs.
"As health systems and hospitals focus more on the upstream factors that affect community health, they will need to become more familiar with the wealth of evidence-based public health resources," Spugnardi said, adding, "the HI-5 Initiative is a very good place to start."
CDC's 14 proven nonclinical interventions
School-based programs to increase physical activity: Expanding and enhancing existing physical education programs and incorporating physical activities into classroom settings, showing positive effects on body mass index and obesity prevention.
School-based violence prevention: Providing students and staff with information about violence, changing how young people think and feel about violence and enhancing interpersonal skills such as communication and conflict resolution. The goal is to reduce youth violence in all types of school environments, as well as reduce delinquency and alcohol and substance abuse, and improve academic performance.
Safe routes to school: Encouraging students and families to walk, bike or use other forms of active transportation to and from school through bicycle safety education, increased traffic enforcement and infrastructure improvements such as sidewalks, crosswalks and lighting.
Motorcycle injury prevention: Requiring all motorcycle drivers and passengers to wear a helmet when riding on public roads.
Tobacco control interventions: Discouraging smoking through a comprehensive approach that includes tobacco price increases, high-impact anti-tobacco mass media campaigns and laws that prohibit smoking in all indoor areas of workplaces, bars and restaurants.
Access to clean syringes: Enacting policies, laws and regulations that support access to clean needles and syringes by allowing pharmacies and/or public health departments to sell or distribute them without prescriptions.
Pricing strategies for alcohol products: Raising the prices of alcohol products, shown to reduce alcohol use and related harms, including sexual violence and motor vehicle accidents.
Multicomponent work site obesity prevention: Discouraging obesity through a comprehensive strategy that includes information and education, behavioral and social strategies, environmental components and financial incentives.
Early childhood education: Improving cognitive development of 3- and 4-year-olds through programs that also can include physical activity, nutritious meals, parental support, health care screenings and social services.
Clean diesel bus fleets: Retrofitting fleets of buses to operate using clean diesel technology, resulting in fewer cardiovascular events and respiratory conditions and improved lung function among children.
Public transportation system introduction or expansion: Increasing access and use of public transit and reducing traffic, leading to reductions in traffic crash injuries, fatalities, traffic congestion and associated air pollution, and increased levels of physical activity.
Home improvement loans and grants: Providing funds for low-income families to improve insulation, air quality, dampness and energy conservation and to remove health and safety hazards from their homes.
Earned income tax credits: Implementing refundable income tax credits at the federal, state and/or local levels for low- and moderate-income working families, associated with reductions in infant mortality and preterm births and improvements in birthweight and maternal mental health.
Water fluoridation: Adjusting fluoride in the community water system to improve oral health and reduce tooth decay, resulting in savings both for families and the health care system.
Copyright © 2016 by the Catholic Health Association
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