Assessing the Public Health System in Delaware

Assessment Results

Essential Public Health Service #7:
Link People to Needed Personal Health Services and Assure the Provision of Health Care when Otherwise Unavailable

On May 10, 2006, an Assessment Team including representatives from non-profit advocacy agencies, parent advocates, Department of Education (DOE), legislature, the Delaware Health Care Commission, and Division of Public Health (DPH) assessed how the public health system performs Essential Service #7: Link People to Needed Personal Health Services and Assure the Provision of Health Care when Otherwise Unavailable. This service includes assessment of access to and availability of quality personal health care services, partnership with public, private, and voluntary sectors to provide a coordinated system of health care, and development of a continuous improvement process to assure the equitable distribution of resources for those in greatest need.

The Assessment Team looked at four activity categories including:

1. planning and implementation;
2. technical assistance and support;
3. evaluation and quality improvement; and
4. resources.

The Team identified a number of gaps in the public health system performance of this essential service in Delaware. A consensus agreed that the statewide public health system is currently performing in the bottom quartile of the model standard for Essential Service #7.

The Assessment Team rated the Delaware public health system as having partially met the model standard in the areas of planning/implementation and in technical assistance/support. Under planning/implementation, Delaware public health system partners are fairly strong at:

1. collaborating to identify medically underserved populations and
2. in delivering services and programs to improve access to personal health care.

Under technical assistance/support, Delaware health care partners work effectively to coordinate complementary programs to optimize access to needed services.

The Team identified noticeable gaps in the areas of evaluation/quality improvement and resources. Gaps included:

1. limited review of programs to assure provision of personal health services;
2. limited inclusion of perspectives of those who experience problems with accessibility and availability of health care;
3. lack of a designated entity to monitor state-wide personal health care delivery; and
4. a limited workforce skilled in reviewing and managing health services quality improvement.

Evaluation of the Assessment Process:

Members of the Assessment Team felt the public hearing information was very helpful and they appreciated the interaction and openness throughout the session. The process and the format of the assessment were well received, but the topics were quite broad and it was difficult to stay focused especially since some of the questions appeared obtuse or open to interpretation.

Sharing of Final Thoughts

This session helped participants to recognize how large the public health system is in Delaware and how perspectives vary among the partners. Consumers and family members look at things differently than agencies, and participants acknowledged the difficulty in focusing on a comprehensive plan when dealing with immediate needs. There was frustration with traditional views and advisory councils that listen but then don’t use what they hear. This is a time for closer public/private partnerships and a paradigm shift.

Priority List

Each member of the Assessment Team was asked to vote on a scale of 1 - 10 on the importance and priority of each of the four activity categories. These are the resulting scores along with the summary of strengths (in italic) and gaps (in bold) that were identified during the public testimony:

7.1 Planning and Implementation (score – 9)

• Community Partnerships
• Lack of computerized planning
• Lack of community resources
• No capacity to ensure optimum care
• Lack of grassroots outreach
• Poor planning – silos
• Lack of consumer involvement with planning
• Administrative processes that make it hard to partner with state for provision of care
• Need to involve the consumer –often the consumer is not involved
• Lack of providers especially mental health & substance abuse.
• Specific barriers to Substance and Mental Wellness
• No walk-in, long wait, inconvenient hours of operation, cultural beliefs, etc
• Workforce skills
• Competitive issues - procurement laws 

7.2 Technical Assistance/Support (score – 3)

• Teaching hospitals
• Community groups
• Un of DE
• DEMS – this is for medical care
• Community resources
• Lack of funding
• Lack of resources to link services,
• No training or lack of training to provide technical support
• Silos
• Poor infrastructure system

7.3 Quality Improvement/Evaluation (score – 7)

• U of DE – studies, surveys, etc … what happens with the information??
• Individual systems do well
• Grant requirements contract – more stringent
• Changes were made – guidelines such as tobacco, cancer, diabetes (screening)
• What happens to the information – once surveyed?
• Do we have report cards??
• Standard language – boilerplate  - no accountability
• Procurement laws –
• Systems - fragmented
• No encouragement for health prevention
• Delivery of care issues
• Safety-net issues
• Lack of consumer involvement with planning
• Dental care issues
• Who is assuring coordination – participants with providers

7.4 Resources (score – 8)

• CHAP – served over 10,000 – integrated system that links patients to service
• Federal $$
• Nurse in every public school in DE
• Health van, CHIP, wellness centers
• Shortage of cash flow – waiting to be reimbursed
• Lack of transportation especially in Sussex County
• Lack of community resources; resource allocation
• Unfunded mandates
• No insurance
• Lack of funds, support systems
• Inconvenient office hours
• Competitive nature – geographic, limited resources
• Lack of support home, respite care, dental care, location (safe environment)
• Case management virtually impossible – referrals fail for many reasons such as transportation issues – 75% of referral not guided to care

Next Steps:

Once the discussion and reports from this meeting are shared with the group, several participants mentioned a need for a system-wide approach that would foster inter-agency cooperation and sharing. One participant expressed the need to bring more consumers, families, and direct care providers to the table. We will keep the team apprised of the remaining assessment processes and future improvement planning meetings.

• Go back to 2006 Assessment Meetings and Summaries

Last Updated: Wednesday July 11 2007