Final Project: Community Needs Assessment

Your Final Project must be written in standard edited English. Be sure to support your work with specific citations from this week’s Learning Resources and additional scholarly sources as appropriate. Refer to the Essential Guide to APA Style for Walden Students to ensure that your in-text citations and reference list are correct. See the rubric for additional requirements related to research and scholarly writing.

Throughout the course, you have been developing your Community Needs Assessment. For your Final Project, submit the items below. Be sure to incorporate the feedback provided by your Instructors and your colleagues.Also, provide headings that separate and define the different sections of the assignment.

Your Final Project will include the following (10–12 pages)

Introduction

Initiative Proposal

Summarizein paragraph formkey relevant information from your Data Analysis(do not submit the worksheets)

SWOT Analysis (Week 6)

Donot submit your Power Point Presentation.

Instead, include a two-page summary of your PowerPoint that identifies the Strengths, Weaknesses, Opportunities, and Threats of your project.

Program Evaluation (Week 8)

Make sure your paper flows without repeating sections

Community Partnerships

Social Change

Explain in 1-2 pages how you would plan to measure social change. For example, would you track the outcomes or the overall process?

Conclusion

References

Conflict Between Good Samaritan Law

North Dakota

The case of the nurse not offering CPR for a dying patient raises certain ethical issues. In this regard, certainly the Good Samaritan law of South Dakota applies to protect nurse employment. The Good Samaritan laws actually differ slightly from state to state but there are certain unifying principles that need to be taken into consideration. The laws are made to protect the healthcare providers as well as ordinary citizens. In this case, the Good Samaritan law protects those health-care professionals to not perform those duties that are not pre-existed. The Good Samaritan statutes protect the health-care providers to reduce the standard care. Those providers who accidently cause any harm to the victim while trying to provide aid are not punished but those conduct that are wilful and show negligent behaviour are punishable under the good Samaritan laws (Howie, Howie, & McMullen, XXXXXXXXXXAn example of gross negligence was a case of California when women assisted a passenger but the passenger was paralyzed and thus, she was not protected under the Good Samaritan law. Therefore, even there is a helping nature was shown by the woman, she was punished causing a dilemma whether help should be offered to the person or not. It is though mentioned by the Good Samaritan law that those acts that are completed with the best intention to offer reasonable care should always be protected.

Ethical dilemma

The ethical dilemma of serving woman and serving employer causes a fix to the nurse. The dispatcher was constantly trying to persuade nurse to give CPR or ask other peoples to do this, but nurse refuses and says it’s a responsibility of 911 and she cannot do

more than this (CBSNEWS, XXXXXXXXXXThe Glenwood Gardens Retirement Facility later released statement that their practice was to immediately call the emergency medical professionals and to wait with the persons needing care. The same work was performed by the nurse but this incident is a wakeup call for the medical industry as nurse obligation towards a dying woman and towards her employer could not prevented the life of the woman. Even after dispatcher assurance that the facility would not be sued if any wrong thing happened to the woman (“Associated press in Bakersfield,” 2013).

Ethical consideration and recommendations

Therefore, certain ethical considerations must be considered by the Good Samaritan laws enacted to protect health care professionals and patients. The professionalism factor must be incorporated into the nurse’s practices. Therefore, Samaritan law must allow the nurses and medical professionals who are competent to perform CPR must conduct this for dying patient. Sometimes patients are unable to give consent to the health-care professionals (Kleinman, 2018) but the patient was incompetent to offer her willingness and the liability rested on nurse ability, but she did not perform CPR out of fear that she would be breeching the employment rules. Therefore, Good Samaritan law must propose such situations in favour to health-care professionals that if there is any untoward incident takes place; the responsibility does not lie on the health-care people. The question of what other practitioners have done in the same situation that the nurse faces requires that Good Samaritan law must protect patient’s interests as well as health professional interests. Therefore, the act should include element of professionalism ethics that demands that a person should enhance his or her knowledge beyond his or her duties to tackle emergency situations. As the Good Samaritan law does not take into account the patients inability to offer consent when the material risks are involved such as in the case of CPR (Johnson, 2012), it should allow health

care professionals to take action according to their discretion. This is present in the Good Samaritan act (Williams, 2014).

The most important thing is saving health care professionals by employer’s actions in case of health care professionals become good Samaritans by violating the employment rules. Therefore, Good Samaritan act must protect those individuals and offer job security to them when they work against the ethics and rules and regulations of a health-care facility. This can avert the likely threat and ethical dilemma to the nurses and health-care professionals

References

CBSNEWS, XXXXXXXXXXcalls reveals nurse refused to give dying women CPR. Retrieved from

https://www.cbsnews.com/news/911-call-reveals-nurse-refused-to-give-dying-woman-cpr/

Howie, W. O., Howie, B. A., & McMullen, P. C XXXXXXXXXXTo assist or not assist: Good Samaritan considerations for nurse practitioners. Journal for Nurse Practitioner 8(9), XXXXXXXXXX.

