The Role of EIS in Communities of Solution: Using GIS and Epi to Activate Health Partnerships Alexander D. Langmuir Lecture, CDC

Transcription

1 The Role of EIS in Communities of Solution: Using GIS and Epi to Activate Health Partnerships Alexander D. Langmuir Lecture, CDC Bob Phillips, MD, MSPH Vice President for Research & Policy American Board of Family Medicine

2 Primary Care and Public Health Exploring Integration to Improve Population Health Public Release March 28, 2012 Paul Wallace, M.D. Committee Chair

3 Committee s Charge Identify the best examples of effective primary care and public health integration and the factors that promote and sustain these efforts. Examine ways by which HRSA and CDC can use provisions in the ACA to promote the integration of primary care and public health. Discuss how HRSA-supported primary care systems and state and local public health departments can effectively integrate and coordinate around specific topics.

4 Why Integrate? A wide array of public and private actors across the nation contribute to the health of populations Achieving substantial and Achieving substantial and lasting improvements in lasting improvements in population health will require a concerted effort aligned under a common goal population health Integration of primary care and public health could enhance the capacity of both sectors to carry out their missions and link with other stakeholders to catalyze a collaborative, intersectoral movement toward improved population health

5 Findings and Conclusions The committee finds that in its current state, the infrastructure for both primary care and public health is inadequate to achieve the nation s population health objectives.

6 Recommendation 3 To develop the workforce needed to support the integration of primary care and public health: HRSA and CDC should explore whether the training component of the Epidemic Intelligence Service (EIS) and the strategic placement of assignees in state and local health departments offer additional opportunities to contribute to the integration of primary care and public health by assisting community health programs supported by HRSA in the use of data for improving community health.

7 Recommendation 3 (cont d) To develop the workforce needed to support the integration of primary care and public health: HRSA and CDC should create all possible linkages among HRSA s primary care training programs (Title VII and VIII), its public health and preventive medicine training programs, and CDC s public health workforce programs (EIS).

8 The Folsom Report, 1967: Communities of Solution health action cannot and should not be an effort imposed from outside and foreign to the people; rather it must be a response of the community to the problems that the people in the community perceive, carried out in a way that is acceptable to them and properly supported by an adequate infrastructure Products: Community Health Centers National Health Service Corps Family Medicine a new specialty Community Annals Oriented of Family Primary Medicine, Care 2012

9 Pholela Health Center, South Africa Community Oriented Primary Care Drs. Sidney and Emily Kark early 1940s Developed COPC into a model of community engagement for improving health South Africa, Australia, Israel.the United States ibit/community_health/model_world.cfm

10 Sidney Kark, Epidemiologist UNC history UNC Epidemiology Professor Dr. Sidney Kark and UNC Epidemiology Professor Dr. John Cassel launch the Evans County (Georgia) Cardiovascular and Cerebrovascular Epidemiologic Study. The study is the first to confirm the importance of physical activity in promoting cardiovascular health and was, for some time, the only cardiovascular disease cohort study with a substantial enrollment of Black participants.

11 Tufts-Delta Health Center Mound Bayou, MS Dr. H. Jack Geiger and Dr. John W. Hatch during construction on the Delta Health Center, 1968 Community Health Center (helped start movement) Community Farm Adult Education Center bit/community_health/common_ground.cfm

12 Community Oriented Primary Care is... A systematic approach to the practice of medicine in the community built on principles of epidemiology and community organizing A method for a health system to collaborate with its community to build bridges and improve health

13 The COPC process... Community definition Community characterization Problem prioritization Detailed assessment Intervention Evaluation COPC needs epidemiologists who can think in terms of personal, public, and community health

14 IT lowers hurdles for COPC You can use patient data to define community Census and CDC data can characterize the nature of health, social, economic, and environmental problems Community characterization is ideal for community engagement to prioritize problems

15 IT lowers hurdles for COPC detailed assessment depends on the problems and available data IT can help with planning, targeting the intervention And with evaluating the outcome

16 A Convergence of Opportunity Community Health Needs Assessment (ACA section 9007): Nonprofit hospitals required to conduct a community health needs assessment at least once every three years, implement plan, evaluate FQHC periodic assessment of the appropriateness of the utilization of services and the quality of services based on community need (program requirements)

17 A Convergence of Opportunity Community Transformation Grants CDC will provide ongoing support to grantees including the identification of disparities in health outcomes and community conditions, the development of leadership teams and coalitions, and the selection, design, implementation, and evaluation of activities.

18 oone County, issouri health ssessment 998 own/gown artnership

19 Poor Access To Care by Census Tract, 1998 Vs. FHC Service Area Phillips R, et al. Using Geographic Information Systems to understand health care access. Archives of Family Medicine. 2000;9(10).

20 Baltimore Medical Systems, 2002 Largest FQHC in Baltimore

21 data/safetynet/phillips. htm Mapping Tools for Monitoring the Safety Net AHRQ publication

22 Johns Hopkins

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24 UDS Mapper 2011 Best Web-Based Application ESRI International Users Conference

25 A Collaboration Robert Graham Center/AAFP Health Foundation of Greater Cincinnati Funded by HRSA How do you use geographic data for 20 million patients, 300 million Americans to figure out where next health centers are needed most?

26 What is the UDS Mapper? The UDS Mapper: is an online mapping tool allows for easy visualization of areas served by Section-330 funded health centers Population data from US Census, CDC was developed by the Robert Graham Center as part of their HealthLandscape mapping platform

27 Data in the UDS Mapper Data available/aggregated by ZCTA: Uniform Data System (2010) data, Patients by ZIP Code Demographic estimates based on 2010 US Census and American Community Survey Disease prevalence, CDC Other map layers provided in the UDS Mapper: Locations of Section 330 Grantees and Delivery Sites (Access Points), FQHC Look-Alikes, Rural Health Clinics, NHSC Sites, hospitals and other Tribal Organization Facilities Medically Underserved Areas/Populations Health Professional Shortage Areas Backgrounds: satellite, street and topographic

28 Demonstration

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30 Conclusion The Epidemic Intelligence Service could be the on-the-ground CDC agent for public health primary care integration Agent for facilitating, standardizing, HARMONIZING community health needs assessments and integrating services Need good epimiology skills for finding and analyzing right data GIS Tools are ready and accepted

31 The EIS Officer is an applied epidemiologist who uses epidemiologic practice and research to improve public health. Because the EIS Program is rooted in public health practice and is based on a philosophy of learning while doing, it maintains a spontaneity and relevance that are essential to addressing the public health challenges of the 21st century --Dr. Stephen Thacker, 2001

32 Welcome Screen- Select Geography Select Geography/ Zoom to Area

33 Legend and Tool Tabs Legend is updated when user changes/ adds layers Click any tab to open or close that tool

34 Default- Penetration of Low- Income Population

35 Main Map: Low-Income Not Served by Grantees

36 Provider Locations and Dominance

37 Threshold Sliders- 25% Poverty and 25% No USC

38 Conclusion IT systems are finally powerful enough to help us Many data sets are available, esp with partnerships Both can help us engage: define, characterize, prioritize, assess, intervene and evaluate I ll COPC, can you COPE?

39 Conclusion The Epidemic Intelligence Service could be the on-the-ground CDC agent for public health primary care integration Agent for facilitating, standardizing, HARMONIZING community health needs assessments and integrating services Need good epimiology skills for finding and analyzing right data GIS Tools are ready and accepted