Public Health Assessments, Turning Point and the Virginia Atlas

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Public Health Assessments, Turning Point and the
Virginia Atlas

• Jeff Wilson, MSHA
• Assistant Administrator
• John Randolph Medical Center
• October 5, 2005

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Assessing the Environment

• Conducting Community Needs Assessments

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Assessing the Environment

• Identify the problem type.
• Identify stakeholders.
• Assess extent of stakeholder agreement.
• Evaluate communitys readiness and capacity.
• Identify where problem can be most effectively
  addressed.

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MAPP Model
MAPP tool was developed by the National
Association of County and City Health Officials
(NACCHO) in cooperation with the Public Health
Practice Program Office, Centers for Disease
Control and Prevention (CDC).
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Turning Point and the Virginia Center for Healthy
Communities
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Turning Point Background

• Robert Wood Johnson W. K. Kellogg Foundation
  initiative
• 21 states and 41 communities
• Strengthen and transform public health
  infrastructure in the 21st century

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Why Turning Point?

• Condition of public health infrastructure
• Market-driven changes in health care
• Changing role of government
• Expectation of inter-sectoral collaboration by
  policy makers
• Expectation for accountability and responsibility
  by consumers

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Underlying Principles

• Community-driven
• Shared Governance
• Intersectoral Collaboration
• Nothing is off the table
• New voices for public health
• Focus on the future

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• The vision for Virginias Turning Point effort
  is improving the health of our communitiesOur
  strong focus on partnerships and community
  involvement will be critical to improving
  health.
• E. Anne Peterson, MD, MPH
• State Commissioner of Health

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Virginias Turning Point Initiative

• Planning Priorities
• Six year initiative Two years strategic planning
  effort led to a funded four year implementation
  plan
• Planning focused on access to care,
  environmental health, communicable disease
  control, health education and communication and
  health information
• Implementation Plan divided among three
  components
• State priority Goal
• Leadership Development
• Social Marketing

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Community Health Improvement

• 4 Year Program
• Assist communities in identifying health concerns
  and figuring out how to best address them
• Improve our ability to evaluate the effectiveness
  of prevention programs
• Develop messages for specific audiences that
  create the greatest impact on health status
• Increase awareness of the contributions public
  health makes to our society

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The Benefits of Turning Point

• Collaboration
• National focus
• Diverse funding for community improvement
• A new voice in public health

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• People are drowning in data but starving for
  information
• Turning Point was a means to obtain critical
  information about improving the publics health

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Virginia Center for Healthy Communities

• Facilitating practical solutions for todays and
  tomorrows health problems in the Commonwealth
• VCCH mission statement

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Virginia Center for Healthy Communities

• Members
• Legislators
• Business community
• Public Health agencies
• Health care providers
• Health insurers
• Faith Community
• Academic Centers
• Local Government

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Background on the Virginia Center for Healthy
Communities

• Non-profit public private partnership
• Developed from the Virginia Turning Point
  Initiative sponsored by the RWJF
• Board members represent key public and private
  stakeholder groups.
• Goal is to enhance community health improvement
  activities through greater involvement by the
  business community.

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The Virginia Atlas of Community Health

• How to Conduct a Community Health Assessment
• March 11, 2005

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The Virginia Atlas of Community Health

• A tool to target and track health improvement
  initiatives
• Designed to streamline and target local
  assessment and evaluation efforts
• Builds on and expands the VHHA Indicators of
  Healthy Communities publications
• Web based system launched February 6, 2004

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How the Virginia Atlas of Community Health was
developed

• Primary Partnership with Steve Horan of the
  Community Health Resource Center
• VCHC identified a consensus set of indicators
• Data sources identified
• Conducted analysis to produce locality and
  zip-code level indicators where actual
  data are available
• Developed synthetic estimates at the locality and
  zip- code level where actual data are not
  available
• Developed methods for producing user-friendly
  tables, maps, and narrative
• Produced the first Virginia Atlas of Community
  Health

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Data Includes

• 114 indicators in nine categories (includes both
  city/county and ZIP code)
• Data from 2001, 2002 and 2003
• Drawn from public health, hospital discharge and
  other data bases
• Broad definition of health, not just health care
• Reports for both city/county as well as zip code
  level analysis

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What can the Atlas do?

