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Interview with Dr. Denise Koo about the CDC’s Community Health Improvement Navigator Tool

Denise Koo, MD, MPH, Captain, United States Public Health Service, is Senior Advisor for Health Systems, Office of Public Health Scientific Services, CDC, currently leading development of the Community Health Improvement Navigator in CDC’s Policy Office. Dr. Koo graduated from Harvard University with a BA in Biochemical Sciences. She combined medical school at the UC San Francisco with an MPH in epidemiology at UC Berkeley. Koo is a graduate of CDC’s Epidemic Intelligence Service and Preventive Medicine Residency. 

Other prior CDC positions include running the National Notifiable Disease Surveillance System, serving as Director of the Division of Public Health Surveillance and Informatics, and most recently, serving as Director of CDC’s Division of Scientific Education and Professional Development. Koo holds appointments as Adjunct Professor of Global Health and of Epidemiology, Rollins School of Public Health, Emory University, and Consulting Professor, Department of Community and Family Medicine, Duke University Medical Center.

Interview by Tom Peterson

Can you describe the CDC Community Health Improvement Navigator?

The Navigator will be a freely available CDC website that provides tools to support hospitals and public health and community partners in their work to improve the health of individuals and communities. The CHI Navigator has 5 components: the first 2 components make the general case for working collaboratively to improve health, with hospital-specific examples; an infographic that provides a visual storyline for how to improve health; resources and tools for specific steps in the community health improvement process, and a database that helps users to select evidence-based interventions.

Up front we make the case for a collaborative approach to health. To make this case we use facts, for example, that the predominant diseases have changed from acute infectious ones to chronic disease. There are also the facts related to the cost of health care in the United States. We spend $2.8 trillion on healthcare annually—nearly 20 percent of our GDP—and more than any country in the world. Yet our health outcomes are not consistent with such expenditures, and fall behind many other countries. Whether you’re talking about infant mortality, life expectancy, and so on, our country ranks no higher than the middle of the pack. This is part of the motivation for our health system’s transformation.

Health is affected by more than just healthcare. Where we work, live, study and play has a greater effect on our health than does the short time we spend in the healthcare system. We need a multipronged, multi-partner approach. We recognize the complexity of tackling health (not solely healthcare) and want to support hospitals and their partners in solving this problem together.

To support this collaborative approach, the Navigator will include some short stories and links, examples from successful hospital efforts. Stakeholder Health has some great examples of hospitals that have partnered with other organizations and put into place interventions that made a real difference. These quick 2-line examples will describe how they impacted health and affected key metrics such as decreasing readmissions, ER visits, and costs. While we’re most interested in the bigger picture of sustainable health improvement, we will also outline how such collaborative approaches support compliance with the IRS Community Health Needs Assessment requirement.

Next component of the Navigator: Our infographic conveys the storyline for community health improvement in an easy-to-remember visual, an “elevator speech” of sorts. It answers What, Where, Who, and How to improve your community’s health. WHAT factors affect health, as in determinants of health? WHERE to consider focusing your efforts? That is, what are the geographic areas of greatest need, and thus, with greatest potential impact? WHO are potential partners and of course, HOW to make lasting impacts on the health of your community? The last visual of the infographic underlines the message that we need a multipronged approach to health, including addressing health behaviors, the environment and socio-economic factors.

With the overwhelming number of tools out there for community health improvement, we’re also trying to help people navigate to the right tool for their needs. This CHI Navigator component identifies key concepts, drawn from key documents such as the Robert Wood Johnson Foundation’s Culture of Health and Principles to Consider for the Implementation of a Community Health Needs Assessment, authored by Sara Rosenbaum, and links them to tools that help operationalize these key concepts– such as collective impact, sustainability, and community engagement.

Can you tell us more about the database?

We want to help hospitals identify more upstream interventions that can complement and enhance the effectiveness of their clinical interventions. With this goal in mind, we developed a queriable database to provide them with ideas for actions to take. This will be like a travel website, only for evidence-based interventions to improve health. On such search engines you can put in your own settings: for example, I can specify that I want to go from Atlanta to Boston, coach, in the morning, on a given date.

With the Navigator database you can specify your interests—the risk factors you wish to target—for example, diabetes and nutrition, and the population you wish to focus on, let’s say adults, or children. You can then submit your query to the database for interventions matching your specifications. Once you review your results, you can narrow your search further by selecting particular intervention settings or types, or selecting specific indicators you wish to measure, like Hemoglobin A1c. Then you submit your query to our database and it will return another list of evidence-based interventions for consideration by you and your community partners. These interventions are drawn from 5 different databases, and our first proof-of-concept is focused on interventions targeting universally high prevalence/high cost risk factors such as tobacco use, diabetes, obesity, hypertension, poor nutrition/diet, physical inactivity, hyperlipidemia, and socioeconomics.

Based on feedback from Stakeholder Health and others, we are also hoping to include interventions related to mental and behavioral health issues.

What are the sources for the information?

We have culled from five very credible sources with clear descriptions of their evidence criteria: The Guide to Community Preventive Services, the What Works for Health database (on the University of Wisconsin website), the AHRQ Health Care Innovations Exchange, the Healthy Communities Institute Promising Practices and the New York Academy of Medicine/Trust for America’s Health Compendium of Proven Community-based Prevention Programs.

We’ve done the hard work of finding these sources and the individual links within those that are online. The interventions they contain all have some level of evidence behind them. From our site, users can go to the original sources to get more information about each intervention. That’s why we call it a navigator.

How might this tool help connect community assets?

The Navigator could help in several ways. Our “resources and tools” component will point to tools that help you identify assets in the community. If you emphasize the “connect” in your question, e.g., you want help in community engagement, we will point you to tools that assist in the community engagement process. If you are considering interventions and have some community assets—people, organizations, places—the queriable database will point you to interventions that leverage such assets.

What is the timing on the Navigator?

We hope to release the infographic in February. We intend to launch the website, with the rest of the tools, in late spring.

Should we be optimistic about the health of Americans?

I believe we’ve finally come to a time and place where more and more people in the health system realize that we can’t focus on healthcare alone. We have to start focusing on health and the various ways and partnerships we need in order to get to health and well-being. It’s a really exciting time.

I was trained as a physician in the late eighties. I was often frustrated and felt that my medical education was missing the boat. It was about putting Band-Aids on body parts and organ systems. It wasn’t about getting at the root causes of poor health. Now, rather, the conversations include not only public health and healthcare, but many other sectors as well. Many organizations recognize the relationship, for example, between education, housing, transportation–and health. There’s an opportunity for all of us to be boundary spanners and to connect with others about the larger system. And these conversations are happening with other disciplines. This kind of systems work will be more impactful and sustainable. It’s a long road and it won’t happen overnight, but it IS happening on the ground.

More and more, people realize that we have to work collaboratively with those outside the health sector. But they don’t always know how to take this different approach. We’re trying to support them in the how.

For more detailed information about the CHI Navigator, check out this Q&A Dr. Koo did as a follow up to a Stakeholder Health webinar.