When the Data Sing Da Data Y You Ca Can U Use | | M May 30, - - PowerPoint PPT Presentation

Ma Magda Pe Peck ScD

Founder and Principal, MP , MP3 H Heal alth th Gr Group

• Strategy. Le
• Leadership. Stories.

Da Data Y You Ca Can U Use | | M May 30, y 30, 2018 2018

When the Data Sing…

Powers of 3

“Urgency of Now. “

Solving Obesity?

Mind set. Knowledge set. Skill set.

De Determ rminants of Health and Health Inequities

Commission on Social Determinants of Health. (2010). A conceptual framework for action on the social determinants of health. Geneva: World Health Organization.

Appetite for COMPLEXITY...

Absence of Social Cohesion/Belonging Lead to ACEs and Diseases of Disconnection and despair

SE SEE AND SE SEIZ IZE “B “Brigh ght Sp Spots” s”

Le Leadership, through the effective use of data.

Ci CityMatCH. CH.org

“Data Use Institute”

Ci CityM tyMatCH tCH’s s “Dat Data a Us Use Tri riangl angle” ”

Data – Research Strategies, Programs Services Policy - Political Will

What we know… What we get

• thers to do!

What we do.

Community

13

Dissatisfaction (D) = CHANGE IS NEEDED Vision (V) = IMAGINE BETTER FUTURE First Steps (F)=WORTHWHILE ACTIONS NOW

Resistance (R) = natural and must be overcome

*Each of the elements must be present. If any of the elements = zero, resistance will not be overcome.

D x V x F > R

V

V

PO POWER TO CHA HANGE GE CHECKLIST

üClearly defined and understandable? üOf enough priority to engage other essential community partners? üAmenable to change? üDoable in the short term (some progress in the next 6-9 months)? üHave baseline data that are available/accessible, reliable and timely? üHave known solutions that can begin to yield measurable change? üHave defined, measurable results?

F

F

Too many, too small, too soon…

D

D

D

D > 0

D x V x F > R

22

DATA = spark D’s for CHANGE

Vision (V) = IMAGINE BETTER FUTURE First Steps (F)=WORTHWHILE ACTIONS NOW

Resistance (R) = natural and must be overcome

*Each of the elements must be present. If any of the elements = zero, resistance will not be overcome.

D x V x F > R

Toward Equity: Eliminating Disparities

5 10 15 20 25 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Black: White:

USA White and Black IMR: 1980-2011

Persistent disparity – >30 year lag…

NCHS

10.9 11.42

Infant Mortality y (2015) in Omaha (Douglas County) y), NE

Carol Gilbert, CityMatCH , David Busse, Douglas County Health Department

“B “Bright Sp Spot”

2005- 2007 2006- 2008 2007- 2009 2008- 2010 2009- 2011 2010- 2012 2011- 2013 2012- 2014 White, not Hispanic 5.7 5.0 4.4 3.7 4.4 4.1 4.9 4.9 Black, not Hispanic 14.5 16.2 15.7 15.1 13.1 12.0 10.0 8.7 Ratio Black/White 2.5 3.2 3.6 4.1 3.0 2.9 2.0 1.8 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 Deaths per 1,000 Live Births

Infant Mortality Rate Trends, Douglas County 3-Year Rolling Averages

*2014 data is provisional

• 1. Assure Community and Analytic Readiness
• 2. Conduct Analytic Phases of PPOR
• 3. Develop Strategic Actions for Targeted Prevention
• 4. Strengthen Existing and/or Launch New Prevention

Initiatives

• 5. Monitor and Evaluate Approach
• 6. Sustain Stakeholder Investment and Political Will

Decided to try PPOR* – 6 Stages *PERINATAL PERIODS OF RISK APPROACH

Peck, Sappenfield et al, MCHJ, 2010.

Welcomed Communities as Full Partners

§There is no substitute for lived experience, which can help us understand

§ Underlying problems and their causes § What solutions will work best

§Make the data clear, comprehensible, compelling to most. Get READY to use the data.

PPOR DATA: Why include fetal deaths?

• 1. Fetal deaths are important to families
• 2. There may be as many or more fetal deaths as there

are infant deaths

• 3. Fetal deaths may provide us with even more

information about infant mortality in the community

Standard infant mortality rates do not include fetal

• deaths. PPOR uses all of the available

information to investigate infant mortality.

