NATIONAL HEALTH

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community   HEALTH   forum

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OMAHA   METROPOLITAN   AREA

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INTRODUCTION

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“Unfortunately, many analysts –

in academia, special-interest groups, governments, and the press –

still presume that the common-pool problems are all social dilemmas in which

the participants themselves cannot avoid producing sub-optimal results,

and in some cases disastrous results.”

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“There is no reason to believe that bureaucrats and politicians,

no matter how well-meaning, are better at solving problems

than the people on the spot, who have the strongest incentive

to get the solution right.”

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“Without monitoring, there can be no credible commitment;

without credible commitment,

there is no reason to propose new rules.”

Elinor  Ostrom      ( 1933 – 2012 )

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The  OMAHA  METROPOLITAN  AREA  will constitute two divisions:  1) Douglas  and Sarpy County east of 72nd street – urban/suburban  2) Douglas and Sarpy County west of 72nd street – suburban/rural.  Each will share a combined  Community HEALTH Forum.

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I.  HOSPITAL  INPATIENT  UTILIZATION   —  Start  early 2018

      A. Data  input

1. Monthly population estimate each Division (12 months data estimated annually in December for the next calendar year) – Note: provisions for  a) estimated data sets,  b) final data sets based on population growth parameters and  c) number of days in the month –
2. Land Designations for each division – Note: provisions for either whole counties or portions of one county based on Zip Codes or Census Tracts
3. Participating Hospitals – 99 or less per Division
4. Hospital reporting —  reporting number of hospital days as defined as the respective division residents occupying a hospital bed at 0001 AM, as totaled daily for an entire month per Division.

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B.  Data  Output

1. Column Total of “resident days per 1000 population per year” for each division reported from all hospitals with notation of percent of hospitals contributing
2. Rolling average for Division: 3 year and 12 month

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C. Reporting  [ NOTE:  All data is deidentified. ]

1. Hospital utilization by each Division’s citizens reported on the first non-holiday, week-day after the 4th day of the month
2. Data collected per joint agreement of each participating hospital’s Medical Staff who identifies its own collecting and submitting process to an agreed upon ANALYSIS SITE
3. Arrangements developed prior to implementation to involve a means for shared monitoring among the reporting hospitals for the timeliness and apparent quality of the data received by the ANALYSIS SITE

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D.  ANALYSIS

1. Identify an  ad hoc  group to finalize a Cooperative Medical Staff Agreement and any process to account for the preservation and quality of the data reporting process
2. Meet with each of the hospital Medical Staff Executive Committees to begin a trial, intially limited to two years, of a monthly report of  a very limited set of deidentified, monthly hospital use of hospital beds by citizens living in the Omaha Metropolitan Area community
3. ANALYSIS  SITE  –  summary and proposal for next phase annually in January

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III.  EQUITABLY  AVAILABLE  PRIMARY  HEALTHCARE  —  Start  mid-2018

A.  Input Data

1.  Location of each Primary Healthcare clinic in Douglas and Sarpy counties
2.  Full-time equivalent providers: physicians, nurse practitioners, physician’s    assistants (as adjusted by MD FTE attributed to hospital based healthcare)
3.  total PCP = MD total FTE  + ( NP total FTE + PA total FTE )  / 2

 

B. Reports

1.  Topographical mapping for each PCP clinic:  1/2  mile diameter  (green)  Set  and  3  mile diameter  (red) set;  each with Color density layering for over-lapping  circles, especially for close proximity layering
2. Census tract set of 2 county maps with PCP FTE, per 3 mile map, coverage per citizen in each census tract color coded
3. Reports produced annually in April

 

C. Analysis

1. Initial analysis by University School of Public Health Departments including involvement of their Primary Provider training programs
2. Douglas/Sarpy County Comment
3. Community Feedback – local institution task
4. Acute Care Hospital leadership questionnaire/comment
5. ANALYSIS SITE  summary and action plan

 

IV.  COMMUNITY  HEALTH  FORUM   —  start early 2019

A.  Institutional Home –

1.  Community Institution:  Private vs Governmental
2.  Operational setting  –  donated;  possible interim affiliation as intermediate funding mediator;  avoid new ‘institutional design’ distractions

B.  ADVOCATE  BOARD  (See  ADVOCATE  SELECTION  Sub-Page)

C.  COMMUNITY  HEALTH  PLAN

• Section One  –  Equitably Available Primary Healthcare

1. Status – mapping
2. Annual assessment
3. Action Plan

• Section Two – Population HEALTH  adversities

1. Status – hospital utilization trends
2. Annual assessment – Current community Collective Thrust Initiatives – Teen age health;  homelessness;  suicide prevention; early childhood education; childhood maltreatment;  mental health
3.  Action Plan – Hospital use Prevention Plan/social capital enhancement

• Section Three – Disaster Readiness Assessment  –  what are they, what are our plans for their possible prevention or pre/post event mitigation