A Partnership in Prevention A prevention plan for Lane County COMMUNITY NEWS Rick Kincade, MD, MSHA Medical Director, Community Health Centers of Lane County Past President, Oregon Medical Association IN STRONG PARTNERSHIP WITH Lane County Public Health, the county’s Coordinated Care Organization, administered by Trillium Community Health Plan, has expanded its prevention efforts significantly over the last three years, with positive initial results. CCOs are based on a collective impact model, which leverages a common agenda, shared measurement systems, mutually reinforcing activities, continuous communication and a backbone support organization. Trillium built its prevention plan in collaboration with its Community Advisory Council members: the county’s Public Health department, PeaceHealth, the United Way and Oregon Research Institute. Trillium has annually budgeted $1.34 PMPM for prevention efforts, and the council is tasked with determining the priority interventions to meet the targeted objectives of the Community Health Improvement Plan. The Community Health Improvement Plan’s stated objectives include a reduction in tobacco use, a reduction in obesity, and an overall improvement in the mental health of Lane County’s population. Schools have been a primary partner in implementing prevention efforts. Armed with the knowledge that every chronic disease is either caused or worsened by tobacco use, and that the vast majority of smokers start as teenagers, the team sought out interventions that prevented kids from ever starting, such as the PAX Good Behavior Game. Early data shows good fidelity to the model, improved classroom behavior with decreased disruptions, and strong faculty engagement. The Quit Tobacco in Pregnancy (QTIP) program addresses the very high prevalence of tobacco use in pregnancy noted in the Community Health Needs Assessment. Fifty-four percent of identified pregnant smokers agreed to participate in the program in its first year, 64 percent of whom were still smoking at enrollment. Gift cards were given to participants at each visit when testing negative for nicotine. Of those still smoking, half had quit by their first prenatal visit. The “Family Check Up” intervention provides parenting skills training at the Lane County Family Mediation Center for over 600 individuals from 375 families. Assessed skills include setting and sticking to limits, understanding children’s developmental needs and understanding one’s value as a parent, with an average skill score improvement for parents of 27 percent. The CCO trains providers to administer short “in the visit” Positive Parenting Program interventions for all parents. The interventions show dramatic improvements in parenting effectiveness and behavioral outcomes in multiple settings. Other CCO prevention interventions have been directed at healthy mental health habits, stress reduction, nutritional and activity education in schools, farm to school produce programs, and local health policy support. The strong partnership of the health systems, providers, educators, business members, patients and payers has created a unique opportunity for our community to improve health, not simply provide healthcare. We’re proud of our efforts, and encourage other states to examine Oregon’s CCO prevention efforts to better understand the power of collaboration in improving health. 28 Medicine in Oregon www.theOMA.org
OMA Medicine in OR Spring 2016
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