Managing Community Health Services - Case Study Example

Managing Community Health Services Introduction This is a managing community health services paper. It comprises of distinct sections that concerns health promotion intervention and integrating managerial epi information with community involvements. Also population health management and community health requirements assessments that are needed to illustrate community benefit. Part (a) concerns 30 day-readmission in a community hospital analysis, part (b) concerns childhood disease dilemma– hospital outreach coordinator and part (c) community health needs assessment. Part A Community Outreach Coordinator (COC) captured the discharge data as follows. Total discharges for the period was 32, 998. The COC found that 3,792 came from urban areas and were not re-admitted within 3- days. She also discovered that there were 9, 428 rural discharges where patients were admitted within the 30 day window out of the total rural discharges of 11,334. a. a contingency table Discharges Readmitted Urban region 3,792 0 Rural region 11,334 9, 428 The contingency table provides only the number discharges against readmitted patients. The remainder of discharges not applicable was found not to relate with the study. b. the appropriate epidemiological statistic: relative risk vs. odds ratio The relative risk for urban readmission is 0% that is (0/3792 * 100) The relative risk for rural readmission cases is 83% (9428/11334 * 100) The odd ratio in urban region is 3792/0 = none The odd ratio in urban region is 11334/9428 = 1.2 Odd ratio 1.2/0 = mathematically invalid however interpretation is 1.2 risk prone more. c. The risk associated with a discharged patient being readmitted in rural region is about one point two times the risk of a discharged urban patient. d. According to the Epi Data the patients mostly affected by readmission are rural dwellers. The steps that is recommendable for this community hospital concern investigation of the matter and establish causes i. organize for field study concerning rural area rate of readmission ii. Establish the factors influencing the rate such as if there is an outbreak or not iii. Define and identify cases iv. Verify the diagnosis v. Describe and adjust the statistics in terms of time, location, and person vi. Carry research concerning developed and evaluated hypotheses vii. Refine hypotheses and carry out additional studies viii. Implement prevention and control measures ix. Communicate findings and recommendation e. a chi-square test of independence Discharges Readmitted Total Urban region 3,792 0 3,792 Rural region 11,334 9, 428 20,762 Total 15,126 9,428 24,554 Discharges Readmitted Urban region Expected (3,792 * 15,126)/ 24554 = 2.336.0 Expected 3792 * 9428 / 24554 1,456.0 Rural region Expected (20762 * 15126)/ 24554 = 12,790 Expected (20762 * 9428)/ 24554 = 7, 972 Discharges Readmitted Observed Expected O – E (O – E)2 (O – E)2/E 3,792 2,336.0 1,456 2,119,936 907.5 0 1,456.0 -1,456 2,119,936 1,456 Observed Expected O – E (O – E)2 (O – E)2/E 11,334 12,790 -1,456 2,119,936 165.7 9, 428 7, 972 1,456 2,119,936 265.9 Chi-square statistics equivalent to 907.5 + 1,456 +165.7 +265.9 = 2,795.1 The result is non-significant. A non-significant analysis means that no effects were realized and chance could elucidate the experiential differences in the cells. Part B The primary populations of interest in this health promotion campaign would be families since childhood dilemmas affect each and every citizen directly or in directly. However, the emphasis would be on parents and aspiring parents. The campaign would involve review of epi data concerning chicken pox. Epidemiology assists in understanding the nature and degree of chicken pox prevalence, causes, symptoms, associated risks and preventive and protective factors in a population (Stevens, 2004). Primary contagion with varicella zoster virus leads to chickenpox, a ubiquitous childhood illness associated with its pruritic vesicular rash. The virus may be got at any time and the existence risk of chickenpox has been revealed by serology to reach 100%. It is reported that chickenpox in grownups has a higher extent of complication, comprising pneumonia and encephalitis. The clinical data to be sought include prevalence ratio and evidence-based strategies used to minimize or prevent the risk. The epidemiology of chickenpox has transformed dramatically since the launching of the varicella vaccine in 1995. In the America, routine children immunization has minimized disease prevalence, complications, hospital admissions, and fatalities in children and in the broad population, representing strong herd immunity (Stevens, 2004). These data can be collected from various clinics and other health care facilities. For both epi and clinical data the health behavior theory applicable is behavior modification. Providers characteristically depend on health information and their proficient condition to encourage patients to adjust. Health behavior models and theories suggest more effective techniques for achieving patient observance and other behavior transformation associated with treatment regimens. Behavior modification emphasizes the remediation of ability deficits or using optimistic and negative fortification to modify operations. Similar to behavior modification, the health belief model emphasizes a reduction of ecological barriers to behavior (Stevens, 2004). The campaign will tackle the health promotion tactics that are associated with the disease. Empowering persons and populations to manage, and make informed choices about, their health though: provision of supportive social, physical and economic environments via different but corresponding methods Working