• The Atlas can map data at the ZIP code level, and
  can overlay two variables to allow comparative
  analysis
• It allows the user to customize data analysis
• Users can generate reports of an array of
  city/county or ZIP code level indicators
• It is home to the 2003 Indicators of Healthy
  Communities report series
• Links users to www.communityhealthresource.net

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How the Atlas can be used

• Zip code level data often dispels conventional
  wisdom
• Two-layer mapping provides a unique level of
  analysis
• Ability to identify health conditions or concerns
  in a small geographic area
• Comparison by zip code, city/county, planning
  district, region or statewide

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What is a community health assessment?

• There are many different definitions
• One that fits in most cases
• A community health assessment is an evaluation of
  the health status of a community of people for
  the purpose of program planning and evaluation.

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Is a community health assessment a community
needs assessment?

• Not quite
• A community health assessment is only one part of
  a community needs assessment
• A community health assessment measures health
  status
• A community needs assessment looks more broadly
  and also measures unmet need for services

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What can we learn from a community health
assessment?

• How healthy is one community compared to other
  communities?
• How many people within the community have
  particular health attributes?
• What kinds of people are at greatest risk of
  having these particular health attributes?
• Where are we most likely to find people with the
  health attributes we are looking for?

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How can we use the Atlas for community health
assessment?

• The Atlas can help us discover
• How healthy one community is compared to other
  communities
• How many people within the community have
  particular health attributes
• Where are we most likely to find these people
• The Atlas can help us explore, but not draw final
  conclusions about
• What kinds of people are at greatest risk of
  having particular health attributes

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The Atlas isnt perfect

• The Atlas
• Contains the latest data that is publicly
  available but at least two years old
• Does not contain trend data - yet
• Does not contain every indicator you might want
• Does not allow stratification by age, race, and
  sex
• Does not provide complete compatibility between
  city/county level indicators and zip code
  indicators
• Zip code boundaries cross city/county lines
• Zip codes are too small for certain ratio
  indicators such as deaths per 100,000

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but it is quick and inexpensive!

• The Atlas
• Does include dozens of indicators
• Does allow downloading of data and graphics
• Does allow geographic analysis of data
• Does support exploratory analysis of
  relationships between variables
• Does allow multiple people to view data at the
  same time from remote locations
• Does allow you to do in an hour or two (for free)
  what consultants charge thousands of dollars to do

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Solets get started!
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Getting Started

• Go the Virginia Center for Healthy Communities
  home page at www.vahealthycommunities.com
• Select Virginia Atlas of Community Health
• Click Register or Login
• If Register complete the requested fields of
  information
• If Login enter UserID and Password

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The Basic Functions

• Create a Map
• Create a Report
• Select a County
• Enter a Zip Code
• Download Virginia Indicators of Healthy
  Communities

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Atlas Example 1

• We have chosen a focus area and are interested in
  learning more about a particular health problem
  in our community

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Scenario

• A community initiative to improve diabetes
  control
• Focus on Central Virginia
• Specifically the Richmond Regional and Crater
  Planning Districts
• Cities of Hopewell, Petersburg, Richmond
• Counties of Chesterfield, Dinwiddie, Goochland,
  Greenville, Hanover, Henrico, Prince George,
  Surrey and Sussex

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First Step

• Take a city/county level view of the situation
• We download the Virginia Indicators of Healthy
  Communities in Excel format
• Under Download Data, click on Microsoft Excel
  format and follow directions
• The file allows you to compare cities and
  counties against each other and against regional
  norms
• We click on the Ambulatory Sensitive Conditions
  worksheet
• We see that Hopewell, Petersburg, Richmond, and
  Greensville rates are more than twice the
  state-wide rate of Diabetes Hospital Discharges
  per 100,000 population
• This is a huge geographic area where do we focus
  our efforts for diabetes control?

