Stakeholders in the Driver’s Seat: Using Data to Drive Effective and Sustainable Implementation L. Ebony Boulware, MD MPH Center for Community and Population Health Improvement Clinical and Translational Science Institute Duke University
Challenge Neighborhood Disadvantage in US • Marked national variation in health, health equity • Social and environmental contexts key contributors • How do we develop, implement, and sustain effective interventions that account for these Area Deprivation Index determinants? 17 markers of education, employment, housing- quality, and poverty (Census and American Community Survey) https://www.neighborhoodatlas.medicine.wisc.edu/mapping AJ Kind, WR Buckingham. N Engl J Med 2018;378:2456-2458.
If we focus on social and environmental determinants of health who will drive change ? Adapted from countyhealthrankings.org
Healthcare sector contributions to drive partnered, sustainable solutions? • Health systems collect data • Data can be aggregated and ‘mapped’ – Identify common health challenges – Quantify health inequities • Data can be democratized for public stakeholders
Durham County, NC Community Health Indicators Program NORTH CAROLINA IS 36 IN OVERALL HEALTH DURHAM COUNTY IS 6TH LARGEST NC COUNTY (~312,000 residents) 14% HISPANIC, 38% BLACK, 42% WHITE 16% BELOW POVERTY; 20% ABOVE $100,000 95% OF DURHAM COUNTY RESIDENTS RECIEVE CARE IN: • Academic Health System • Federally Qualified Community Health Center
Mapping Social Environmental Contexts Durham Neighborhood Compass AMERICAN COMMUNITY SURVEY US CENSUS BUREAU DURHAM COUNTY BOARD OF ELECTIONS DURHAM CITY/COUNTY INSPECTIONS DURHAM COUNTY TAX ADMINISTRATION DURHAM POLICE NC DIVISION OF CHILDCARE AND EARLY EDUCATION DURHAM NEIGHBORHOOD IMPROVEMENT SERVICES US ENVIRONMENTAL PROTECTION AGENCY Civic engagement, demographics, economy, education, environment, housing, infrastructure and amenities, safety N https://compass.durhamnc.gov/ W E *Established 2014 S
Democratizing Health System Data to Fuel Implementation Public Health Business Healthcare Educators Government Philanthropy Community and Development Investors Non Profits
Mapping Durham Health Durham Neighborhood Compass Diabetes Mellitus (adult) Stroke Myocardial Infarction Chronic kidney disease • Hypertension • Obesity (pediatric and adult) • COPD • Cancer • Asthma • Alzheimer’s disease • Sickle Cell disease • Pre-term birth https://compass.durhamnc.gov/ *Health Conditions added 2018
Important Questions What are the best strategies to convene community stakeholders and align priorities to develop relevant and effective interventions? Can democratized data be leveraged to inspire and measure collective impact of interventions? When do we know interventions have been effective? Who guides the prioritization for implementation?
THANK YOU Dukehealthimprovement.org https://www.ctsi.duke.edu/
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