Johnson Lee J, XXXXXXXXXXLiability risks for the Good Samaritan. Retrieved from

medicaleconomics.modernmedicine.com/medical.../liability-risks-good-samaritan

Kleinman Irwin, XXXXXXXXXXThe right to refuse treatment: ethical considerations for the competent patient. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1335174/pdf/cmaj XXXXXXXXXXpdf

Williams Mary Dr., XXXXXXXXXXWhat’s in those Good Samaritan laws exactly? Retrieved from

https://www.cprcertified.com/blog/whats-in-those-good-samaritan-laws-exactly

FINAL PROJECT PROGRAM EVALUATION

Student Name: John T.Y Boakai

Table of Contents

Introduction. 3

Proposed pilot program to evaluate the initiative. 3

Proposed program initially developed. 3

Proposed pilot program.. 4

Small-scale program to determine feasibility of final project 5

Number of participants, organization, staffs and volunteers to be involved. 5

Evaluating the pilot program using Total Quality Management (TQM) tool 6

Actions taken by non-governmental and healthcare organizations to execute the initiative. 6

Conclusion. 7

References. 8

Introduction

Health is an intangible aspect that needs to be maintained for not only the existence of life, but also for the wellbeing of individuals. Health assessments help to identify the health status of a place and its population, as well as the extent to which they are at risks of developing one or more health disorders. If health disorders are detected in the due process, health initiatives are suggested for eliminating or preventing the same. The current assignment deals in proposing a pilot program for the evaluation of such a health initiative presented for cancer amongst the US population.

Proposed pilot program to evaluate the initiative

Proposed program initially developed

In the previous weeks, health statuses have been studies comparatively between North Dakota and The United States (US). The process has been expanded over week 3 to week 6, which have been a cumulative procedure of assessing the demographic details of the two selected places and the assessment of what the local community of these places need in terms of health requisites. Through the process, the progress of health conditions has been assessed, along with identifying the key health problems that the local people face. As mentioned by Sallis, Owen and Fisher (2015), health issues cannot be identified until the entire population of a place is to be studied.

Therefore, populations of both the areas have been studied in comparison to one another. The parameters, which have been placed on comparison, are the overall population of the places, percentage of population under 5 years of age, those above 65 years of age, percentage of male and female population, their ethnic groups, linguistic backgrounds, education, income as well as poverty levels.

Apart from these, separate data have been collected for the health-related information, where the life expectancy, infant mortality and 10 diseases imposing highest concerns were identified. Amongst these 10 diseases, it was analyzed that the most commonly occurring health disease is cancer amongst their population. Based on this data and further analyses, three objectives have been stated, to achieve which, three activities per objective have also been suggested.

Proposed pilot program

A pilot program is referred to as primary experiment that is conducted on a small-scale to analyze if the tested process or program is effective or not. As mentioned by Collison (2018), within a pilot study, it is measured the extent, to which the tested program or procedure is feasible. The feasibility is determined on grounds of costs, effectiveness, extent to which the desired outcomes could be achieved; time required for the process, amount of equipment or resources required and the negative influences, if any. Hence, if the tested project is identified to possess any loophole areas, then before its actual execution, those issues could be eliminated.

However, as argued by Durham, Suhayda, Normand, Jankiewicz and Fogg (2016), it is to be noted that it differs from the other evaluation programs in the context that it is conducted even before the actual project being conducted. That implies that in order to analyze the effectiveness of a project, it is not necessary to conduct it, in particular. Rather, a prior analysis through pilot program not only helps improvement of the process beforehand, but also saves costs, efforts, resources and time implications.

Therefore, for the initiative that has been suggested against cancer prevalence in the US, a pilot program could be proposed for checking if the activities are capable to meet the identified objectives. Firstly, the activities suggested for meeting the objective of spreading

awareness amongst the population about cancer will be analyzed. Further, the activities suggested for meeting the objective of preventing cancer occurrence through lifestyle interventions will be analyzed for their effectiveness. Lastly, the activities supporting the objective of providing free diagnosis and screening of cancer will be assessed for checking their feasibility in supporting the US population to combat against this disease.

Small-scale program to determine feasibility of final project

For the purpose of conducting the pilot program, a small-scale program will be conducted to assess the feasibility of the proposed initiative. Firstly, a survey questionnaire will be conducted of a sample out of the US population and similarly of a North Dakota sample for understanding the extent to which they have become aware of cancer as a serious health concern, its implications as well as ways of prevention. Further, an interview will be conducted of the healthcare professionals if they are aware of the ways, in which cancer can be prevented and if they implement these strategies in supporting the community people. Lastly, another interview will be conducted of the care managers, to assess if they have been successful in garnering support from the government to make the screening and diagnosis of the disease free for the population.

Number of participants, organization, staffs and volunteers to be involved

The pilot study will be conducted over a wide range of participants, because the objectives to be addressed through the health initiative are of broad spectrum. Hence, as suggested by White, Roczen, Coyne and Wiencek (2014), various types of participants should be involved if the impact of a certain research or program is on a varied range of population. Therefore, for the first objective of spreading awareness about cancer, since the US population is to be made aware, the participants will be a sample of this population and that from the population of North Dakota.

For the second objective, since the lifestyle guidance are to be provided to the population by the healthcare professionals, therefore, an interview will be conducted of theirs only. Lastly, since the facilitation of free cancer screening and diagnosis are not possible without the initiatives by the care managers, therefore, they would be interviewed and the renowned healthcare as well as non-governmental organizations will be involved in the entire process.

