The Community Health Improvement Process for Montgomery County, Maryland
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Editorial Policy

Introduction

The 'Healthy Montgomery' website is intended to be a place where community members and policy makers can learn about the overall health of the residents in Montgomery, Maryland. It is a website dedicated providing local health data, resources, promising best practices, news articles, and community events. In keeping with our mission and values, it is important that the site provide balanced information on a broad range of topics affecting the health of our community and highlight the assets in our community. 

These editorial guidelines are written to provide background on the different features of the site, how the content of the site is selected and managed, and describe the governing body of the site.

Advertising 

No advertising will be permitted unless the governing body approves it.

Governing Body 

The Montgomery County Department of Health and Health and Human Services (DHHS), in conjuncture with hospitals and other health and social services agencies in Montgomery County, has established a Community Health Improvement Process (CHIP). The CHIP governing body reviews the news articles, promising practices, featured content and calendar of events, and strives to ensure balanced content. The governing body and the Healthy Montgomery Website do not endorse or advocate any political initiatives or political figures.

Community Indicator Data

What is it: Community indicators provide a measure of how our community is doing. For each indicator, the actual value is shown as well as information about how we are doing compared to other geographic areas (the red-yellow-green gauge) or how we are doing measured over time (green or red up and down arrows) or how we compare to a national or state average (blue/white or tri-color gradation gauge) to give some context to the information. It is important to remember that while we may be doing better on some indicators than other parts of the country or compared to a state or national average, that does not mean that we should not be working to improve all indicators. 

Each indicator is described, links are provided for data sources, and information is given on what the values mean. Some of these indicators are maintained by the Healthy Communities Institute (HCI) based on national and statewide data, while others are managed by our governing body.

The primary aims of the indicator system are to inform and facilitate positive change. We therefore must provide accurate, reliable, and timely data at a geographically-meaningful level. We accomplish this by selecting sources of data that meet the following criteria:
• a validated methodology for data collection and analysis
• scheduled, regular publication of findings
• focus on data values for small geographic areas, such as counties and postal codes that are available for all county-level locations in Maryland or the U.S or locally through our community partners

Methods

Through the Healthy Communities indicator system, community members have easy access to critical information about their community. The status of the community can be displayed in several ways that are easy to understand.

Regional Comparison Indicators

For indicators that are meaningfully displayed as an objective value that can be compared to other communities, the local value is assigned a status (green = excellent, yellow = fair, or red = poor) based on how the local value ranks in comparison to other communities. These indicators compare a community's measure to a distribution of other relevant geographies. For indicators where a high value is good, indicators are assigned green values if the value is better than or equal to the 50th percentile, yellow if the value is between the 50th percentile and the 25th percentile, and red if the value is less than the 25th percentile. In this ranking approach, the median is the value that provides the cut-off between the green and yellow ranking.

Regional Comparison Indicator Example: The infant mortality rate in all 3077 US counties is collected and the rate of infant mortality (number of infant deaths/100 births) is entered in a spreadsheet. The rates are ordered from lowest to highest. The 50th percentile or median value is the rate of the 1,539th value in the list of values (3077 / 2 = 1538.5, standard rounding rules round the number to 1539).Often the distribution of counties within a state or other regions must be used instead of US counties because the data is not available nationally. The cut-off point between yellow and red is the 75th percentile, or the 2,309 value in the list of values.

Average Comparison Indicators

For indicators that are not meaningfully displayed as an objective value (i.e. median home value) or where we do not have values for other communities, but do have a national or state mean value, the blue/white indicator dial (if direction does not matter) or tri-color dial (if direction matters) simply shows how our community compares nationally or statewide. This indicator is a useful way to present community data compared to the state or national median or mean value and allow the user to interpret the local indicator value.

Average Comparison Indicator Example: In a community the median home price is above the median home value compared to 23 other counties in the state. The fact that the median home value is above the median can be interpreted in two ways, depending on the end-users perspective: if you are selling your home, high median values may be a beneficial, but if you are trying to purchase a home, high median values may be a negative.

