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
S AN D IEGO C OUNTY
I NNOVATIVE P ARTNERSHIPS FOR S URVEILLANCE � Background on programs � Why we needed a clinical partner � About our partner � What we’re doing as a result
C URRENT C HRONIC D ISEASE F RAMEWORK Lead to Result in OVER BEHAVIORS DISEASES PERCENT Cancer No Physical Activity Heart Disease & Stroke of Deaths Poor Diet Type 2 Diabetes in San Diego Tobacco Use Lung Disease
C ONTINUUM OF S UCCESS H IGHLIGHTED P ROGRAMS CPPW: CTG: NEOP: Prevention (1422): 14 Interventions 26 Interventions 14 Interventions 15 Interventions 2010-2012 2011-2014 2011-2019 2014-2018 • Healthy eating • Tobacco-free living • Active living • Healthy eating • Healthy eating • Healthy eating • Clinical and Health Outcomes • Active living • Active living • Active living Interventions community preventive Upstream Improved • Clinical and community services preventive services • Health systems • Social and emotional Interventions wellness • Healthy and safe • Healthy and safe • Healthy and safe • Healthy and safe physical physical physical environments physical environments environments environments 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.
P UBLIC H EALTH S ERVICES B RANCHES Public Health Services Public Health Services works Emergency Medical Services to prevent epidemics and the spread of disease, protect TB Control and Refugee Health against environmental hazards, prevent injuries, promote and HIV, STD, and Hepatitis Branch encourage healthy behaviors, respond to disasters and assist Epidemiology and communities in recovery and Immunization Services assure the quality and accessibility of health services Maternal, Child, and Family throughout the county. Health Services
H EALTHY W ORKS : P REVENTION I NITIATIVE (1422)
B E T HERE S AN D IEGO (BTSD) C OMPONENT 2 Be There San Diego Clinical Collaborative � Right Care Initiative � Focused on Heart Disease and Stroke Prevention � University of Best Practices � Data for Quality
B E T HERE S AN D IEGO : P UBLIC / P RIVATE P ARTNERSHIP 9
B E T HERE S AN D IEGO S URVEILLANCE Be There San Diego and Surveillance � Staff and partner expertise � Relationships with healthcare organizations � Link with existing efforts: Regional Clinical Quality Indicators project
C HRONIC D ISEASE P ILOT P ROJECT DATA LIMITATIONS: WHAT’S MISSING? ? No data for early clinical conditions Little neighborhood-level data
P ROGRESSION OF D IABETES Early clinical conditions IFG/IGT Type 2 Diabetes NGT NORMAL TO DIABETIC • Estimates of prevalence of prediabetes range from 33 to 42* percent of 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 .
S AN D IEGO CPPW: BMI S URVEILLANCE Expansion of data collection for body mass index (BMI) surveillance 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
C HRONIC D ISEASE S URVEILLANCE P ROJECT Goal: develop basic infrastructure and recruit 1-3 clinics to submit data for proof-of-concept system Prevention grant : $75,000/year of internal funds for surveillance system (9/30/14 to 9/29/18) Encrypted File Transfer
C HRONIC D ISEASE S URVEILLANCE P ROJECT 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…. . X Encrypted File Transfer
C HRONIC D ISEASE S URVEILLANCE P ROJECT EHR T OOLKIT 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 T OOLKIT P ILOT P ROJECT F UNDING TA Funding SAN DIEGO COUNTY IT NETWORK Community EHR Data Health Centers
C HRONIC D ISEASE S URVEILLANCE P ROJECT G OVERNANCE WHO HAS ACCESS, WHEN AND HOW: • Data Use Agreements • Health Officer Order
C HRONIC D ISEASE S URVEILLANCE P ROJECT D ATA 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
C HRONIC D ISEASE S URVEILLANCE P ROJECT I NFRASTRUCTURE PILOT DEVELOPMENT INCLUDES : • Dropbox • Server Space • Development of Analytics LARGE MEDICAL SYSTEM SAN DIEGO COUNTY IT NETWORK PGP sFTP COMMUNITY CLINIC DAILY SWEEP PRIVATE MEDICAL OFFICE
C HRONIC D ISEASE S URVEILLANCE P ROJECT N EXT S TEPS Finalize Infrastructure • Leveraging ArcGIS database • Develop data management tools and analytics • Utilize open source tools: Python and R Plans for Clinic Recruitment • Fund clinics to develop queries • Revise Data Use Agreements • Develop draft clinic reports
C HRONIC D ISEASE S URVEILLANCE P ROJECT P ROJECT T EAM 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
Q UESTIONS ? Deirdre Browner, MPH deirdre.browner@sdcounty.ca.gov
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