Novel Approaches to Addressing Health Disparities & Social - PowerPoint PPT Presentation

Novel Approaches to Addressing Health Disparities & Social Determinants of Health HEALTH EDUCATORS INSTITUTE CONFERENCE AMY R. SHEON, PHD, MPH EXECUTIVE DIRECTOR URBAN HEALTH INITIATIVE

Disclosure—Amy Sheon President and CEO, Public Health Innovators, LLC: provides consultation to health systems, governments, philanthropic, corporate, non-profit and academic clients around digital health equity and innovation. Funding Contracts Through Case Western Reserve University: ◦ Public Insight Data: Health data visualization Subject Matter Expert ◦ NODE.Health/Uber Health (Evidence Base for Mobile Health) ◦ Ohio Department of Medicaid (Virtual Reality SDOH Simulation) ◦ Office of Cuyahoga County Executive, via Connected Insights, re digital connectivity and health 2 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Learning Objectives  Demonstrate novel data visualization techniques including mapping and storytelling to increase understanding of social determinants of health (SDOH)  Describe potential value of digital medicine for public health  Describe disparities in digital skills and connectivity, and frame them as a social justice issue  Describe use of public health data in a medical hackathon  Demonstrate use of virtual reality to increase awareness of social determinants of health and increase empathy accuracy 3 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Part 1: Health Disparity Data Visualization https://www.healthdatamatters.org 4 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

https://www.healthdatamatters.org/ 5 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Rationale  Provide single place for accessing definitive data on health outcomes and social determinants of health  Bring focus on health disparities and health equity, esp place-based  Encourage open data movement  Spawn innovation through real-time data access 6 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Historic Lens: Redlining & Health HOLC REDLINING, CIRCA 1930S http://guides.osu.edu/maps-geospatial-data/maps/redlining/ 7 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Cuyahoga County: Health Status LIFE EXPECTANCY, 2010-2015 % LIVING IN POVERTY Data source: Cuyahoga County Board of Health 8 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Power of Data Visualizations % BLACK 9 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Historic Lens: Redlining & Health Redlining and Life Expectancy 90 Redlining and Cancer 500 85 450 400 80 R² = 0.1602 350 Deaths/100,000 300 Years 75 250 200 R² = 0.2138 70 150 100 65 50 Not Redlined Redlined 0 Not Redlined Redlined 60 Data source: Cuyahoga County Board of Health 10 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Part 2: Digital Medicine Technology to improve population health AKA: Connected Health, Mobile Health https://www.medinaction.com/technology-revolutionizing- healthcare-the-future-is-changing-now/ 11 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

What can you do with Digital Health Tools? Caregiver Participate in proxy access research; update health status 12 7/31/2019 @AMYSHEON

Low Levels of MyChart Use at MetroHealth 200,000 180,000 N=243,248 160,000 Number of Patients 140,000 70.9% 120,000 100,000 80,000 60,000 29.1% 40,000 20,000 0 Do Not Use PHR Use PHR Journal of the American Medical Informatics Association , Volume 24, Issue 5, September 2017, Pages 927– 932, https://doi.org/10.1093/jamia/ocx020 13 7/31/2019 @AMYSHEON

Public Health Lens: Look at Disparities 40 40 35 30 34.1 30 30.2 25 25.1 20 23.8 20 23.4 16.1 15 10 10 5 0 18-64 years 65-79 years 80+ years 0 White Black Hispanic 40% 39.3% 30% 26.5% 20% 23.4% 17.4% Perzynski, et al 2017 10% 0% UNINSURED MEDICAID MEDICARE COMMERCIAL 14 7/31/2019 @AMYSHEON

Public Health Lens: SocioEcologic Model of HIT Barriers Fed/State/Local broadband policies Access to internet, training, care Provider workflow, policies Trust, support, content, development Language, usability, privacy, cost SEM Model Source : U.S. Centers for Disease Control and Prevention 15 7/31/2019 @AMYSHEON

Up Upstream C Cause: e: M MyChart t Us Use b by B Broa oadband Ac Acces ess 40 35 36.3 34.8 30 29.8 25 % Using PHR 22.5 20 17.5 15 10 5 0 0 - 20% 20 - 40% 40 - 60% 60 - 80% 80 - 100% Census Tract Broadband Coverage % of total population Perzynski, et al 2017 16 7/31/2019 @AMYSHEON