Time Period Comparison Indicators

These indicators show how an outcome varies over a significant amount of time, a commonly accepted period in the field, as indicated in the description. These indicators have three states: getting better, getting worse, or stayed the same. These indicators are typically used when distribution data is not available to calculate a comparison distribution or when trend data seems more relevant and important on an issue than comparison to other locales. They are also useful to highlight when a measure compares favorably to other communities, but the measure is actually moving in the wrong direction.

Time Period Comparison Indicator Example: In community A, the % of the population that is overweight or obese is 50.5% and this percentage has been growing over the last three years. The yearly percentages exceed the CDC 2010 Healthy People goal for healthy weight (<40% of adult population overweight or obese), though the local value (50.5%) is still better than the median value where 61.3% of adult population is overweight or obese in the state. In this case, a time period comparison indicator can be used to show that the community trend is increasing and there is a growing percentage of the adult population that is either overweight or obese.

Community Indicator Data Standards:

1. Data must be scientifically collected using quality research standards and/or be peer reviewed.
2. Data from academic institutions or government entities is preferred
3. Service statistics from local agencies are not typically scientifically collected data. This information can be incorporated into the site in other areas, but not usually as community indicators
4. The source of the data is identified and if a conflict of interest could exist on the part of the data collector, that will be clearly noted, e.g. a data collector with a commercial interest in the data.

Criteria for consideration of proposed new indicators:

1. Does it add value? (Does it fill a gap? Is it a good enough proxy measure for an area for which we want an indicator? Is it better than a current indicator?)
2. Dependable updates? (Is there the capacity for ongoing measurement?)
3. Is it scientifically valid? (Has it undergone a peer review process?)
4. Is the data available - both a value for our county and some comparison data?

Promising Practices

What is it: Databases of promising practices and articles and literature are both initially populated by a database of national resources created by the Healthy Communities Institute. In our local communities, we have the opportunity to add local content to these sections. The sources include health departments, federal agencies, universities, and community organizations--not individuals.

Adding a promising practice: Our governing body will consult with community experts/leaders in the topic area to determine the appropriateness of adding local promising practices. Again, we will use the four central questions as part of determining appropriateness of content: Does it add value or fill a gap? Are there dependable mechanisms to keep the content current? Is it valid and credible? Is it available?

The intervention must be community-focused, health related, effective, and an evidence-based practice. The research and/or evaluation process must be rigorous and the results statistically significant.

Feature Articles

What is it: on the home page, we post local feature articles and stories on topics that enhance, analyze and provide deeper understanding of the community health indicator data, potentially promising practices, and community assets. Feature articles may be as simple as linking to existing web articles about a particular issue along with a brief article that relates to local assets or indicators or they may be completely written and created locally. Feature articles are generally rotated on a weekly basis with an eye to providing a diverse array of stories with a local emphasis.

Adding feature articles: The site administrator, in consultation with the governing body, will choose the feature articles based on what they deem important local health news.

Featured Content

What is it: on the home page we highlight a local health program and provide relevant website and resources for that program.

Adding featured content: The site administrator, in consultation with the governing body and other local health leaders, will choose the featured content. 

Community Events

Healthy Montgomery provides access to a variety of community calendars. These calendars offer information on health fairs, health classes and lectures, screenings, or other relevant events.

Local Resources

The local resources section provides a comprehensive community services search tool that connects residents of Montgomery to important local health services. This section is populated with resources from infoMontgomery resource tool.

Resources

Links to government sites, academic centers, and some community-based organizations and foundations will be permitted only if the other site includes health-related information and data. Links will not be provided to advocacy organizations and organizations that offer or support products or services that are detrimental to health, such as tobacco products.

Website Survey

What is it: Website survey questions are non-scientific polls to gather information about how well the 'Healthy Montgomery' website is serving its audience.

Adding website survey: The site administrator will manage this tool.