In April 2011, Summa Health System opened a health center in Akron, Ohio, on a parcel of land adjacent to the House of the Lord. The center is a test case for communal efforts to reduce health problems while building a capacity for research into lessening health disparities, says Benjamin Sutton, vice president of integrated innovations and strategy.
Sutton says a physician on staff, Teresa Myers, M.D., has a very different approach to primary care — much more personalized, intent just as much on setting up diabetes patients with nutritionists as doing medical check-ups. Instead of sending people off to diabetes education, they go to a test kitchen at the center to learn how to cook a healthy meal. The center offers management of hypertension, obesity and other chronic diseases prevalent in an area where the average household income is $25,000.
The aim to help people become healthy and keep them that way is not new to the 7,000-member church congregation across the street. Its pastor, Bishop Joey Johnson, has been preaching good diet and healthy lifestyle to the African-American neighborhood for many years. Summa's entry adds clinical and research resources to the mutual goal of improving community health, says Sutton.
After years spent putting together a clinical continuum of care, the next challenge for providers is to extend their reach into hot spots of health need and make an impact. And the first step is to determine who's already doing that in the community. "If there are programs or facilities out there that are working and already in place, why not take advantage of them?" says Barbara Gray, a vice president at Premier Inc.
It means "doing work to see the connections and build the connections among inpatient care, outpatient care, community health programs and partnerships with other community organizations," says Michael Bilton, executive director of the Association for Community Health Improvement. "Connecting pieces is one part of the task in front of us."
Norton Healthcare is strengthening an existing connection with the health department in Louisville, Ky., under which it has helped with a large cancer-screening program. Working with local, federally qualified health centers, the department determines where the highest incidence is and concentrates screening in those areas, says Steven Hester, M.D., a Norton senior vice president and chief medical officer. A mobile unit goes in with mammography and cervical screening equipment, and staff also does breast exams and prostate screening. "If we want to have success in terms of improving overall health, we need to figure out where the greatest number of those patients are," Hester says.
During the H1N1 flu outbreak in 2009, "it turned out that our health department had a significant amount of vaccine but no one to administer it," he recalls. Norton provided a nurse to go into all public schools and vaccinate the children. "They have resources, we have resources, let's try and match them up and try to improve the overall health of our community," Hester says. Now, every year the health department supplies seasonal flu vaccine and the hospital system supplies the staff to administer it.
Norton also provides financial help for the health department to develop a program called Healthy Start, in which members of Norton's educational team go into homes of pregnant women to provide prenatal care and education, and to monitor them during their pregnancy, all to prevent premature births.
The programs may be outside the hospital network but well within its mission objectives, something the Norton governing board saw to about four years ago. "Our board put a challenge to us to say if we're going to do things in the community, we want to have measurable outcomes and benefit," Hester says. That meant tracking the results of initiatives around prevalent diseases, with the objective to "decrease the incidence of that disease because of our investment." Projects are chosen with an eye toward the greatest measurable impact.
Sometimes it just takes an eye to see the target. The focus in Keene, N.H., is on childhood obesity, where surveys show that 18 to 20 percent of 5- to 20-year-olds in the surrounding county are categorized as obese, says Donald Caruso, M.D, medical director at Cheshire Medical Center/Dartmouth-Hitchcock Keene. Having metrics and data are helpful to direct attention, "but you need to just look around, walk down Main Street, go into your local supermarket and you can realize right away there's an obesity problem within your community," he says.
The health home concept is working as a starting point to begin the discussion with families, he says. The campaign also has spread to influencing school lunch programs, YMCA course offerings, restaurant menus and other pressure points that can affect nutrition and lifestyle. The hospital can't do it all, Caruso says, but it can be a leader, energizing the community and seeing to long-term commitment when the campaign hits a stretch of resistance or apathy.
Cheshire went first to the city to foster cooperation, and then went to schools to challenge them to be partners in the children's welfare. Realizing that diet and health habits are a family matter, the hospital pushed to get businesses enlisted in spreading the message to their employees. Cheshire started with the largest businesses "just because it was easier to deal with a singular entity and be able to touch a lot of people," Caruso says. But smaller businesses were receptive, too, especially since their owners and managers are likely to live in town and "want to create a healthier environment," he adds.
The result was a degree of momentum that could be sustained without active prodding by Cheshire leaders alone. "Now we sit back and make sure it happens," Caruso says. "We no longer have to lead; it's independent of us as an entity right now." Businesses supply the resources to plan what the community needs and the pieces that have to be in place to change behaviors, and "a lot of it is volunteer time. There's very little capital necessary early on in terms of their investment." Also, by reaching out to health-oriented businesses such as dance and gymnastics studios as well as the YMCA, there are positive gains all around, he adds.
Community resources come in many packages. One of the newest concepts for Cheshire, Caruso says, is the mentorship program that equips people who have dealt with a certain target condition to tell their stories to others. For people with chronic diseases it's important to make them able to help themselves, but it doesn't always have to be the clinical professional showing the way, he says. "Within the community there are other people who have diabetes, who have battled the illness in terms of, 'How do I eat right?' and 'How do I keep my weight down?' 'How do I stay physically active?' "
The approach began with a popular mentor program called In Shape that serves people with chronic mental illness, and it's now being applied to the chronic illness population in general, beginning with diabetes. The hospital helps to train the mentors so they can bring more to the one-on-one situation. The program underscores the importance of stratifying target populations by health risk so limited resources can be applied to the right places.
For more on population health, read "10 Facts about Population Health," in the July/August issue of Trustee.
John Morrissey is a freelance writer in Mount Prospect, Ill.