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Second Step

• Take a zip-code level view of the situation
• Go to main menu and select view health
  information on an interactive map of Virginia
• Select Create Map
• Select Richmond Regional and Crater Planning
  Districts
• Select Ambulatory Sensitive Conditions as the
  Category
• Select Diabetes Hospital Discharges as the
  Indicator
• Select Color Range Green to Red
• Click Create Thematic Map

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Second Step (continued)

• Map shows both Planning Districts
• It appears that a lot of areas across the region
  are of concern in terms of diabetes
• Return to the menu and refine the map using More
  Options
• Select Equal Value, Create Thematic Map

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Second Step (continued)

• Focusing on the Bright Red zip codes, notice
  that
• Richmond City had larger numbers of diabetes
  hospital discharges in its eastern region
• Specifically, zip code 23222 and 23223 which cuts
  across Richmond City and Henrico County
• Petersburg shows 23803 as the problematic area.
  This zip code actually cuts across Petersburg,
  Chesterfield and Dinwiddie counties
• The Red zip codes might be a good place to start
  for a diabetes control effort
• Click on the Zip Code labels below the map to
  learn more about the other characteristics of
  these zip codes

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So what have we learned

• Data shows that Zip codes 23222, 23223 and 23803
  would be areas to focus our diabetes intervention
• Atlas allows users to gain a statewide
  perspective and then focus attention on
  progressively smaller units of analysis
• Geographic regions
• City/County
• Zip Codes

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Atlas Example 2

• Lets use the Atlas to determine what health
  issue we should address in our community

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Common Question 1

• How healthy is my city/county compared to the
  rest of the state?
• Select a County under Create a Report
• (pick Fairfax for purpose of the training)
• Click Go
• The Table shows Fairfax County compared to
  statewide indicators

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Common Question 1a

• How healthy is my city/county compared to other
  cities and counties?
• You could repeat the process under Question 1 for
  multiple cities and counties
• The easier method is to download the Excel
  spreadsheet with Virginia health indicators
• Under Download Data, click on Microsoft Excel
  format and follow directions
• The file allows you to compare cities and
  counties against each other and against regional
  norms

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Common Question 2

• How many people in my community have a particular
  health attribute?
• Lets use Asthma hospital discharges in Fairfax
  as an example
• Repeat the process we used under Question 1 to
  view the Fairfax indicator table
• Select Fairfax County under create a report
• Click Go

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Common Question 2

• How many people in my community have a particular
  health attribute?
• As shown in the Table, in 2001 there were 100.3
  asthma hospital discharges per 100,000 population
  in Fairfax County
• This indicator is a ratio of cases/100,000
  population
• Need to find the total number of cases in a
  population of 985,161
• Multiply rate by (total pop/100,000)
• 100.3 (985,161/100,000)100.3 9.85161 988
  asthma hospital discharges

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Common Question 3

• Where are we most likely to find people with a
  particular health attribute?
• Continuing with the Fairfax County asthma
  example, where are we most likely to find the 988
  asthma hospital discharges?
• Lets look at a map..

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Common Question 3

• Where are we most likely to find people with a
  particular health attribute?
• Lets look at a map..
• Under Create a Map, click on interactive map of
  Virginia
• When the map of Virginia comes up, click on
  Create a Map in the Legend box
• Under Select Planning Districts, click on
  Northern Virginia
• Under Background Thematic, click on Ambulatory
  Sensitive Conditions as the category
• Under Indicator, choose Asthma hospital
  discharges
• Under color range, choose Green to Red
• Click Create Thematic Map at the bottom

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Common Question 3

• Where are we most likely to find people with a
  particular health attribute?
• Lets look at a mapcontinued
• The Red-shaded zip codes had the most asthma
  hospital discharges
• Lets use roads to help us situate these zip
  codes
• At the bottom of the Legend, click the boxes for
  Divided Highways and Major Roads
• At the top left of the screen, click the Refresh
  icon it looks like a little page to the left of
  the D

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Common Question 3

• Where are we most likely to find people with a
  particular health attribute?
• Lets look at a mapcontinued
• Lets zoom in for a little closer look
• Option 1. Increase Map Size to 1024 x 768
• Option 2. Click on magnifying glass with in
  the lens, point at the center of Fairfax, and
  click

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Common Question 3

• Where are we most likely to find people with a
  particular health attribute?
• Lets look at a mapcontinued
• Now we can see better, but we realize that the
  Red-shaded zips might contain anywhere from 39 to
  117 cases of asthma hospital discharges. Where
  is that zip code with up to 117 cases?
• Lets explore the options for the Legend
• Scroll over to the legend
• Click on the Pencil icon next to Planning
  District Thematic to change the map
• At the bottom left of the next page, click on
  More Options to Refine Your Map

