NEW ULM, Minn.
In health care today, enhancing the quality and experience of patient care, reducing per capita health care expenditures and improving the health of our nation's population all at the same time is considered the "Triple Aim." There is an increasing focus at the local, state and national levels on "population health" and improving the health of entire communities.
A new University of Kentucky study published Dec. 5 by the Commonwealth Center for Governance Studies, Inc. takes an in-depth look at 12 highly successful collaborative population health partnerships in 11 states. Minnesota's own Hearts Beat Back: The Heart of New Ulm Project is among them.
A collaborative partnership of the Minneapolis Heart Institute Foundation; New Ulm Medical Center, part of Allina Health, and the community of New Ulm, Hearts Beat Back: The Heart of New Ulm project is a 10-year initiative to significantly reduce heart attacks among residents in the community of New Ulm, Minn. Earlier this year, the project was awarded the 2014 NOVA Award from the American Hospital Association and a 2014 Community Benefit Award (small hospital category) from the Minnesota Hospital Association.
Titled "Models of Collaboration Involving Hospitals, Public Health Departments and Others: Improving Community Health through Successful Partnerships," the study was conducted by the University of Kentucky's College of Public Health in conjunction with Commonwealth Center for Governance Studies, Inc. The study’s authors narrowed down an initial field of 157 nominations to the 12 chosen partnerships, which all involve hospitals, public health departments and other stakeholders who share a commitment to improving the health of communities they jointly serve.
Lawrence Prybil, PhD, LFACHE, the Norton professor in Healthcare Leadership at the University of Kentucky and principal investigator for the study, said, "There’s a striking paradox that in the United States, we spend a large and growing proportion of our nation's resources on health care, but the outcomes in terms of access to services, the quality of those services, and the health of our population do not match other countries whose spending per capita is lower. Improving access to outpatient and inpatient medical services and the quality of those services, while important, cannot resolve this paradox alone. Greater attention and resources must be devoted to promoting a safer environment, healthy lifestyles, prevention of illnesses and injuries, and early detection and treatment of health problems, as well as dealing with the underlying determinants of health."
"Through engaging community organizations and citizens in their programs and activities, the partnerships in this study are generating collective interest and action, building community spirit and social capital, and helping to create a 'culture of health' within their communities they serve," Prybil said.
The success in New Ulm
Prybil explained that from the start, it was clear that the New Ulm project was highly successful as measured by the study's eight core criteria: clearly stated vision, mission and values; a strong culture of collaboration with other parties and mutual respect and trust; clear goals and objectives; a durable organizational structure; highly qualified and dedicated leadership; effective partnership operations; demonstrated outcomes and sustainability; and solid metrics for performance evaluation and improvement.
He further explained that among a wide array of reasons why Hearts Beat Back in New Ulm has been successful is the project's emphasis on a specific community health need—reducing heart attacks and heart disease in the community—as opposed to something broader, such as becoming "one of America’s most fit cities."
"Leaders who choose a narrow set of needs on which to focus their efforts have a relatively less difficult challenge in setting objectives, developing or facilitating interventions directed at those needs, and selecting metrics to measure progress as compared to partnerships with a more expansive mission and focus," said Prybil.
Hearts Beat Back has also been successful at leveraging data to mobilize the community. The project uses the electronic health record as the primary population-level surveillance tool, with supporting data from other methodologies and sources, such as phone and mail surveys and data from the public health department.
Rebecca Lindberg, director of population health for the Minneapolis Heart Institute Foundation, said, "The use of data to mobilize partners and the community has been critical to our project's success. Data does not have impact unless used strategically to facilitate change. In New Ulm, data has helped us identify the risks in our target population, evaluate change, and provide important information that can be used to communicate progress or need for additional change. It's also helped us demonstrate our impact and gain support among key partners and funders."
Toby Freier, president of New Ulm Medical Center, said, "The community culture in New Ulm has transformed in significant ways to support healthier lifestyles. The project has become sort of a fabric of our community, with its impact being seen everywhere you go."
Data show significant improvements in the health of community residents. From 2009 to 2011, New Ulm made bigger improvements than Minnesota in the rates of acute heart attacks and deaths from coronary heart disease, according to the Minnesota Department of Health. In addition, electronic health record data from NUMC comparing 2008-09 to 2012-13 shows that among adults age 40-79, the percent with blood pressure within the recommended range increased from 79 to 84 percent; the percent with LDL ("bad") cholesterol within the recommended range increased from 68 to 72 percent; and the percent with total cholesterol within the recommended range increased from 58 percent to 65 percent.
According to Lindberg, these blood pressure and cholesterol improvements are particularly notable because they represent larger improvements than trends being seen in the rest of the country.