CDC Assessment Initiative Accessing, Interpreting, and Communicating Information for Public Health D

1
CDC Assessment InitiativeAccessing,
Interpreting, and Communicating Information for
Public Health Decisions

• Nelson Adekoya, DrPH
• Centers for Disease Control and Prevention
• National Center for Public Health Informatics

1
2
Background

• Mission of Public Health To provide conditions
  in which people can be healthy by applying
  scientific and technical knowledge to prevent
  disease and to promote health
• Governmental Role Assessment, policy
  development, and quality assurance

2
3
Why Assessment Is Necessary

• Without accurate information on the health status
  of a society, we cannot make decisions regarding
  which concerns to prioritize, which policies
  might be the most effective, or which
  interventions should be implemented

3
4
Assessment Initiative

• Cooperative agreement to enhance capacity of
  state and local health departments to use data
  for developing policy and ensuring that needed
  health services are provided

4
5
Cooperative Agreement

• States working through local health jurisdictions
  and communities to
• Improve access to data
• Improve skills to accurately interpret and
  understand data
• Improve effective usage of data

5
6
Why Perform Assessments?

• Assessments answer
• What are the major health problems?
• What population groups are at risk?
• How are the risks distributed geographically?
• What services are available?
• Are health resources adequate?
• What do local citizens see as health concerns?
• What do health providers see as health concerns?

6
7
Benefits of Assessment

• Increased resources
• Better decision making
• Ability to be proactive
• Increased visibility
• Improved collaboration/cooperation
• Improved services
• Improved community perception of local health
  jurisdictions
• Increased awareness of public health concerns
• Decreased influence of politics on health
  priorities

7
8
AI The First 5 Years

• First funding cycle September 19921997
• Administered by NCHS
• Seven States Funded
• IA, ME, NC, OH, OR, TX, and UT
• Objectives
• Improve ability to assess progress toward HP 2000
  objectives
• Use resulting information for policy and program
  development

8
9
AI The First 5 Years

• Results
• State data systems evaluated
• Access to and use of health data by local
  agencies increased
• Training and technical assistance on data
  analysis and interpretation provided
• CDC Guidelines for Evaluating Surveillance
  Systems

9
10
The First 5 Years Lessons Learned

• Importance of . . .
• Collaboration with new partners
• Effective communication between program managers
  and data analysts
• Use of simple, consistent formats for data
  presentation

10
11
The First 5 Years Lessons Learned

• Importance of . . .
• Building technical expertise at the local level
• Integration of assessment activities with all
  other state health department activities
• Advisory groups helpful in the integration
  process

11
12
AI Second Funding Cycle

• September 19972002
• Administration transferred to EPO
• Focus on Partnerships
• With Managed Care
• With Medicaid
• With Community Organizations and Other Groups
• Six States Funded
• MN, NY, MO, MA, OR, and NC

12
13
AI Second Funding Cycle

• Objectives
• Year 1
• Establish consortia of partners and develop
  5-year strategic plan
• Years 25
• Implement plan
• Disseminate health assessment information
• Evaluate processes used

13
14
AI Second Funding Cycle

• Key Accomplishments States
• Managed Care Partnerships
• MN Linking administrative claims data regarding
  pregnant women to birth records
• Assessing relationship of maternal morbidity to
  birth outcomes
• MA Used BRFSS data to identify health plan
  affiliation of respondents
• Provided profiles of health risk behaviors for
  the general population versus MCO enrollees

14
15
AI Second Funding Cycle

• Key Accomplishments States
• NC Collaborated with Healthy Carolinians to
  develop a comprehensive Community Health
  Assessment Guide

15
16
AI Second Funding Cycle

• Key Accomplishments States
• NY Completed a comprehensive CHA review,
  analyzing results from 56 counties
• Distributed a summary of strengths, barriers, and
  opportunities for action
• Currently developing an electronic community
  health assessment (CHA) Clearinghouse
• MO Developed an Internet-based data
  dissemination system that allows interactive
  querying of health data sets

16
17
AI Second Funding Cycle

• Key Accomplishments States
• Medicaid Partnerships
• OR
• Compiled state Medicaid files
• Used to assess preventive services, clinical
  outcomes, and health status of Medicaid
  recipients throughout Oregon
• Completed a Medicaid BRFSS
• Using Medicaid data to develop a diabetes disease
  registry