Evaluating the pilot program using Total Quality Management (TQM) tool 1355

For the collection of information from the US and North Dakota people, survey questionnaire will be conducted, where a structured, closed-ended questionnaire form will be distributed to each of the sampled participant. They would be selected randomly through probability sampling technique, for unbiased selection. Multiple-choice type questions will be asked to them, after seeking their informed consent.

For the interview, participants will be approached conveniently through non-probability method for selecting only the concerned personnel. They would be asked semi-structured, open-ended questions for elaborate information. The tool for analyzing the responses will be a TQM tool, such as the Fishbone diagram that help to analyze the cause and the effect of the initiative (Pereira & Cister, 2016).

Actions taken by non-governmental and healthcare organizations to execute the initiative

In the entire process, the participation of the non-governmental and healthcare organizations will be checked for that if they are interested in contributing to the noble cause.

Their efforts will be analyzed based on their reviews of the initiatives, feedbacks on the same, previous attempts to improve the awareness about cancer and monetary contributions made to support the needful people (Medical News Today, 2017).

Conclusion

As identified from the previously conducted health needs assessment and the framed local health initiative, it is clearly evident that the population of US, including North Dakota, are highly susceptible to cancer. However, the lifestyles and food habits of the people have failed the prevention of the same. Therefore, the local health initiative of preventing cancer has not been completely successful with them. Besides, eventually, given the large number of people suffering from this disease, it is also not being possible to collaborate with the governmental organizations to make the cancer screening or diagnosis to be conducted for free.

References

Collison, L XXXXXXXXXXA transition to practice pilot program for nurses in primary healthcare. Australian Nursing and Midwifery Journal, 25(8), 38

Durham, M. L., Suhayda, R., Normand, P., Jankiewicz, A., & Fogg, L XXXXXXXXXXReducing medication administration errors in acute and critical care: multifaceted pilot program targeting RN awareness and behaviors. Journal of Nursing Administration, 46(2), 75-81.

Medical News Today, XXXXXXXXXXThe top 10 leading causes of death in the United States Retrieved from https://www. medicalnewstoday.com/articles/282929.php

Pereira, M. G., & Cister, A. M XXXXXXXXXXTotal Quality Management in the Hospital Area and Its Contribution to Patient Safety. Journal of Statistical Science and Application, XXXXXXXXXX), XXXXXXXXXX.

Sallis, J. F., Owen, N., & Fisher, E XXXXXXXXXXEcological models of health behavior. Health behavior: Theory, research, and practice, 5, 43-64.

White, K. R., Roczen, M. L., Coyne, P. J., & Wiencek, C XXXXXXXXXXAcute and critical care nurses’ perceptions of palliative care competencies: a pilot study. The Journal of Continuing Education in Nursing.

Abstract

The report compares the demographics of the US and North Dakota on the basis of Census 2017 in terms of population, gender, age, ethnic groups, income, education, language and poverty levels. It also compares the two places on the basis of health-related data like life expectancy and Infant Mortality rate and enlists 10 diseases with the highest prevalence in the US and North Dakota.

The second section analyzes the data collected in the first section, describes the population and health issues in each area. At last, the report illustrates three objectives we hope to accomplish with our SMART initiatives and three activities we will use to accomplish those objectives.

Keywords: Census, SMART, demographics, population

Introduction

North Dakota is a state located in Midwestern dimensions of US. It is 19^th largest state of US in the area and most sparsely populated. The capital of North Dakota is Bismarck. It is located in Great Plains region and possesses a continental climate. Most of the people speak English as their native language. Being one of the fastest growing states in the US, most of the population is involved in agriculture (50states,2018).

United States (US) is highly developed and urbanized country consists of 50 states of North America. Its capital is Washington DC and present president Donald Trump. Most of the people speak English and follow Christianity as religion. It has a diverse range of climatic conditions in different parts of the country ranging from arid, desert, Mediterranean, tropical and oceanic (Global Edge, 2018).

DATA COLLECTION WORKSHEET

Name:______________________________

City/Country: North Dakota

SECTION 1: DATA COLLECTION

HEALTH-RELATED DATA

References

United States Census Bureau XXXXXXXXXXQuick Facts United States. Retrieved on 15 March 2018 from https://www.census.gov/quickfacts/fact/table/US/PST045217

United States Census Bureau XXXXXXXXXXQuick Facts North Dakota. Retrieved on 15 March 2018 from https://www.census.gov/quickfacts/ND

World Population Review XXXXXXXXXXThe United States Population 2018. Retrieved on 15 March 2018 from http://worldpopulationreview.com/countries/united-states-population/

Global Edge XXXXXXXXXXUnited States: Introduction. Retrieved on 15 March 2018 from https://globaledge.msu.edu/countries/united-states

50States XXXXXXXXXXNorth Dakota (ND). Retrieved on 15 March 2018 from https://www.50states.com/ndakota.htm

USA Health Rankings XXXXXXXXXXNorth Dakota Heart Disease. Retrieved on 15 March 2018 from http://www.worldlifeexpectancy.com/usa/north-dakota-heart-disease

SECTION 2: PROPOSAL OUTLINE

Final Project Initiative Proposal

Data Analysis & Comparison

North Dakota (ND) is a state while the US is a country. Both hugely vary in terms of area and population size. In demographics, ND has a comparatively higher population under the age of 5 years (7.3%) than the US (6.2%). The US has an increasing number of the population over the age of 65 years (15.2%) than North Dakota (14.5%). US population consists of more females while ND has a higher number of males than females (US Census Bureau, 2017).

