Appendix 2: MAPP Core Indicators, 2008 Marion County Community Health Assessment

Appendix II: MAPP Core Indicators

The following was extracted from the National Association of County and City Health Officials (NACCHO) MAPP website, http://www.naccho.org/topics/infrastructure/mapp/upload/chsa.pdf, in July 2007.

Mobilizing for Action through Planning and Partnerships (MAPP) is a community-wide strategic planning tool for improving community health, prioritizing public health issues and identifying resources for addressing them.

The Marion County Community Health Assessment Report focuses on core indicators, or data elements that MAPP recommends all communities collect and track. The indicators are cross-referenced with other major public health initiatives, including 25 indicators recommended by the Institute of Medicine and adopted by HRSA for funding of county--level health programs. The MAPP process recommends collecting trend data over five years and comparison data for state, national, and, as relevant, peer-county data to highlight the community’s outstanding health issues. The core indicators used in the CHA all have national or comparative population goals or values to provide a context for their interpretation.

A complete outline of the MAPP assessment and health planning process may be found in the NACCHO publication Achieving Healthier Communities through MAPP: A Users Handbook, available at http://www.naccho.org/pubs/product1.cfm?Product_ID=66.

Category One: Demographic Characteristics

Category Definition: Demographic characteristics include measures of total population as well as percent of total population by age group, gender, race and ethnicity, where these populations and subpopulations are located, and the rate of change in population density over time, due to births, deaths and migration patterns.

Category Two: Socioeconomic Characteristics

Category Definition: Socioeconomic characteristics include measures that have been shown to affect health status, such as income, education, and employment, and the proportion of the population represented by various levels of these variables.

Core Indicators

· Employment – Percent Unemployed

· Percent Below Poverty Level

o Children

o Families

o Total

· Median Household Income

· Ratio of students graduating who entered 9th grade 3 years prior

· Special Populations

o Migrant persons

o Homeless persons

o Non-English speaking persons

· Persons aged 25 and older with less than a high school education

· Persons without health insurance

· Single parent families

Category Three: Health Resource Availability

Category Definition: This domain represents factors associated with health system capacity, which may include both the number of licensed and credentialed health personnel and the physical capacity of health facilities. In addition, the category of health resources includes measures of access, utilization, cost and quality of health care and prevention services. Service delivery patterns and roles of public and private sectors as payers and/or providers may also be relevant.

Core Indicators

· Medicaid eligibles to participating physicians

· Licensed dentists: rate total population (CHSI Report)

· Licensed primary care physicians (general practice, family practice, internal medicine, obstetric, gynecologic, and pediatric): rate total population (CHSI Report)

· Licensed hospital beds: total, acute, specialty beds; rate total population (and occupancy rate)

· Visiting nurse services/in home support services: rate total population

· Proportion of population without a regular source of primary care (including dental services)

· Per capita health care spending for Medicare beneficiaries (the Medicare adjusted average per capita cost)

· Local health department full-time equivalents employees (FTEs): number per total population

· Total operating budget of local health department: dollars per total population

Category Four: Quality of Life

Category Definition: Quality of Life (QOL) is a construct that “connotes an overall sense of well-being when applied to an individual” and a “supportive environment when applied to a community” (Moriarty, 1996). While some dimensions of QOL can be quantified using indicators research has shown to be related to determinants of health and community-well being, other valid dimensions of QOL include perceptions of community residents about aspects of their neighborhoods and communities that either enhance or diminish their quality of life.

Core Indicators

· Proportion of persons satisfied with the quality of life in the community (IOM, 1997)

· Proportion of adults satisfied with the health care system in the community (IOM, 1997)

· Proportion of parents in the PTA

· Number of openings in child care facilities for low income families

· Number of neighborhood crime watch areas

· Civic organizations/association members per 1,000 population

· Percent of registered voters who vote

Category Five: Behavioral Risk Factors

Category Definition: Risk factors in this category include behaviors which are believed to cause, or to be contributing factors to, injuries, disease, and death during youth and adolescence and increased morbidity or mortality in later life.

