Assessment of Community Health Plans Provides Feedback to Improve U.S. Army Injury Prevention

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Community Health Improvement Planning has been shown to be an effective mechanism for communities to address their pressing health concerns. However, many struggle with the strategic planning process and do not have the means for quality improvement.

DISCLAIMER: The views expressed in this document are those of the author(s) and do not necessarily reflect the official policy of the Department of Defense, Department of the Army, U.S. Army Medical Department or the U.S.

Community coalitions are a well-established framework to effectively address complex community health issues by facilitating collaboration across diverse partners. Community coalitions are required by U.S. Army regulation. Specifically, each U.S. Army installation must establish a Commander’s Ready and Resilient Council (CR2C) to oversee and monitor health initiatives supporting the installation community. The CR2Cs integrate organizations on an installation to develop strategic action plans that address the top public health concerns of that community. In 2015, the U.S. Army Medical Command (MEDCOM) directed the formation of Injury Prevention Teams to support CR2Cs. The teams were responsible for developing community health improvement plans to prevent injuries at their local U.S. Army Installation.

However, communities can struggle to build robust health improvement plans without technical assistance, objective standards to meet, and quality improvement feedback to drive and sustain change. Use of the Plan Quality Index (PQI) allowed the U.S. Army to implement an evidence-based quality improvement process. Implementation of the PQI as part of a technical assistance model for U.S. Army installations resulted in identification of characteristics of strong and weak health plans and enabled adjustment of plans to better achieve success.

The U.S. Army active-duty military is an example of a population with a critical public health problem, injuries, that would benefit from a routinely-applied strategic planning process to address injuries at organizational, community, environmental, and cultural levels. To assist with development of high-quality plans, the U.S. Army Public Health Center (APHC) Injury Prevention Branch and Directorate of Health Promotion and Wellness initiated a quality review of installation Injury Prevention Team plans. As a result of this project, seventeen teams were provided with recommendations for quality improvement efforts in their community health action planning cycle. The PQI is a means by which other health improvement teams can facilitate quality improvement in their community health planning efforts as well.

Major Findings:

  • The mean overall PQI score for high-ranking plans (64.6±9.5) was significantly higher than the mean score for low-ranking plans (26.2±12.7; p<0.001).
  • High-ranking plans were twice as likely to include the following key components: goals, objectives, SMART objectives, activities, identified responsible parties, population of interest, timelines, and evaluation plans (p<0.001; risk ratio: 2.0, 95% CI: 1.4-2.9).
  • The weakest planning components among all plans were lack of use of SMART objectives (18%), lack of identification of responsible parties (18%), missing evaluation plan (24%), and lack of specific timelines (35%).

Why this is important:

  • Evidence suggests that well-developed health improvement plans (ie, “action plans”) are more likely to achieve identified goals and objectives.
  • Individualized PQI assessments provided guidance to improve action plans.
  • The use of the PQI tool introduced a standardized assessment, enabled tailored feedback for each installation, and improved technical support to the field.
  • PQI implementation and quality review processes assisted U.S. Army installations in enhancing their community health planning, establishing a foundation to address a leading military health issue.

Read our paper in the Journal of Public Health Management and Practice:

References:

  1. Center for Prevention Research and Development. 2006. Evidence-Based Practices for Effective Community Coalitions: A Summary of Current Research. Champaign, Illinois: Center for Prevention Research and Development, Institute of Government and Public Affairs, University of Illinois.
  2. Courie AF, MS Rivera, and A Pompey. 2014. Managing Public Health in the Army Through a Standard Community Health Promotion Council Model. AMEDD Journal. Jul-Sep:82–90.
  3. Butterfoss FD, RM Goodman, and A Wandersman. Community Coalitions for Prevention and Health Promotion: Factors Predicting Satisfaction, Participation, and Planning. Health Educ Q. 1996;23(1):65–79.
  4. Dunet DO, Butterfoss FD, Hamre R, Kuester S. Using the State Plan Index to Evaluate the Quality of State Plans to Prevent Obesity and Other Chronic Diseases. Prev Chronic Dis. 2005;2(2):A10.
  5. Butterfoss FD, Dunet DO. State Plan Index: A Tool for Assessing the Quality of State Public Health Plans. Prev Chronic Dis. 2005;2(2):A15.

Dr. Anna Courie serves as the Director of Responder Wellness for a national organization. She has worked for over 25 years in the healthcare profession including Intensive Care, Army Public Health, Health Promotion practice, and integration of public health strategy across disparate organizations to achieve health improvement goals.

Dr. Michelle Canham-Chervak is the Injury Prevention Branch Chief, Defense Centers for Public Health-Aberdeen (formerly U.S. Army Public Health Center). With over 25 years in the field of public health, she is trained in occupational injury epidemiology and has served as an injury epidemiologist and strategic initiatives lead for Department of Defense and U.S. Army projects. Drs. Courie and Chervak worked closely to execute the unique military public health initiative described in this article.

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