North Dakota has a higher number of Whites (88%) than the US (73%). The second largest ethnic community in ND consists of American Indians or Alaska Natives while in the US the second majority group is Blacks or African Americans. The ratio of nonnative speaking people is considerably higher in the US (17%) than in ND (5%). The education level of both the places is relatively similar. Median household income is slightly higher in ND than in the US. Poverty levels are less in ND (10.7%) than in US (12.7%). It reflects that ND is a quality place to live economically (US Census Bureau, 2017).

Comparison of health related data shows ND has higher life expectancy and low infant mortality rates than the US. Highest mortality causing disease in ND is Cancer while in US, most of the deaths occur due to heart diseases (USA Health Rankings, 2017).

Cardiovascular Diseases

The health issue I have chosen for my population health initiative is ‘Cancer’. It is one of the major causes of deaths in all the 51 states of United States among both men and women, according to USA Health Rankings, 2017. Main causes of cancer can be obesity and sedentary lifestyle along with exposure to carcinogens.

Men and women are equally affected by the disease. Many issues like cigarette smoking, sedentary lifestyle, obesity, alcohol, exposure to carcinogens and an unhealthy lifestyle are major causes of cancer (Nichols, XXXXXXXXXXOther factors may include UV radiations exposure, air pollution and radon gas, HPV and infections, hormonal imbalances, hereditary transmission of mutated genes, and age. Cancer can be of many types depending upon the organ affected: like Breast cancer, Bowel cancer, Bladder cancer, Cervical, lung, kidney, skin, stomach or any other kind of cancer.

Population Demographics: North Dakota

As per the postulates of Gallup Healthways wellbeing Index 2013, North Dakota is the happiest state in the USA and it is a great place to settle down. The unemployment rate in ND is just 2.6% which is the lowest rate in the US (Census XXXXXXXXXXAround 25% people do agriculture and 90% of the land in the state is used for the farming purpose. The state excels in the production of spring wheat, durum wheat, lentils, beans, honey, and beef. The population consists of whites as a major community with most of the people just having high school or more degree (92%). The higher education levels are mere 28%. Total life expectancy in ND is 80 years and infant mortality rate around 16%. Cancer and Cardiovascular diseases are the top reasons for deaths in ND. These demographics are important because ND is a part of the developed country. It is smaller in size and sparsely populated with 90% of the land being used in farming. The quality of life is great because of all the available resources. The literacy rate is good, so most of the people have high school or more education level (Global Edge, 2018).

Objectives

1. To increase awareness about causes of Cancer in population.

2. To suggest ways to prevent Cancer and improving lifestyle

3. To establish free cancer screening and diagnosis centers.

Activities

Three Activities for Objective 1

1. Cancer Awareness Workshops: We can organize lively and practical cancer awareness training workshops at main parts of the state, providing the trainees all the tools and confidence to talk about cancer in the local area with other people. Cancer Awareness measures (CAM) i.e a set of questions designed to spread awareness about cancer, can be shared with people.

2. Online Courses: Free interactive courses can be planned online to give confidence and know-how about cancer myths and folk beliefs from facts. It will encourage healthy lifestyle changes.

3. Cancer Campaigns: Roadshows and hubs can attract huge crowds towards the content and programs.

Three Activities for Objective 2

1. Adopting a healthy lifestyle: Major health risks like alcohol, diet, active lifestyle and sun awareness must be informed to the public through campaigns and other initiatives.

2. To inform about Carcinogens and their possible exposure in daily life.

3. To help fight obesity and high BMI problems in children through college programs like quiz and contests.

Three Activities for Objective 3

1. Working in coordination with government policies to ensure the policies tackle the major health issues.

2. Installation of camps in popular urban and rural locations in the state to provide free cancer screening and diagnostic tests at least once a year.

3. To suggest Return on Investment (RoI) tools for decision makers of public health to model the impacts of interventions and to analyze the cost estimates against improvements and benefits.

References

Nicholes, H XXXXXXXXXXThe top 10 leading causes of death in the United States. Retrieved on 15 March 2018 from https://www.medicalnewstoday.com/articles/282929.php

Week 9 discussion

Developing Community Partnerships

For this week discussion I will select North Dakota as my focus point. North Dakota community is located in the Great Plains in the United States region. The Health Information Network at North Dakota provides secure and stable health information exchange platform. Even the Centre for Medicaid and Medicare services provides supportive and health IT infrastructure for growing exponential development of healthcare services. Quality healthcare for North Dakota needs to be provided for the people. With this community in place, the health care initiative can be handled well as stakeholder trust can be build, neutrality for competitive marketplace can also be maintained, engagement of stakeholders for healthcare network will provide effective care and even market the organizational culture as it innovates the ideas of the citizens as well ("Five Strategic Initiatives for North Dakota | North Dakota Office of the Governor", 2018).

North Dakota is dedicated towards working for the continuum of care and even behavioral health and addiction are the major factors to which they cater. North Dakota makes sure it does everything which fosters proper health initiative and even progresses towards health improvement. It is for this purpose that in the year 2017 comprehensive plan was prepared that could support all forms of behavioral health issues in the community and even cure people who were suffering from substance abuse. North Dakota has also tried its best to form a partnership with the tribal group so that issues if any can be handled with care and opportunity for government to government collaboration can also be provided at the same time. Activities in North Dakota is rigorous and even respectfully encourages people to admit all that they can work for better development (The North Dakota Health Information Network Business Plan, 2016).

