DIAGNÓSTICO DEL SECTOR Y CICLO DE VIDA DEL PRODUCTO

developed to address the health issues identified. While data identified CVD risk factors across various groups within the target population, the key to successfully mobilizing an entire community has been strategically sharing the data with stakeholders. Given the project impacts various sectors — clinical, worksite and

community — as well as environments, it was important to include all stakeholders in the conversations. Ideas were presented on how to improve the health of the population, feedback was gathered related to the ideas, messages for programs or social marketing campaigns were pilot tested with intended audiences (e.g., focus groups), and then interventions were implemented and evaluated. A comprehensive social marketing strategy to engage high proportions of the community was also part of the intervention plan.

For example, results sent to individuals after their screenings helped empower them to take action.

Providers received the results via the EHR, which expanded data available to treat patients. At the clinic level, data was used to target high-risk population groups systematically. Clinical leadership at NUMC, the steering committee and the community members (through newspaper articles, e-newsletter, local cable access TV show, etc.) received tailored messaging around the aggregate results (i.e., community diagnosis, progress and areas for improvement). Annually the project has shared success stories, aggregate data, and current and future plans at a community summit and through an annual report that is delivered to every household.

the community, as well as clinical leadership and steering committee engagement, feedback has been gathered on the types of interventions that could be designed to improve health. Ongoing surveys and assessments were utilized once the interventions were implemented to determine changes in CVD risk factors and modifications needed to improve existing interventions. Follow-up screenings and regular review of EHR population-level data determined changes needed to continue to impact key health metrics within the population.

Data suggests the strategies are working. Screening data from 2011 (2-year outcomes) observed statistically significant improvements in lifestyle behaviors (i.e., decrease in tobacco use, increases in fruits and vegetable consumption and physical activity levels, and reductions in stress). Screenings to re-assess lifestyle behaviors are in progress. Exhibit 2 provides 5-year project outcomes for CVD risk factors based on EHR data. Significant improvement in blood pressure and lipids were noted over 5 years. The bulk of these population-level improvements seem to be driven by better risk factor control among the sizeable number of individuals who were not at goal at baseline.

The use of data to mobilize partners and the community has been critical to the project’s success. Data does not have impact unless used strategically to facilitate change.

It helps identify the risks in a target population, evaluate change, and provide important information that can be used to communicate progress or need for additional change. Data can also provide support with key partners and funders (e.g., demonstrate impact). Through collaborative and coordinated action, transparent use and communication of data, and ongoing dialogue and partnerships across various sectors, disciplines and the community, success has been achieved.

(n ≈ 7,000), along with associated population and individual level general intervention strategies in the Heart of New Ulm Project.

Prevalence of Modifiable CVD Risk Factors from the EHR for HONU Target Area Residents Age 40-79 2008/09

n = 7222 2010/11

n = 7432 2012/13

n = 7584 p-value

Systolic BP (mmHg) 125.7 ± 0.2 125.1 ± 0.2 124.7 ± 0.2 <0.001

Diastolic BP (mmHg) 74.7 ± 0.1 73.7 ± 0.1 72.7 ± 0.1 <0.001

BP at goal (<140/90 mmHg) 78.7 81.3 84.3 <0.001

BP medication 33.5 39.1 44.1 <0.001

LDL (mg/dL) 115.0 ± 0.5 111.5 ± 0.4 112.5 ± 0.4 <0.001

LDL at goal (< 130 mg/dL) 68.0 72.4 72.1 <0.001

HDL (mg/dL) 50.7 ± 0.2 49.1 ± 0.2 48.9 ± 0.2 <0.001

HDL at goal (> 40 mg/dL men, >

50 mg/dL women) 64.0 58.9 57.8 <0.001

Lipid medication 19.8 24.2 28.0 <0.001

Triglycerides (mg/dL) 140.4 ± 1.1 133.8 ± 1.0 132.4 ± 1.2 <0.001

Triglycerides at goal

(<150 mg/dL) 66.4 68.7 70.1 <0.001

BMI (kg/m2) 30.1 ± 0.1 30.1 ± 0.1 30.1 ± 0.1 0.534

Not Obese (< 30 kg/m2) 55.9 55.6 55.4 0.474

Glucose (mg/dL) 105.6 ± 0.4 106.6 ± 0.5 109.4 ± 0.5 <0.001

Glucose at goal (<100 mg/dL) 54.3 55.4 47.9 <0.001

Aspirin Medication 23.3 30.0 36.0 <0.001

Non-Smoking 86.2 86.1 86.3 0.080

Continuous outcomes are reported as mean ± standard error, and categorical outcomes are reported as percent of sample. P-values are a test for trend.

Reference: Sidebottom AC, Sillah A, Vock DM, Miedema MD, Pereira R, Benson G, Boucher JL, Knickelbine T, VanWormer JJ. Improvements in Cardiovascular Disease Risk Factors after Five Years of a Population-Based Intervention: The Heart of New Ulm Project. AHA Abstract 2014

Creating balanced scorecards (see Exhibit 1) for the goals of the health community initiative tied to specific metrics and targets used to measure progress, and simultaneously integrating this tool into the action planning process, has been an important feature for aligning and engaging partners with Healthy Monadnock’s goals and strategies.

Cheshire Medical Center/Dartmouth-Hitchcock Keene has an ongoing contract with Antioch University New England (AUNE) to provide evaluation services for the Healthy Monadnock 2020 (HM2020) initiative. These efforts involve the routine monitoring — at the county, state, and national levels — of 27 healthy eating, active

living, and community health-status and quality of life-related indicators (see Exhibit 1) through existing, publicly available, epidemiological data (e.g., BRFSS, CDC mortality data) as well as through HM2020’s bi-annual Community Survey (CS), a random digital survey of 625 Cheshire County residents that the AUNE evaluation team undertakes to address gaps in epidemiological data. The CS includes fruit and vegetable consumption and physical activity indicators, individual mental and physical health and well-being indicators, and community health and social connection indicators. The team collects CS data bi-annually and last collected it in May 2014.

Targets for each indicator were determined by the Healthiest Community Advisory board in cooperation with community stakeholders in 2008, and reviewed and updated in 2013. The indicators and targets are regularly updated by the community and shared with the community as a way to increase awareness of the initiative and its progress, engage implementation partners (Champions) and align community partners with the goals and strategies of the initiative.

The evaluation team subscribes to a participatory, action-oriented evaluation model (utilization-focused evaluation [UFE]; Patton, 2008) and since 2008, engages key stakeholders — project staff, community partners and stakeholders, and the Healthiest Community Advisory board (HCAB) — in the design of the evaluation plan, project database, and data dashboards; negotiates the ongoing data collection, entry, and extraction procedures with project partners; manages the data and conducts statistical analyses; facilitates utilization of the findings to improve the program; and develops the evaluation reports, presentations, and publications. The evaluation Partnership Profile

Model of Collaboration: Founded in 2007 by the Cheshire Medical Center with funding from the Cheshire Health Foundation, grants and private foundations, Healthy Monadnock utilizes a “champions” program through which partner agencies pledge to live, share and inspire others to follow the goals and values of Healthy Monadnock.

Mission and Focus: The mission of Healthy Monadnock 2020 is to make the Monadnock region the healthiest community in the nation through engagement of champions (partners, organizations, schools and individuals) working to make the healthy choice the easy choice. Focus areas include healthy eating, active living, education, livable wages/jobs and mental well-being.

Partnership Contact:

• Linda Rubin, Director of Healthy Community Initiative, Healthy Monadnock