What were your funding sources?
Initially we had grant money from Allina Health. That was an arrangement made by our preventive cardiologist whose vision this project was. We supplemented it after studying strategies and deciding what we wanted to do in New Ulm; in working with the community to set that strategy, we looked for grant opportunities to do that. We have had a USDA grant and a CDC grant. Cindy mentioned the training opportunities; a lot of those were grant opportunities that our team and people in the community have been able to participate in. We also have moved over the last couple of years to a philanthropic approach, both through the Minnesota Heart Institute Foundation and through New Ulm Medical Center Foundation. We both dedicated money from our galas to the project; they have a golf tournament and money has gone to the project. We have also had private donors that are very interested in prevention, and have contributed to the project. So it has been a mix.

How are you working around HIPPA and confidentiality? Did you obtain consent from each of your individuals for your intervention?
Yes, 80% of the population in New Ulm has approved us using their information. We follow all HIPPA guidelines in all our projects and they all go through IRB as research projects, and are regulated that way. We were lucky. We came out into the community as a research project and have had very high success in people working with us, no matter whether it’s the electronic health record (HER), or completing surveys. People have been happy to be a part of it. They feel like this project has been a gift to them, and that they are making a difference in their community. They know that what we are learning in New Ulm will be used to disseminate and share with other communities and they feel excited about that opportunity to participate.

What have been the most successful forms of communication with the community?
We’ve tried to do all different types of communication and whenever we have an event we ask people how they heard about it. We use the newspaper; a lot of people in New Ulm still purchase the hard copy of the paper, and it’s also available online. We tried to do Twitter in New Ulm, but people here to do not Tweet! We do use Facebook. We do an annual report back to the community on what we have accomplished, and the changes we’ve observed. We create fact sheets for different audiences on various topics. More than one channel is not necessarily better than another; people see the messages in different locations and through different mechanisms. We’re trying to be strategic about how we message, and we do message testing to see what sorts of messages appeal to them most. We are constantly getting their input on it as well. We are kind of blanketing the community, and that repetition helps it to be successful.

Can you tell us what you did to find disease “hot spots?”
We are very fortunate to be able to use the EHR to help identify hot spots. It knows addresses and diagnostic codes. So we picked a few chronic disease diagnostic codes, and were able to use mapping to identify where the highest concentration of diagnoses were. We also have a very talented individual at New Ulm Medical Center that helps with that, and then Minnesota Heart Institute Foundation has a very deep area of expertise in data analysis which has also been very useful.

Do you utilize a Health Information Exchange (HIE) to gather data?
HIE has not matured to its full capacity yet in MN. There is some direct secure messaging that occurs in facilities and large organizations like Allina have complete exchange throughout their systems. But to exchange health information across organizations is not mature yet, vendors are coming and going, and we are working on it.

What “Walk Audit” assessment tool did you use?
Our experience is that what matters is having the right person leading the walk audit and being passionate about the environment. It’s more about how you feel walking in an area, not necessarily if sidewalks are wide enough or in good repair. It’s about whether you feel comfortable and safe, and if not, what’s preventing you from feeling that. Why do you avoid a particular area or choose not to cross a specific intersection? Often it’s the speed of traffic or the amount of traffic. Mark Fenton was our consultant on that and was very helpful.

What strategies can you recommend for community engagement (physicians, dieticians, specialists, pharmacies, restaurants, grocery stores), especially to target clients who are uninsured/underinsured?
As we mentioned previously we spend a great deal of time understanding the community through one on one interviews, focus groups, surveys, and listening sessions. We work to understand their motivation and their challenges and start where they are.  Where they want to start may not be where we would want them to start, but by providing that flexibility we are able to build their trust and a relationship so they are willing to gradually get to where we would like to be. That’s why getting a Complete Streets policy in place took four years. 

 

When working with the uninsured/underinsured we have found that they know what they need to be doing to improve their health, but other challenges in their lives prevent them from putting into practice their knowledge. Really listening to their needs – whether it is health related or not – is key. Working to improve and address their challenges will allow them to be able to focus their attention on their health down the road.  

When working on so many projects, coordination seems key. How are the specific interventions decided upon? Are they all decided by the full HONU partnership team?
Many of the specific interventions are determined by the assessments we have conducted in our community and the opportunities we see are available to us as well as the working to fill the gaps we have identified. Each action team is responsible for developing their specific interventions using the data we have collected and the evidence based or evidence informed strategies available. We tend to pick the low hanging fruit to begin with so we have early success and create a level of confidence within the action team members. The interventions are then shared with the HONU Leadership team for their guidance and approval. That is why capacity building with action team members is so critical. The team members understand what strategies have worked in other locations and we adapt them to work in New Ulm.