References

Five Strategic Initiatives for North Dakota | North Dakota Office of the Governor. (2018).Governor.nd.gov. Retrieved 24 April 2018, from https://www.governor.nd.gov/five-strategic-initiatives-north-dakota

The North Dakota Health Information Network Business Plan XXXXXXXXXXpp XXXXXXXXXXRetrieved from https://www.nd.gov/itd/sites/itd/files/NDHealthIt/Resources/NDHIN%20Business%20Plan%20-%202016.pdf

John -

How much of a factor is the oil exploration that is happening in North Dakota; where the cost of living is increasing and need for healthcarehas risen?

Read this:

http://www.jamestownsun.com/news/ XXXXXXXXXXrising-costs

Dr. Moretz

11 days ago

Week 7 discussion

Effective Population Health Initiatives

For this week discussion on the Accountable Care Organizations I will be discussing Medicare Shared Savings Program. This program offers providers and suppliers (e.g., physicians, hospitals, and others involved in patient care) an opportunity to create a new type of health care entity. The Medicare Shared Savings Program is a voluntary program that encourages groups of doctors, hospitals, and other health care providers to come together as an ACO to give coordinated, high quality care to their Medicare patients. Within the shared saving program, the providers share in financial savings if they meet quality and cost benchmarks. Providers can also choose to share in losses in exchange for a higher percentage of shared savings.

The CMS is a program within the organization that promotes population health initiatives, as a health care payer, the Centers for Medicare and Medicaid Services (CMS) focuses primarily on health care delivery for it beneficiaries. The agency has, however, articulated a commitment to improving broader population health through the CMS Quality Strategy, which aims to "improve the health of the U.S. population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care. This vision reconciles the clinical and community perspectives on population health by considering the various populations to which an individual belongs as a series of concentric circles(New England Journal of Medicine. Jan 08, 2015.)CMS is working in each of these domains to encourage incremental progress toward population health.

For medical practices, which are structured around individual, face-to-face encounters, pursuing a population-based approach means considering what happens between visits; using patient registries and other tools to improve the use of preventive care services; addressing health disparities by considering social, economic, and cultural factors; and referring patients to a wider range of community services community resources and to assign community health workers to assist patients with translation, appointment scheduling, referrals, and transportation.

This organization promote best practices hire the appropriate staff, introduce new processes into workflow, manage technology and data, provide ongoing training and support, and create a sustainable program that will be able to promote population health.

In conclusion the Medicare Shared Saving Program is committed to achieving better health for individuals, better population health, and lowering growth in expenditures.

Reference;

https://www.usa.philips.com/healthcare/finance/reimbursement/aco-map

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/

https://search-proquest-com.ezp.waldenulibrary.org/docview/ XXXXXXXXXX?accountid=14872

http://medicaleconomics.modernmedicine.com/medical-economics/news/five-best-practices-population-health-success?page=0,1

McWilliams, J. M., Landon, B. E., Chernew, M. E., & Zaslavsky, A. M XXXXXXXXXXChanges in patients’ experiences in Medicare Accountable Care Organizations. New England Journal of Medicine, 371(18), 1715–1724.

Kassler, W. J., Tomoyasu, N., & Conway, P. H XXXXXXXXXXBeyond a traditional payer—CMS’s role in improving population health. New England Journal of Medicine, 372(2), 109–111.

RE: week 7 Discussion

COLLAPSE

John -

Thanks for your response but please give a practical example of an ACO and a program that the ACO is implementingthe shared savings program.

Dr. Moretz

John Boakai

Week 5 Discussion

COLLAPSE

The impact of social determinants on rural population health to understand this issue, we need to discuss what social determinants to health are. According to the (World health organization WHO) determinants of health are “the conditions in which people are born, grow, live, work and age.” (“About Social Determinants of Health”, n.d., para 1). There are four main types, or conditions, of social determinants, including: social and economic environments, the physical environment, a person’s individual characteristics and their behaviors. These social determinants, in turn, are chiefly responsible for the health inequities – the avoidable differences in health.

As the healthcare system’s responsibility expands beyond the clinic walls and into the community, the need to understand and address the social determinants of health has become a top priority.

Helping patients to overcome socioeconomic barriers to better health by spending more on community improvements can reduce downstream medical costs, found the Robert Wood Johnson Foundation in a recent study.

Income-level, educational attainment, race/ethnicity, and health literacy all impact the ability of people to access health services and to meet their basic needs, such as clean water and safe housing, which are essential to staying healthy. Rural residents are more likely to experience some of the contributing social factors that impact health, such as poverty. The impact of these challenges can be compounded by the barriers already present in rural areas, such as limited public transportation options and fewer choices to acquire healthy food.