Look at fetal and infant deaths and rates through PPOR ‘Mapping’

500-1499 g 1500+ g

Maternal Health/ Prematurity

Maternal Care Newborn Care Infant Health

Birthweight Age at Death

Fetal Death >=24 weeks Neonatal 0-27 days Post- neonatal 28-364 days

Fi First P t Per erinatal Pe Periods of Risk “Ma Map” p”

Do Douglas County (Omaha), NE, NE, All Races

Fetal-Infant Rate= 10.0

Fetal-Infant Rate=

1999-2002 2003-2006 2007-2010

Fetal-Infant Rate=

2011-2014 4.1 2.2 1.7 2.0

Fetal-Infant Rate=

Maternal Health/ Prematurity Maternal Care Newborn Care Infant Health

Preconception Health Toxic Stress, Other Exposures Behaviors before pregnancy Mental Health Prenatal Care Access and Quality High Risk Referral Obstetrical Care Quality of Caring, Doulas Perinatal Management Neonatal Care Pediatric Surgery Home Visitation Sleep Position Smoking Injury Prevention Child Care Quality

Perinatal Periods of Risk (PPOR) Approach Helps Narrow the Choices of Action

White non-Hispanic 3.1 2.0 1.9 1.6 White Fetal-Infant Rate = 8.6 Black non-Hispanic 2.4 4.0 2.4 8.8 Black Fetal-Infant Rate =17.6

GAPS: Comparing Different Subpopulations

PPOR also asks: How many deaths might have been prevented? Compare, using a Reference Group

• If one population group already

can have very low mortality,

• ther groups can reach that

goal.

• Instead of comparing

racial/ethnic groups, we compare all groups to this agreed-upon reference group.

• Community helps decides who

is compared to whom.

…A matter of health equity.

Calculating Excess Rates

(US 2000-2002 Reference Group)

Urban Cty

Maternal Health/ Prematurity

Maternal Care Newborn Care Infant Health Fetal-Infant Mortality ALL

4.2 2.1 1.9 2.0 10.1

US Reference Group

2.2 1.5 1.1 0.9 5.7

Excess Mortality Rates

0.8 0.6 2.0 1.1 4.4

_

Estimated Excess Number of Deaths

(US 2000-2002 Reference Group ) Racial- Ethnic Groups Maternal Health/ Prematurity Maternal Care Newborn Care Infant Health Fetal-Infant Mortality

White, non- Hispanic

14 8 13 11 47

Black, non- Hispanic

22 3 4 10 39

Other Races

9 2 1 6 18

All

46 13 18 26 103

Maternal Health/ Prematurity Maternal Care Newborn Care Infant Health

Preconception Health Toxic Stress, Other Exposures Behaviors before pregnancy Mental Health Prenatal Care Access and Quality High Risk Referral Obstetrical Care Quality of Caring, Doulas Perinatal Management Neonatal Care Pediatric Surgery Home Visitation Sleep Position Smoking Injury Prevention Child Care Quality

Perinatal Periods of Risk (PPOR) Approach Helps Narrow the Choices of Action

Pe Perinatal Pe Periods of Risk “Maps” 1999-2014 2014 Do Douglas Co County (Omaha), , NE, NE, All Races

Fetal-Infant Rate=10.0

3.4 1.2 1.8 1.8

Fetal-Infant Rate=8.2 Fetal-Infant Rate=8.3

1999-2002 2003-2006 2007-2010 2.4 1.0 1.5 1.3

Fetal-Infant Rate= 6.3

2011-2014 3.7 2.2 1.2 1.2 4.1 2.2 1.7 2.0

Av Average PPO PPOR Ra Rates ( (Fe Feta tal+Infant De Death ths)

Douglas County, NE 1995-2014*

*2014 data is provisional

0.5 1 1.5 2 2.5 3 3.5 4 4.5 95- 98 96- 99 97- 00 98- 01 99- 02 00- 03 01- 04 02- 05 03- 06 04- 07 05- 08 06- 09 07- 10 08- 11 09- 12 10- 13 11- 14

MH/P MC NC IH

3 more things…

Th Thelma’ elma’s Box

1.

• 1. U

University o ty of P Pennsyl ylvania 1948 ( 1948 (MSW) M Masters T Thesis 2.

• 2. U

University o ty of Ca California - Ber Berkel eley M y Master ers i in Di Divinity ty, 2000 G 2000 Graduati tion H Hood

• 3. …………..

And the Bikini?

Persistent Fierce Optimism