Innovative Practices to Improve Population Health Surveillance - - PowerPoint PPT Presentation

Innovative Practices to Improve Population Health Surveillance through a Partnership with a Clinical Collaborative

Deirdre Browner, Kitty Bailey, Thomas R. Coleman, Dean Sidelinger, Sayone Thihalolipavan, Wilma J. Wooten

Concordium 2016

SAN DIEGO COUNTY

INNOVATIVE PARTNERSHIPS FOR SURVEILLANCE

Background on programs Why we needed a clinical partner About our partner What we’re doing as a result

CURRENT CHRONIC DISEASE FRAMEWORK BEHAVIORS DISEASES PERCENT

Result in

OVER No Physical Activity Poor Diet Tobacco Use Cancer Heart Disease & Stroke Type 2 Diabetes Lung Disease

• f Deaths

in San Diego Lead to

CONTINUUM OF SUCCESS HIGHLIGHTED PROGRAMS

• Tobacco-free living
• Healthy eating
• Active living
• Clinical and community

preventive services

• Social and emotional

wellness

• Healthy and safe

physical environments

• Healthy eating
• Active living
• Healthy and safe

physical environments

• Healthy eating
• Active living
• Healthy and safe

physical environments

• Healthy eating
• Active living
• Clinical and

community preventive services

• Health systems

Interventions

• Healthy and safe

physical environments

CPPW: 14 Interventions 2010-2012 CTG: 26 Interventions 2011-2014 NEOP: 14 Interventions 2011-2019 Prevention (1422): 15 Interventions 2014-2018

Upstream Interventions Improved Health Outcomes

Since the launch of Live Well San Diego, Healthy Works has secured more than $50 million in external funding to address 3-4-50 in San Diego County.

PUBLIC HEALTH SERVICES BRANCHES

Emergency Medical Services TB Control and Refugee Health HIV, STD, and Hepatitis Branch Epidemiology and Immunization Services Maternal, Child, and Family Health Services

Public Health Services Public Health Services works to prevent epidemics and the spread of disease, protect against environmental hazards, prevent injuries, promote and encourage healthy behaviors, respond to disasters and assist communities in recovery and assure the quality and accessibility of health services throughout the county.

HEALTHY WORKS: PREVENTION INITIATIVE (1422)

BE THERE SAN DIEGO (BTSD) COMPONENT 2

Be There San Diego Clinical Collaborative

Right Care Initiative Focused on Heart Disease and Stroke Prevention University of Best Practices Data for Quality

BE THERE SAN DIEGO: PUBLIC / PRIVATE PARTNERSHIP

9

BE THERE SAN DIEGO SURVEILLANCE

Be There San Diego and Surveillance

Staff and partner expertise Relationships with healthcare organizations Link with existing efforts: Regional Clinical Quality Indicators project

CHRONIC DISEASE PILOT PROJECT DATA LIMITATIONS: WHAT’S MISSING?

No data for early clinical conditions Little neighborhood-level data

?

PROGRESSION OF DIABETES

Early clinical conditions

Type 2 Diabetes IFG/IGT NORMAL TO DIABETIC NGT

• Estimates of prevalence of prediabetes range from 33 to 42* percent
• f the adult population
• Two out of five prediabetics will progress to type 2 diabetes in five years

*Babey SH, Wolstein J, Diamant AL, Goldstein H. Prediabetes in California: Nearly Half of California Adults on Path to Diabetes. Los Angeles, CA: UCLA Center for Health Policy Research and California Center for Public Health Advocacy, 2016.

Developed 12 interfaces for BMI data collection through electronic health records to develop a source of local BMI data that would: Utilize existing technology Provide data at various geographic levels Have a level of scalability Be sustainable Progress to date: 4.3 million records for over 750,000 people

SAN DIEGO CPPW: BMI SURVEILLANCE

Expansion of data collection for body mass index (BMI) surveillance

CHRONIC DISEASE SURVEILLANCE PROJECT Prevention grant: $75,000/year of internal funds for surveillance system (9/30/14 to 9/29/18)

Goal: develop basic infrastructure and recruit 1-3 clinics to submit data for proof-of-concept system

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CHRONIC DISEASE SURVEILLANCE PROJECT

Progress and Challenges

• Developed a draft list of data elements
• Addressed governance with Data Use Agreement

template

• Connected with Community Health Centers

1422 grant dollars could not be used to fund clinics…..

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CHRONIC DISEASE SURVEILLANCE PROJECT EHR TOOLKIT

EHR Toolkit pilot

• Public Health Informatics Institute (PHII) partnered with

Chronic Disease and funded toolkit pilot (ended 6/30/16)

• Project focused on TA through webinars and site visits

and included $50,000 in funding for participation

EHR TOOLKIT PILOT PROJECT

TA Funding

Community Health Centers

SAN DIEGO COUNTY IT NETWORK

EHR Data

FUNDING

CHRONIC DISEASE SURVEILLANCE PROJECT GOVERNANCE

• Data Use Agreements
• Health Officer Order

WHO HAS ACCESS, WHEN AND HOW:

CHRONIC DISEASE SURVEILLANCE PROJECT DATA

Revised Data Elements

Diseases: diabetes, heart disease, hypertension, and stroke as well as prediabetes and elevated blood pressure (ICD) Demographics: street address, age, sex, race/ethnicity Laboratory data: HA1c, HDL, LDL, Total Cholesterol (eventually LOINC) Risk factors: BMI and smoking

CHRONIC DISEASE SURVEILLANCE PROJECT INFRASTRUCTURE

PILOT DEVELOPMENT INCLUDES:

• Dropbox

LARGE MEDICAL SYSTEM COMMUNITY CLINIC PRIVATE MEDICAL OFFICE

DAILY SWEEP SAN DIEGO COUNTY IT NETWORK sFTP

• Server Space
• Development of Analytics

PGP

CHRONIC DISEASE SURVEILLANCE PROJECT NEXT STEPS Finalize Infrastructure

• Leveraging ArcGIS database
• Develop data management tools and analytics
• Utilize open source tools: Python and R
• Fund clinics to develop queries
• Revise Data Use Agreements
• Develop draft clinic reports

Plans for Clinic Recruitment

CHRONIC DISEASE SURVEILLANCE PROJECT PROJECT TEAM

Chronic Disease Surveillance Demonstration Project

Deirdre Browner, MPH Senior Epidemiologist Rob Wester, MA, MPH Immunization Registry Manager* Christy Rosenberg, MPH Director of Programs, BTSD Kitty Bailey, MSW Executive Director, BTSD Ashley Stegall, MPH Epidemiologist Christy Lopez, MPH Epidemiologist

Thanks to…..

Jim Jellison, Claire Loe, and Trish Miller, the PHII team and Brian Lee from CDC

QUESTIONS?

Deirdre Browner, MPH deirdre.browner@sdcounty.ca.gov