These are some of the factors that determining impact on rural population health Income, employment, and poverty Educational attainment and literacy Race/ethnicity Sexual orientation/gender identity Health literacy Adequate community infrastructure, which can ensure public safety, allow access to media, and promote wellness Environmental health, including water quality, air quality, and pollution Access to safe and healthy homes, including issues related to energy costs and weatherization needs, lead-based paint, and other safety issues Access to safe and affordable transportation, which can impact both job access and healthcare access. Unsafe transportation, such as vehicles in poor condition, may increase risk of injury. Access to healthy and affordable food Access to healthcare services

As an administrator I think that the rural population health can be improve through the following means

Easy access to healthcare services availability to healthcare centers that is improving doctors to patient’s ratio, increasing per capital income, cost effectiveness healthcare services, accessible healthcare facility at affordable cost, promoting health and prevention of diseases by immunization of children and providing adequate medication to adult to prevent illness.

Another means is creating awareness by helping the rural population to develop healthy living habit, maintain hygiene in day to day activity, eating healthy food.

I believed the rural population will have a better health if they fallow these procedure with in their communities.

References;

https://healthitanalytics.com/features/what-are-the-social-determinants-of-population-health

https://axesspointe.org/social-determinants-impact-access-healthcare-patient-outcomes/

https://www.ruralhealthinfo.org/topics/social-determinants-of-health

Week 4 discussion

Social Determinants of Population health in Fargo, North Dakota

This assessment evaluates the social determinants of health in Fargo city and analyzes their impact on the outcomes of the population. The study determines the influence of ‘Education and Income’ on their present health condition and potential future implications to encourage adoption of good health practices.

Fargo is a city situated in Cass Province of North Dakota. Being one of the most populous cities in North Dakota, it has a population of around 120,762 people living in it according to census 2016. Most of the population comprises of Whites but migrants from diverse countries have also increased enormously since 2000. The households are smaller than other communities. It has comparatively higher number of youth enrolled in universities (17.5%) than other cities on North Dakota (US Census, XXXXXXXXXXHealthcare and social assistance offer the highest number of jobs in Fargo (US Census, 2002).

Implications of ‘Education level and Income’ over Health

The health standard of people in a city is affected by their behavior which is linked to the social or economic status of the families (i.e. education, job and married life) and environmental conditions (like poverty level and availability of resources). Social determinants of health are significant to assess the stability of a community as many diseases spread through physical contact. Moreover, there are many overlapping risks associated with certain groups.

Higher the education levels of people, greater the capability to acquire high paying jobs and better the health standard of the family. In Fargo, most of the people have education level greater than a high school degree but only one-fourth of the population has postgraduate degree qualification. However, more new generation youngsters are getting enrolled in universities. According to census 2000, Fargo has a population of 74,644 with age 15 years or more. Out of which 13,083 are enrolled in universities which are 17.5% rate. One out of three people in Fargo has bachelor’s degree. 34.4% of population greater than 25 years of age holds a graduate degree and 91% people hold a high school degree (US Census, XXXXXXXXXXAmong ethnic groups in Fargo, Asian and Pacific Island citizens have the highest rate of college enrollment (61%) with at least a graduate degree, while American Indians have the lowest rate of college enrollments (8%) for attaining a minimum degree (US Census, 2000).

Income distribution of Fargo reflects a total balance with the middle class of society with a median income range of $34-$52K. The median household income ($35,510) is less than other communities but the average size of the family is also smaller in Fargo. In racial groups, the American Indians have the lowest income ($17,738). The poverty rate in Fargo is 11.8% (US Census,2000) which is very less than many other communities in North Dakota. Less than 2 out of 10 children in Fargo are poverty affected (17.7%). This is a good indication of economic wellness of the city when compared to other communities (US Census,2000).

Fargo is economically well established with a high standard of living and quality of life. The access to healthcare facilities is feasible. Many Public health programs are there to encourage health awareness, nutrition, immunization, health inspections, family planning and environmental health. The development of these facilities is sure to increase in future, providing advanced healthcare services to the citizens.

References

US Census(2000).Understanding our community. Retrieved on 21 March 2018 fromhttp://download.cityoffargo.com/0/aboutcommunity.pdf

US Census XXXXXXXXXXEconomic sectors. Retrieved on 21 March 2018 fromhttp://download.cityoffargo.com/0/profile_2000_census_econ.pdf

Institute of Medicine US, XXXXXXXXXXThe Future of the Public's Health in the 21st Century. Washington (DC): National Academies Press (US); XXXXXXXXXXUnderstanding Population Health and Its Determinants.Available from: https://www.ncbi.nlm.nih.gov/books/NBK221225/

Song, R., Hall, H. I., Harrison, K. M., Sharpe, T. T., Lin, L. S., & Dean, H. D XXXXXXXXXXIdentifying the Impact of Social Determinants of Health on Disease Rates Using Correlation Analysis of Area-Based Summary Information.Public Health Reports,126(Suppl 3), 70–80.

REPLYQUOTE

John -

Thanks for your response.

I agree with the availability of jobs.

I think that there should a tiered system where jobs that do not pay enough for a "living wage" could be supplemented with state/federal funding until the person advances to a position with adequate funding. This would allow the person to remain in the workforce, keep Medicaid, and other necessary supplemental benefits until their income could replace these.

Thoughts?

Dr. Moretz

SHIFTING TOWARD POPULATION HEALTH

Summary of selected Health Initiatives in North Dakota, how they shift focus towards population health and Outcomes of the shift

Health initiatives are steps taken for the overall improvements of the prevailing health systems or the services provided by the healthcare organizations in a given area. According to Chowdhury (2016), health initiatives in the communities of the US have always aimed towards generating the cumulative outcome of creating awareness about any health problems, being active in mitigating or preventing them, maintenance of the overall well-being of the population and raising funds for supporting the required interventions. One such health initiative is the North Dakota State Health Improvement Plan related to the state of North Dakota, which brought about revolutionary benefits to the health outcomes of the people in that state.