The indicators below correlate with information found in the Behavioral Risk Factor Surveillance System (BRFSS). For more information, go to http://www.cdc.gov/nccdphp/brfss/pdf/userguide.pdf.

General Risk: For each of the following, look at risk by percent of total population, by subgroups: age, gender, race, ethnicity, income, education (as appropriate to describe prevalence and to design appropriate subgroup interventions)

Core Indicators

Substance Use and Abuse

· Tobacco use*

· Illegal drug use

· Binge drinking

Lifestyle

· Nutrition

· Obesity

· Exercise

· Sedentary lifestyle

Protective Factors (safety)

· Seatbelt use

· Child safety seat use

· Bicycle helmet use

· Condom use

Screening

· Pap Smear (Percent of age-specific female population)

· Mammography (Percent of age-specific female population

Category Six: Environmental Health Indicators

Category Definition: The physical environment directly impacts health and quality of life. Clean air and water, as well as safely prepared food, are essential to physical health. Exposure to environmental substances such as lead or hazardous waste increases risk for preventable disease. Unintentional home, workplace, or recreational injuries affect all age groups and may result in premature disability or mortality.

Core Indicators

· Air quality - number and type of U.S. Environmental Protection Agency air quality standards not met (IOM, 1997; CHSI Report)

· Water quality - proportion of assessed rivers, lakes, and estuaries that support beneficial uses (e.g., fishing and swimming approved) (IOM, 1997)

· Indoor clean air - Percent of public facilities designated tobacco-free

· Workplace hazards - Percent of OSHA violations

· Food safety – food-borne disease: rate per total population (CHSI Report)

· Lead exposure - Percent of children under 5 years of age who are tested and have blood levels exceeding 10mcg/dL

· Waterborne disease: rate per total population

· Fluoridated water - percent total population with fluoridated water supplies

· Rabies in animals: number of cases

Category Seven: Social and Mental Health

Category Definition: This category represents social and mental factors and conditions, which directly or indirectly influence overall health status and individual and community quality of life. Mental health conditions and overall psychological well-being and safety may be influenced by substance abuse and violence within the home and within the community.

Core Indicators

· During the past 30 days, average number of days for which adults report that their mental health was not good (IOM, 1997) (See Category 9 for similar question regarding physical health)

· Number and rate of confirmed cases of child abuse and neglect among children (IOM, 1997)

· Homicide rate: age adjusted; total, white, non-white (IOM, 1997, CHSI Report)

· Suicide rate: age adjusted; total, white, non-white; teen suicide (IOM, 1997, CHSI Report)

· Domestic violence: rate per total population

· Psychiatric admissions: rate per total population

· Alcohol related motor vehicle injuries/mortality: rate per total population

· Drug-related mortality rate

Category Eight: Maternal and Child Health

Category Definition: One of the most significant areas for monitoring and comparison relates to the health of a vulnerable population: infants and children. This category focuses on birth data and outcomes as well as mortality data for infants and children. Because maternal care is correlated with birth outcomes, measures of maternal access to, and/or utilization of, care is included. Births to teen mothers is a critical indicator of increased risk for both mother and child.

Core Indicators

· Infant mortality (death within 1st year): total, white, non-white rate per 1000 live births (IOM, 1997, CHSI Report)

· Entrance into prenatal care in 1st trimester: Percent total, white, non-white per live births

· Births to adolescents (ages 10-17) as a proportion of total live births (IOM, 1997, CHSI Report)

· Adolescent pregnancy rate (ages 15-17)

· Very low birth weight (less than 1,500 grams): Percent total live births, white, non-white (CHSI Report)

· Child mortality: rate per population age 1-14 / 100,000

· Neonatal mortality: total, white, non-white, rate per live births

· Post Neonatal mortality: total, white, non-white rate per live births

Category Nine: Death, Illness, and Injury

Category Definition: Health status in a community is measured in terms of mortality (rates of death within a population) and morbidity (rates of the incidence and prevalence of disease). Mortality may be represented by crude rates or age-adjusted rates (AAM); by degree of premature death (Years of Potential Life Lost or YPLL); and by cause (disease - cancer and non-cancer or injury - intentional, unintentional). Morbidity may be represented by age-adjusted (AA) incidence of cancer and chronic disease. Adjustment on rates should use projected Year 2000 standard population.

