Can quality improvement models work on a community level?

The overall goal of the Community Transformation Grants (CTG) is to reduce rates of adult obesity, tobacco use, and death and disability due to cardiovascular disease. The Massachusetts Department of Public Health (MDPH) was awarded 2 CTG which have provided the opportunity to develop a continuous quality improvement process for 52 funded communities. Individualized community progress reports were developed as a way to create uniform measures of effectiveness and set process targets, as well as community health goals. MDPH compiled data from 14 data sources to develop feedback reports for annual distribution. Small area estimation was used to calculate community-level estimates of three modifiable chronic disease risk factors: nutrition, physical activity, and smoking; and three chronic disease outcomes: hypertension, obesity, and heart disease. To provide a community-specific picture of the environment, data was collected on neighborhood walkability, park safety, and availability of healthy foods in local food stores and restaurants. In January 2013, MDPH distributed Progress Reports to all funded communities. Nearly all report functions were compiled using an automated process. Preliminary data has shown clear differences between communities in both walkability and healthy food availability. These reports can be used not only to inform progress and adjust activities in order to meet program objectives, but also to measure the impact of activities on vulnerable populations and ensure focus on health equity. Coordinators can use information provided annually to improve implementation of initiatives based on the current availability of healthy foods, walkability and demographic makeup of their communities.