For the identification of the impact and effectiveness of a health outcome upon the overall health standards of a state in the US, the health initiative– North Dakota State Health Improvement Plan has been selected. It is so because, according to Elliott et al. (2015), this plan was considered as the first of its kind to have shifted its focus from the health and well-being of the individual to the overall well-being of the population. It was named Healthy North Dakota, introduced by the Governor of North Dakota in 2002, inspiring every individual of the area to be health-conscious. According to this health initiative, irrespective of the age, gender or any characteristic division of the individual, they are required to take in healthy diet, exercise regularly, control alcohol and tobacco consumption (ND Health, XXXXXXXXXXIn other words, it can be stated that this initiative aimed mainly to inspire people to lead a healthier lifestyle.

The initiatives, which were under this plan, were to undertake the partnership of Statewide Vision and Strategy (SVS) and to implement selected prevention and wellness initiatives. As viewed by Satterfield (2016), these initiatives helped the people to consider the significance of shifting focus towards the population health than towards personal benefits, because these could modulate their perceptions towards health as a basic requirement.

The consequences of the shift were realized in the forms of an increased ownership and personal health responsibilities, establish better infrastructure for providing better quality of the healthcare services and implementing suitable medical technology. Hence, as perceived by Strand, Davidson and Schulze (2017), these outcomes could be considered as successful in affecting the health standards in the not

However, as argued by Adams et al. (2015), the benefit of Healthy North Dakota plan became even more overwhelming when the outcomes were realized on the international levels. It was found that the human resource was diversified, as the employees were being recruited on a global platform (ND Health, XXXXXXXXXXNot only that, the alignment of the financial resources made with health outcomes led to providing healthcare services to everybody, irrespective of whichever culture group, ethnicity, educational qualification, economic group, demographical or social group they belonged to. Hence, as a whole, the consequences of this shift can be inferred to be beneficial for population health.

References

Adams, D., Fullerton, K., Jajosky, R., Sharp, P., Onweh, D., Schley, A., ... & Kugeler, K XXXXXXXXXXSummary of notifiable infectious diseases and conditions—United States, 2013.MMWR Morb Mortal Wkly Rep,62(53), 1-122.

Chowdhury, P. P XXXXXXXXXXSurveillance for certain health behaviors, chronic diseases, and conditions, access to health care, and use of preventive health services among states and selected local areas—Behavioral Risk Factor Surveillance System, United States, 2012.MMWR. Surveillance Summaries,65.

Elliott, A. J., White Hat, E. R., Angal, J., Grey Owl, V., Puumala, S. E., & Baete Kenyon, D XXXXXXXXXXFostering Social Determinants of Health Transdisciplinary Research: The Collaborative Research Center for American Indian Health.International journal of environmental research and public health,13(1), 24.

ND Health, (2017)North Dakota State Health Improvement PlanRetrieved from https://www.ndhealth.gov/phsp/documents/ND_StateHealthImprovementPlan.pdf

Satterfield, D XXXXXXXXXXHealth promotion and diabetes prevention in American Indian and Alaska Native communities—Traditional Foods Project, 2008–2014.MMWR supplements,65.

Strand, M. A., Davidson, K. M., & Schulze, N XXXXXXXXXXLinking pharmacists to the delivery of public health services.Journal of the American Pharmacists Association,57(6), XXXXXXXXXX.

POPULATION HEALTH

Significance to address population health issues for healthcare administrators

Addressing the population health issues of a community or area having a specific for healthcare administrators because it helps to provide health and health services for all the people within the population, by distributing health amongst them equally. As mentioned by De Blok, Meijboom, Luijkx, Schols and Schroeder (2014), it also supports the cause of healthcare service provision that whether the services are generating beneficial outcomes or not. For example, Edgewood Vista is a local healthcare facility for elderly people that provide them assisted living at Fargo, North Dakota community (Edgewood Senior Living, XXXXXXXXXXHence, it serves the purpose of caring for elderly people in the population, so that health is distributed to them as well, along with addressing overall well-being of the population.

Being aware of health issues in community through sources

Information about the community health issues can be gained from both secondary and primary researches. Primary surveys can be conducted with the community members, their families and acquaintances to be aware of the standards of health and life within the community, while interviews could be conducted of the healthcare professionals to evaluate the issues which largely occur there (Tegegn, Yazachew & Gelaw, XXXXXXXXXXSecondary sources such as government report, community healthcare reports, reports by the local authorities and journal articles published for that community can impart authentic information. Within Edgewood Vista, it would be most appropriate to interview the care professionals and evaluate their previous health records to access information on health issues of elderly people.

Response of healthcare administration to population health issues

Healthcare administration responds to manage population health issues and reduce them by the active roles of the healthcare administrators, following the three-interrelated stages:

• Identifying and analyzing the distribution of health as well as its outcomes within the chosen population
• Identifying and evaluating the factors that have led to the current health situations or issues
• Identifying and implementing the required interventions in accordance with these issues, so that the factors could generate positive health outcomes (Watts et al., XXXXXXXXXX)

In the course of this response, healthcare administrators ensure patient safety, care quality, prevention of diseases and coordinating care.