in partnership with a wide variety of sectors allowing individuals to manage the determinants of physical condition Equipping sectors and systems to address the communal determinants of health. Health promotion the campaign will engage in include: setting and supportive environment, promoting community involvement or action, doing health information and social marketing and promoting health education and skills development. Practical activities would comprise: integration of health promotion principles in organizational policies, structures and practices to create supportive environment; involve in community participation in priority setting (Stevens, 2004); presentation of information to a broad or specific audience and engage in health education through volunteers. Deliverance of these health promotion activities would involve public seminars to sensitize the public on chickenpox. The community hospital outreach coordinator, Chief Operating Officer, Chief Nursing Officer and the Director of Emergency Department will be instrumental in health promotion activities since they are expert and experience health practitioners. The campaign cannot be done without community hospital initiatives. The campaign calendars to be linked with hospitals mobile immunization or vaccinations programs for the disease. It is easy to campaign with trusted organization since huge audience is reached. The outcome metrics would involve feedback document that assesses the outcome of every promotional activities. Health Promotional Activity Participant Feedback Selected Audience feedback Final Feedback Fail Average Success Fail Average Success Fail Average Success setting and supportive environment community involvement or action health information and social marketing health education and skills Table1: Outcome metrics Part C This part involves community health needs assessment (CHNA). In this part, CHNA is analyzed in accordance to six guidelines of ACHE community health assessment toolkit. The ACHI Toolkit is a guide for preparation; leading and applying community health requirements assessments to improved and ultimately enhance the health of communities. The strategy has guidelines such as (1) identifying the group (team) and resources (2) defining the scope and purpose (3) Collecting and assessing (analyzing) data (4) Choosing priorities (5) documenting and communicating outcomes (6) preparation of action and monitoring the progress (Morrison, 2011). These are the standards or guidelines used while implementing the health needs assessment. The first assessment question is whether the infrastructure will differ from the one used prior. The infrastructure of assessment would not differ so much; however, the execution of activities such as priorities setting will differ since data collected of hurricane is accurate as compared to hypothesized data used before. The $25,000 has been granted to revise CHNA to reflect the impact of hurricane sandy. The fund would be used to organize team and resources to assist in collecting actual data after the impact. The purpose is to update and revise the CHNA to reflect the community needs following the impact of hurricane sandy. The first CHNA forecasted and preempted what would happen, however, the revised is updated to provide accurate data and recommendations. The geo area becomes a subject of hurricane impact and thus change will be determined of impact basis. Disaster does not target particular group so it is hard to only target a certain group during CHNA. This is a community assessment and target is the community restoration. The data collection process changes from theoretical assumptions to real time data collection activities for primary data. The samples easy to collect simply by sending team to affected areas to collect necessary data. However, collection process much be done cautiously due to health hazards caused by dust and other environmental risks. The data collected shows the extent of hurricane impact so that accurate adjustment could be implemented on the first CHNA. Collecting data would involve integration of other stakeholders such as Water Company to know impact on water supply, power suppliers’ data on power impact, real estate departments and health sector data (Morrison, 2011). The new priorities are determined by the impact hurricane sandy on the community. This is possible to assess through data that is collected. The data collected prior form the secondary data of research while the data collected after the sand is primary data. Integration of these data provide an opportunity for reevaluation, revise planning and budgeting, informed decision making and elaborate needs assessment and recommendations. Quick delivery of message to public is achievable through social media. This is the fastest mode of communicating in a short timeframe. Community health needs assessment interventions that need hospital support would be incorporated into their strategic plans and used for community benefit. This would be possible through discussion with pertinent stakeholders and sharing recommendations to assist in integration process. Conclusion The paper has handled three sections of managing community health services. The first part entailed community hospital admission and readmission trend. Second section was about the health promotional campaign concerning a disease. Lastly, a disaster impacts and interventions approach within a community health sector. References Morrison, E. E. (2011). Ethics in health administration: A practical approach for decision makers. Sudbury, Mass: Jones and Bartlett Publishers. Stevens, A. (2004). Health care needs assessment: The epidemiologically based needs assessment reviews. Oxford: Radcliffe. Read More