17
18
AI Second Funding Cycle

• Key Accomplishments
• Intramural Activities
• Annual Conference (AI and NAPHSIS)
• Publications
• Assessment Initiative Supplement Issue of the
  Journal of Public Health Management and Practice
  (Dhara, et al. 2002)

18
19
AI Third Funding Cycle

• September 20022007
• Administration EPO and NCPHI/OD
• Focus on production of effective assessment
  methods and practices that can be disseminated to
  and used by other states
• Data Linkage
• Data Dissemination Systems
• CHA Practices

19
20
AI Third Funding Cycle

• Focus Area 1 Improving data dissemination
  through development/enhancement of interactive
  data query systems
• MO, UT, and RI
• Focus Area 2 Improving data usage by improving
  community health assessment practices
• NY, WA, FL, and NM

20
21
AI Third Funding Cycle

• Key Accomplishments States
• NY Completed Epi lnfo/Epi Map tutorial (Asthma)
  http//www.cdc.gov/epiinfo/tutorials.htm
• Completed Evidence-Based Online Course
  http//www.ebth.org
• Developed an electronic CHA Clearinghouse
• MO Added and updated new profiles into their
  Internet-based data dissemination system that
  allows interactive querying of health data sets
  (e.g., BRFSS, ED data, Medicaid, Hospital
  Discharge, and injuries)

21
22
AI Third Funding Cycle

• Key Accomplishments States
• UT IBIS-PH query system interface was coupled
  with SAS IntrNet software demonstrated that
  Utahs interface could be used by a state by
  using SAS IntrNet to run data queries
• Successfully transferred IBIS technology to
  Arizona
• WA Built a shared vision for CHA through PH
  Leadership Forum (local health administrators and
  health officers) to educate leadership on value
  of CHA to their agencies and strategies for
  building capacity

22
23
AI Third Funding Cycle

• Key Accomplishments States
• RI Health-Based Query System (BRFSS and YRBS
  data)
• FL Statewide implementation of the National
  Public Health Performance Standards Program
  (NPHPSP), a tool to improve PH infrastructure and
  performance at state and local levels

23
24
AI Third Funding Cycle

• Key Accomplishments States
• NM Worked with tribal councils to strengthen
  community assessment
• Worked with NM NEDSS steering committee to
  include tribal affiliation and residence fields

24
25
AI Third Funding Cycle

• Key Accomplishments
• NAHDO Published white papers on statistical
  approaches reducing disclosure risk in
  Internet-based data query system HIPAA
• NAPHSIS Coordinated survey of states to assess
  current status of Internet-based data query
  system

25
26
AI Third Funding Cycle

• Key Accomplishments
• Assessment Initiative supplemental issue of the
  Journal of Public Health Management and Practice
  (March/April 2006)

26
27
Under Development . . .

• www.grants.gov
• RFA Improve state and local health information
  and data systems
• Cooperative Agreements Continuation funding
  (20062007)

27
28
Future Directions

• Encourage publications of successful approaches
  in peer-reviewed journals
• Encourage grass-roots education on assessment
  (sustainability) and advocate state support
  (formalize)
• Foster growth and development in new states

28
29
Future Directions

• Increase opportunities for states to collaborate
  and exchange information (e.g., site visits,
  annual conference, and regional conferences)
• Continue collaborations with national
  organizations on related projects (NAHDO,
  NAPHSIS, APHA, and CSTE) to facilitate
  state-to-state transfer of system, expertise, and
  knowledge

29
30
Future Consideration

• Develop or establish relationships with
  universities and research institutions
• Begin development of cooperative agreements for
  the next 5-year cycle for the states
• Consider tiered program announcement
  specifying different objectives for new versus
  previously funded states

30
31
Summary

• Need for the AI will continue as . . .
• Evidenced-based decision making is more widely
  accepted as the norm
• Electronic data systems continue to advance
• The concept of data integration evolves
• Build on existing expertise, relationships, and
  accomplishments to pave the way for the future

Assessment Initiative Making data more visible,
accessible, and understandable!