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Common Question 3

• Where are we most likely to find people with a
  particular health attribute?
• Lets look at a mapcontinued
• We see that the setting is to Automatically
  calculate ranges using Equal Count. This means
  the software will arrange the Legend so that each
  category has a roughly equal number of zip codes
  in it.
• Change the setting to Equal Value. This means
  the software will arrange the Legend so that each
  category has a roughly equal range of values in
  it.
• Scroll down and click Create Thematic Map

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Common Question 3

• Where are we most likely to find people with a
  particular health attribute?
• Lets look at a mapcontinued
• Now we can see that the two zip codes with the
  highest number of cases are 22193 and 22191.
  Which is highest?
• Scroll down to the bottom of the screen
• Click on zip code 22191
• Scroll to the bottom of the page
• We see that 22191 had 109 asthma hospital
  discharges
• Click Back and scroll to the bottom again
• Click on zip code 22193
• Scroll to the bottom of the page
• We see that 22193 had 116 asthma hospital
  discharges by far the highest zip code in the
  range
• We can also peruse the Table to find other
  characteristics of 22193

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Common Question 3

• Where are we most likely to find people with a
  particular health attribute?
• Lets look at a mapcontinued
• Another option
• FYI, you can also set your own custom ranges for
  the legend
• Click back to return to the map page
• Scroll over to the Legend box
• Click the Pencil icon to change the map
• Click More Options to Refine Your Map
• You could click Use Custom Ranges and fill in
  whatever ranges you are interested in just make
  sure that there is no break in the sequence of
  your numbers.

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Common Question 4

• Who is most at risk for having a particular
  health attribute?
• The Atlas can help us explore this issue, but it
  does not allow actual stratification by age, sex,
  race, etc.
• Example
• Asthma hospitalization is an indicator of primary
  care access problems
• Lets explore relationships between asthma
  hospital discharges, income, and insurance status
  

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Common Question 4

• Who is most at risk for having a particular
  health attribute?
• Asthma and low-income
• Click on Pencil icon to Change Thematic Map
• Under Point Thematic (Bubble), select Economy
• For the Indicator, select Population below 200
  Poverty
• Click More Options to Refine Your Map
• Set ranges for Background Thematic to Equal
  Count
• Set ranges for Point Thematic (Bubble) to Equal
  Count
• Click Create Thematic Map

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Common Question 4

• Who is most at risk for having a particular
  health attribute?
• Asthma and low-income
• We see a general (but not absolute) pattern of
  larger yellow bubbles in the Red- or
  Maroon-shaded areas, and smaller bubbles in the
  Green-shaded areas
• This indicates that zip codes with larger numbers
  of asthma hospital discharges also have larger
  numbers of low-income people

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Common Question 4

• Who is most at risk for having a particular
  health attribute?
• Asthma and uninsured
• Click on Pencil icon to Change Thematic Map
• Under Point Thematic (Bubble), select Insurance
• For the Indicator, select Uninsured (all income
  levels)
• Click More Options to Refine Your Map
• Set ranges for Background Thematic to Equal
  Count
• Set ranges for Point Thematic (Bubble) to Equal
  Count
• Click Create Thematic Map

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Common Question 4

• Who is most at risk for having a particular
  health attribute?
• Asthma and uninsured
• Again, we see a general (but not absolute)
  pattern of larger yellow bubbles in the Red- or
  Maroon-shaded areas, and smaller bubbles in the
  Green-shaded areas
• This indicates that zip codes with larger numbers
  of asthma hospital discharges also have larger
  numbers of uninsured people
• This comes as no surprise because low-income
  people are more likely to be uninsured

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So what have we learned?

• Fairfax looks healthy compared to the state as a
  whole
• Fairfax looks healthy compared to its neighbors
• Although Fairfax looks healthy on ratio
  indicators (i.e. rates per 100,000), it still has
  large raw numbers of people with health problems
• For example, 988 asthma hospital discharges in
  2001
• More than a quarter of these came from two zip
  codes in the I-95 corridor 22191, and 22193
• Areas with large numbers of asthma discharges
  generally have large numbers of low-income
  persons and uninsured
• Initiatives to improve access to care for asthma
  will have to address financial access

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Any Questions?

• The Virginia Atlas of Community Health has
  several avenues for accessing additional
  information or clarifying questions
• Walkthrough
• Users Guide
• Health Indicator Look-up
• E-mail questions

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Any Questions?

• Yedda Stancil - 804-965-1214
• yedda_at_vahealthycommunities.com