Core Indicators

· General health status (percent respondents reporting their health status as excellent, very good, good, fair, poor) (IOM, 1997, CHSI Report) (See Category 7 for similar question regarding mental health)

· Average number of sick days within the past month (CHSI Report)

Mortality (Age adjusted rates)

Note: Adjustment on rates should use projected Year 2000 standard population.

· All causes: AAM, total, by age, race, and gender (CHSI Report)

· All cancers: AAM, total, white, non-white (CHSI Report)

· Unintentional Injuries: Total, by age, race, and gender (CHSI Report)

· Years of Productive Life Lost (YPLL): number of YPLL under age 75 per population (total, white, non-white)

· Breast cancer (IOM, CHSI Report)

· Lung cancer (IOM, CHSI Report)

· Cardiovascular disease (IOM, 1997, CHSI Report)

· Motor vehicle crashes (IOM, 1997, CHSI Report)

· Cervical cancer

· Colorectal cancer (CHSI Report)

· Chronic obstructive lung disease

· Chronic liver disease and cirrhosis: AAM, total, white, non-white

· Diabetes mellitus: AAM, total, white, non-white (CHSI Report)

· Pneumonia/influenza: AAM, total, white, non-white

· Stroke: AAM, total, white, non-white (CHSI Report)

Category Ten: Communicable Disease

Category Definition: Measures within this category include diseases which are usually transmitted through person-to-person contact or shared use of contaminated instruments / materials. Many of these diseases can be prevented through a high level of vaccine coverage of vulnerable populations, or though the use of protective measures, such as condoms for the prevention of sexually-transmitted diseases.

Core Indicators

· Proportion of 2-year old children who have received all age-appropriate vaccines, as recommended by the Advisory Committee on Immunization Practices (IOM, 1997)

· Proportion of adults aged 65 and older who have ever been immunized for pneumococcal pneumonia (IOM, 1997)

· Proportion of adults aged 65 and older who have been immunized in the past 12 months for influenza (IOM, 1997, CHSI Report)

· Vaccine preventable: Percent of appropriately immunized children/population

· Syphilis (primary and secondary) cases: reported incidence by age, race, gender (IOM, 1997 CHSI Report – number of cases)

· Gonorrhea cases: rate total population

· Chlamydia: reported incidence

· Tuberculosis: AAM, reported incidence by age, race, and gender (IOM, 1997, CHSI Report – number of cases)

· AIDS: AAM, reported incidence by age, race, gender (IOM, 1997, CHSI Report – number of cases)

· Bacterial meningitis cases: reported incidence

· Hepatitis A cases: reported incidence (CHSI Report – number of cases)

· Hepatitis B cases: reported incidence (CHSI Report – number of cases)

· Hepatitis C cases: reported incidence

Category Eleven: Sentinel Events

Category Definition: Sentinel events are those cases of unnecessary disease, disability, or untimely death that could be avoided if appropriate and timely medical care or preventive services were provided. These include vaccine-preventable illness, late stage cancer diagnosis, and unexpected syndromes or infections. Sentinel events may alert the community to health system problems such as inadequate vaccine coverage, lack of primary care and/or screening, a bioterrorist event, or the introduction of globally transmitted infections.

Core Indicators

Vaccine preventable disease

· Measles: number and rate/total population (CHSI Report – number of cases)

· Mumps: number and rate/total population

· Rubella: number and rate/total population (CHSI Report – number of cases)

· Pertussis: number and rate/total population (CHSI Report – number of cases)

· Tetanus: number and rate/total population

Other

· Percent late stage diagnosis cancer – cervical

· Percent late stage diagnosis cancer – breast

· Number of deaths or age-adjusted death rate for work-related injuries (IOM, 1997)

· Unexpected syndromes due to unusual toxins or infectious agents, possibly related to a bioterrorist event (i.e., smallpox, anthrax)