Nemour's Journey to Improve Child Health and Wellness

Added on Sep 22, 2016

Assessing and Addressing Children's Health Needs: Nemour's Journey to Improve Child Health and Wellness
By Audrey Doyle
From Industry Edge September 2016

For a hospital to meet the health needs of its patients, first it must determine what those needs are.

“That knowledge is what a community health needs assessment gives us,” said Mary Kate Mouser, operational vice president of Nemours Health & Prevention Services (NHPS), the health promotion and disease prevention arm of the Nemours pediatric health system. “Our CHNAs measure the current health status of the children and families in the communities we serve so we can better understand their health needs. We use this research to identify community partners and resources to help develop action plans to address those needs.”

Nemours comprises two free-standing hospitals: Nemours/Alfred I. duPont Children’s Hospital in Wilmington, Del., which opened its doors in 1940, and Nemours Children’s Hospital (NCH) in Orlando, Fla., which has been in operation since 2012. The organization also includes 60 primary, specialty and urgent care clinics located in Delaware, Florida, New Jersey and Pennsylvania.

Both Nemours and NCH conducted their first formal community health needs assessments (CHNAs) in 2013 to meet an IRS requirement newly added to the Affordable Care Act (ACA) mandating that tax-exempt hospitals and health systems conduct a CHNA every three years to determine the health status, behaviors, and emergent and immediate health needs of the people in their service areas.

In addition to fulfilling legislative requirements, CHNAs can help facilitate population health management and, importantly, can contribute to the reduction of patient suffering by informing targeted improvement strategies to better address patient needs.

To ensure that the CHNA includes a strong cross-section of perspectives and viewpoints, the ACA requires that facilities seek input from a variety of sources. It also requires that facilities work with relevant partners to develop detailed strategies designed to meet the health needs identified in the CHNA, and that they make their CHNAs, action plans and periodic progress reports publicly available by posting them on their websites. Failure to comply with the requirement results in a fine of up to $50,000 per year and the risk of losing nonprofit status.

Nemours, like many other hospitals throughout the United States, had been voluntarily conducting its own needs assessments since NHPS was formed in 2004. However, the CHNA requirement formalizes the process and holds hospitals accountable for their progress in continuing to meet the evolving health needs of their community.

It also ensures that data are gathered and implementation strategies are developed and carried out as a result of input and collaboration among a number of stakeholders, which can include neighboring health care facilities, government agencies, policymakers, local organizations, schools and the business community, among other groups.

According to Mouser, strong collaboration is required in a CHNA to achieve a clear and accurate picture of the health status and needs of a community and drive the changes required to meet those needs. “In our CHNAs, we played an important role in pinpointing and alleviating the barriers to health for the children and families we serve,” Mouser said. “But we didn’t do it alone. Many groups played a part in helping us identify the barriers and implement sustainable changes that will lead to improved health in the long run.”

For example, in addition to conducting 1,000 telephone and online interviews with families in their respective areas, for their 2013 CHNAs Nemours and NCH worked with public health agencies, physicians and other health care providers, social service agencies, area schools and various community leaders, as well as with data from the U.S. Centers for Disease Control and Prevention (CDC), county and state public health departments, the U.S. Census Bureau and the CDC’s National Center for Health Statistics, to identify emergent and immediate health needs, said Martha Santoni, government relations coordinator at NCH.

The hospitals also included public health data, vital statistics data, focus group results and results from additional surveys detailing the health of adults and parents in their service areas. Understanding the health needs of the entire family, Nemours feels, is the most effective way to improve the health of children, even those who never enter a Nemours facility.

“Our CHNAs are very important to our ability to best understand the needs of the children in our communities, but because children are members of families, we feel it’s just as important to understand what’s happening in the care of adults,” said Mouser. “By breaking down barriers to health for the entire family, we’re able to help children practice healthier behaviors that will carry them into adulthood. That’s something we’re deeply committed to. Keeping kids healthy is just as important as taking care of them when they’re sick or hurt.”