Digital Divides As Social Justice Issue % With Broadband Internet 17 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

CLEVELAND SCENE MAGAZINE http://guides.osu.edu/maps-geospatial- data/maps/redlining/ 18 7/31/2019 @AMYSHEON

% HH with no internet, % Black 2017 ACS 5 year estimate 19 7/31/2019 @AMYSHEON

Digital Inclusion Framework 20 7/31/2019 @AMYSHEON

% No Internet %HH Only Internet is Mobile 21 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Digital Divides Risk Widening Health Disparities Diabete tes P Prev evalence, e, B BRFSS % Has Cell Data Plan 500 500 C Cities P Project 201 2015 22 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Part 3: Digital Skills & Access as SDOH Computers and Broadband in Home, 7 Cities % of Adults 65+ Years % of <HS Grads 100.0 100.0 90.0 90.0 80.0 80.0 70.0 70.0 60.0 60.0 50.0 50.0 40.0 40.0 2015 2016 2017 2015 2016 2017 % of Unemployed Adults % of Adults with BA % of HS Grads 100.0 100.0 100.0 90.0 90.0 90.0 80.0 80.0 80.0 70.0 70.0 60.0 70.0 50.0 60.0 60.0 40.0 50.0 2015 2016 2017 50.0 40.0 40.0 2015 2016 2017 2015 2016 2017 American Community Survey, 2015, 2016, 2017; analysis by Sheon. See: Health Data Matters LiveStories hdm.livestories.com 23 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Digital Natives? % of Youth <18 with Broadband 24 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Digital Inclusion as a Social Determinant of Health 25 7/31/2019 @AMYSHEON

Public Health Approach: Reframing “Digital Skills and Connectivity as Social Determinants of Health (SDOH)” panel 26 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Solution: Population-based approach  Screening, Brief Intervention, Referral to Treatment (SBIRT) ◦ Screen all patients for digital skills and connectivity ◦ Refer to community organizations to address gaps in equipment, connectivity and basic digital skills ◦ Train patients to use health apps ◦ Train community health workers to screen, refer and train ◦ “Train the Trainer” model; partner with local CHW training programs 27 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Solution: Population-based approach  Screening, Brief Intervention, Referral to Treatment (SBIRT) Cembali, NDIA 2018 Digital Inclusion Net Summit 28 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Community Health Worker Model Addressing Disparities in Diabetes Management Through Novel Approaches to Encourage Technology Adoption and Use How can health systems leverage Amy R Sheon, Shari D Bolen, Bill Callahan, Sarah Shick, technology to engage patients? Adam T Perzynski Sheon AR, Carroll L. 2019 JMIR Diabetes 2017;2(2):6751 29 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Part 4: Bringing Public Health Perspective to Innovation 30 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Part 5: Bringing Innovation to Public Health: Neighborhood Immersion for Compassion & Empathy (NICE) VR Simulation for Medicaid Providers 31 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Thanks to: Health Data Matters and Neighborhood Dan Quigg, Public Insight Data Immersion for Compassion & Empathy teams: ◦ Scott Frank Digital Inclusion Partners: ◦ Matthew Kucmanic ◦ Angela Siefer, National Digital ◦ Lauren Wooster Inclusion Alliance (NDIA) ◦ Alex Rothbaum ◦ Bill Callahan, NDIA Policy Director ◦ Bianca Wilson and Connect Your Community 2.0 ◦ Regime Willis ◦ Samantha Schartman, Connected Live Stories (Adnan Mahmud) Insights Global Health Metrics (Adam Perzynski) ◦ Adam Perzynski, MetroHealth System BioflightVR (Rik Shorten, Paul Suchy) ◦ Wanda Davis, Ashbury Senior CWRU Medicaid Equity Simulation Team Computer Community Center 32 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE

Questions Amy.Sheon@case.edu @amysheon linkedin.com/in/amy-sheon-a1807212/ 33 October 17, 2019 AMY SHEON OHIO HEI CONFERENCE