Health initiative addressing a need in Fargo North Dakota community and population supported

Within Fargo at North Dakota, Edgewood Vista is taking care of the elderly people to live their lives in a better way through Assisted Living. They have taken up this initiative to keep the elderly people of the population healthy, to increase their life expectancy, to reduce the occurrences of health disorders in them and to help them live with their incurable health issues with the help of management of those diseases or Assisted Living (Edgewood Senior Living, XXXXXXXXXXFargo, North Dakota is a highly-populated city in the US, with more 10.1% of the community being comprised of people aged above 65 years and 8.3% people living devoid of their families as in 2010 (World Media Group, USA, XXXXXXXXXXTherefore, supporting the older population of this community was the most appropriate and effective step taken for population health initiative.

Role of healthcare facilities in community and its effects

Healthcare facilities in the community conduct multiple roles of healthcare service delivery that lead to the effects of either reduced occurrences of diseases in that area or prevention of infection. While organizations such as Edgewood Vista have provided elderly care to impact the well-being of older people in the community positively, Centers for Disease Control and Prevention (CDC) on the other hand, has played significant roles of reducing healthcare-associated infections at care organizations, create awareness against HIV, present vital signs to detect diseases, reduce cardiac issues through awareness, reduce smoking, screening of infants, maintain physical and mental health of children, prevent violence against them, reduce concussion amongst athletes as well as prevent parasitic infections (CDC, XXXXXXXXXXAt Fargo, North Dakota, CDC had run the anti-smoking campaign "Tips from a Former Smoker”, to yield positive impact of reducing more than $5 expenditure for hospitalization due to tobacco-related health issues (BreatheND, 2012).

References

BreatheND, (2012)North Dakotan Featured in CDC Campaign— The Great American Smokeout 2016Retrieved from http://www.breathend.com/news/NorthDakotanFeaturedinCDCCampaign/

CDC, (2013)CDC Looks Ahead: 13 Public Health Issues in 2013 | CDC Works For You 24/7 Blog | Blogs |CDC Retrieved from http://blogs.cdc.gov/cdcworksforyou24-7/2013/01/cdc-looks-ahead-13-public-health-issues-in-2013/

De Blok, C., Meijboom, B., Luijkx, K., Schols, J., & Schroeder, R XXXXXXXXXXInterfaces in service modularity: a typology developed in modular health care provision.Journal of Operations Management,32(4), XXXXXXXXXX.

Edgewood Senior Living, (2018)Welcome to: Edgewood in FargoRetrieved from https://edgewoodseniorliving.com/community/edgewood-vista-in-fargo-nd

Tegegn, A., Yazachew, M., & Gelaw, Y XXXXXXXXXXReproductive health knowledge and attitude among adolescents: a community based study in Jimma Town, Southwest Ethiopia.The Ethiopian Journal of Health Development (EJHD),22(3).

Watts, N., Adger, W. N., Agnolucci, P., Blackstock, J., Byass, P., Cai, W., ... & Cox, P. M XXXXXXXXXXHealth and climate change: policy responses to protect public health.The Lancet,386(10006), XXXXXXXXXX.

World Media Group, USA, (2018)Fargo, ND Income and CareersRetrieved from http://www.usa.com/fargo-nd-income-and-careers.htm#Poverty-Level

John -

Thanks for your response.

If you were conducting a survey in your communityrelated to health, what questions would you ask?

What do you anticipate the results would show?

Dr. Moretz

Week 10 Discussion

COLLAPSE

Best Practices in Global Population Health

The second-best healthcare practise in the world after France is carried out in the country of Ireland. A general practitioner visits in Ireland costs approximately €40 to €60. The Irish government in the year 2015 abolished charges for health treatment of children under the age of 6 years and people with medical card also receive the free GP medical assistance.

In most of the cases, people pay for the prescription from pharmacies at about €145 per month under the Drugs payment scheme but the medical card holders do not pay for the medical attention but only pay for the prescription, that also at a lower rate of €2.5 per item. Due to the benefits of the medical healthcare system, by the end of September 46% of the total population had health insurance which excludes the children below 6 years old. This means that each and every one would receive a private treatment at each and every hospital, be it private or public. (Humphries, N., Crowe, S., McDermott, C., McAleese, S., & Brugha, R. (2017).)

Ireland has more number of nurses than any other rich country in the world. In the year 2010 alone, Ireland spent more on healthcare for the individual than the whole European Union. A count of 680 people per doctor is available at Ireland which is higher than any other country in Europe. There are no social security contributions required to take advantage of the Ireland’s healthcare system. (Woods, N., Ahern, S., Burke, F., Eaton, K. A., & Widström, E XXXXXXXXXXThe unemployed in Ireland are eligible for free medical treatment if they fill the form E119 and students can fill out the form 109 for free medical support

References

Woods, N., Ahern, S., Burke, F., Eaton, K. A., & Widström, E XXXXXXXXXXThe healthcare system and the provision of oral healthcare in European Union member states. Part 7: Republic of Ireland.British dental journal,222(7), 541.

Humphries, N., Crowe, S., McDermott, C., McAleese, S., & Brugha, R XXXXXXXXXXThe consequences of Ireland’s culture of medical migration.Human resources for health,15(1), 87.