Dissecting the Data

According to Mouser and Santoni, the 2013 CHNA process involved the collection of qualitative and quantitative data from which they identified several areas of opportunity representing the significant health needs of children and adolescents in their service areas. For each area of opportunity, the resultant data were evaluated using the following criteria:

  • Magnitude: The number of children affected
  • Seriousness: The degree to which the health issue leads to death, disability or loss of quality of life
  • Impact: The degree to which the health issue affects/exacerbates other health issues
  • Feasibility: The ability to reasonably impact the issue, given available resources
  • Consequences of inaction: The risk of exacerbating the problem by not addressing it at the earliest opportunity

Based on those criteria, three top priorities for each service area were identified. In the Delaware Valley, the top three included access to health services; nutrition, physical activity and weight; and mental and emotional health. In Central Florida, the top three included access to health services; nutrition, physical activity and weight; and prenatal and infant health. The hospitals then developed objectives for each priority area and action plans for reaching those objectives.

According to Mouser and Santoni, numerous activities and programs have been created and executed over the past few years to address the health needs identified as top priorities in their CHNAs.

For example, to improve access to health services in the Delaware Valley, one strategy of Nemours was to create a Patient Navigation Department that expedites appointments and facilitates the integration and coordination of care across disciplines for complex patients and their families. Another was to partner with the Delaware School Nurses Association and the Delaware Department of Education to facilitate the exchange of critical medical and educational information between school nurses and Nemours’ clinicians.

To improve access to health services in Central Florida, NCH implemented several strategies, among them partnering with community hospitals in three counties; expanding into 14 pediatric primary care locations, six pediatric urgent care centers and three specialty care locations; and launching Nemours CareConnect, a telehealth service through which families can access pediatric experts from NCH via their mobile phone, tablet or computer 24 hours a day, seven days a week.

As one of several ways to address issues concerning nutrition, physical activity and weight in Delaware’s Sussex and Kent counties, which had the highest percentage of overweight or obese children and the highest percentage of obese children among the five counties surveyed in Nemours’ CHNA, NHPS began working with the University of Delaware (UD) on a multiyear contract that the Delaware Division of Public Health awarded to UD and the Sussex County Health Promotion Coalition to promote healthy eating and active living through existing relationships with organizations, coalitions and schools in Kent County. NHPS’s responsibilities included conducting training sessions for a family-based healthy lifestyles program and strengthening parents’ involvement in an evidence-based health, nutrition education and physical activity program being taught in schools nationwide.

Meanwhile, one of NCH’s efforts to address issues concerning nutrition, physical activity and weight in Central Florida’s children involved training 181 educators to teach children healthy habits by means of health promotion and disease prevention programs offered through NCH’s Florida Prevention Initiative. According to Santoni, more than 3,000 children have thus far received education in the classroom on developing positive associations with healthy eating and physical activity as a result.

An Ounce of Prevention

The programs and initiatives that have been put in place as a result of Nemours’ and NCH’s 2013 CHNAs have helped the hospitals encourage wellness development and enhance the quality of health and health care for children in their areas. As the ACA mandate requires hospitals and health systems to perform a CHNA every three years, both facilities completed a second CHNA earlier this year and plan to make the results publicly available by the end of the year.

For this new iteration, Mouser said Nemours is in the process of determining whether/how it will measure changes in population health and patient experience that may occur as a result of strategies it puts in place starting in 2017. As she explained, the organization’s goal is not just to improve children’s health in the short term and encourage healthy lifestyles in the intermediate term, but also to improve children’s health outcomes in the long term. Achieving such changes in population health will take time.

“Unhealthy behaviors don’t develop overnight. They take years—sometimes decades—to form. So it’s going to take an extended period of time for any solution to result in positive, measurable changes in population health,” said Mouser. “Our CHNAs will be instrumental in helping us to pinpoint which unhealthy behaviors are having the biggest impact on our communities and to work toward solutions that will reverse those behaviors and keep kids healthy.”

“Every adult was once a child,” concluded Santoni. “Therefore, it is of vital importance that we continue to educate and care for the children in our communities and give them the best chance of becoming healthy adults.”