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Applying Data Warehousing to Community Health Assessment WITS’99 Keynote Address. Alan R. Hevner University of South Florida [email protected]. Preface - WITS Retrospective. As we approach 2000, a quick look back: WITS’91 - Boston (Ram and Wang) WITS’92 - Dallas (Storey and Whinston) - PowerPoint PPT Presentation
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Applying Data Warehousing to Community Health Assessment
WITS’99 Keynote Address
Alan R. Hevner
University of South Florida
December 11, 1999 2WITS'99 Keynote Address
Preface - WITS RetrospectiveAs we approach 2000, a quick look back:
WITS’91 - Boston (Ram and Wang)WITS’92 - Dallas (Storey and Whinston)WITS’93 - Orlando (Hevner and Kamel)WITS’94 - Vancouver (De and Woo)WITS’95 - Amsterdam (Jarke and Ram)WITS’96 - Cleveland (Ernst and Sen)WITS’97 - Atlanta (Segev and Vaishnavi)WITS’98 - Helsinki (Bubenko and March)WITS’99 - Charlotte (Narasimhan and Sarkar)
December 11, 1999 3WITS'99 Keynote Address
Outline
Research Motivation - Community Health Measurement and Assessment
The CATCH MethodologyA Data Warehousing SolutionData Dissemination ModesCommunity Health Decision MakingA CATCH Demonstration
December 11, 1999 4WITS'99 Keynote Address
AcknowledgementsCo-Principal Investigators
James Studnicki - College of Public Health, USFDon Berndt - College of Business Admin., USF
Research StaffCenter for Health Outcomes Research StaffDoctoral and Masters Students
FundingU.S. Dept. of Commerce TIIAP GrantBear Stearns Research LaboratoryFlorida Communities
December 11, 1999 5WITS'99 Keynote Address
Research Motivation U.S. has the Highest Per Capita Health Expenditures in the
World Low Rank of U.S. as defined by Health Status Indicators Transition from a Disease to Health focus and from a Treatment
to a Prevention strategy Health Priorities defined by Political Agendas and the
Managerial Objectives of Health Organizations rather than Objective Evaluation
Pluralistic, Non-Integrated Health Care Systems No Single Organization is Responsible for the Health of the Community
No Uniform Method to define the “Health of the Community” which is Universally Accepted and Consistently Applied
December 11, 1999 6WITS'99 Keynote Address
Community Health PlanningInstitute of Medicine (IOM) 1988 Report on the
Future of Public HealthRecommends a regular and systematic collection,
assemblage, and analysis of information on the health status and needs of communities.
IOM 1997 Report on Using Performance Monitoring to Improve Community HealthCalls for a Community Health Profile which can be used
to support priority setting, resource allocation decisions, and the evaluation of health program impacts.
December 11, 1999 7WITS'99 Keynote Address
Collaborative Health Decision MakingMulti-Sector Community Health Stakeholders
Health OrganizationsPublic Sector AgenciesMedical Care ProvidersBusinessesReligious CommunityEducational InstitutionsGovernment Agencies
Decisions must be based on Unbiased, Timely Information
December 11, 1999 8WITS'99 Keynote Address
CATCH Methodology
Comprehensive Assessment for Tracking Community Health (CATCH)
Project initiated in 199114 Florida County ApplicationsMarion County, Indiana (Indianapolis)Potential Regional, National, and
International Applications
December 11, 1999 WITS'99 Keynote Address
Community Health Indicators
Indicator 1Indicator 2...Indicator i..
State Averages
Peer Community Averages
Additional Health Standard Comparisons
Indicator 1Indicator 2...Indicator i.
Indicator 1Indicator 2...Indicator i.
State
Favorable Unfavorable
Fav.
Peer
Unfav.
Prioritized List of Community Health Challenges
1. Indicator i
2. Indicator j
,
.
.
CATCH N-Dimensional Comparison Matrix
Health Challenges
Fav/Fav
Indicators
Fav/Unfav
Indicators
Unfav/Fav
Indicators
F
I
L
T
E
R
S
CATCHMethodology
December 11, 1999 10WITS'99 Keynote Address
Data Collection and AnalysisTen Indicator Groups
DemographicsSocioeconomicMaternal and Child HealthSocial and Mental HealthPhysical Environmental HealthHealth Status: Morbidity/MortalitySentinel Events Infectious DiseasesHealth Resource AvailabilityBehavioral Risk Factors
December 11, 1999 11WITS'99 Keynote Address
Priority Filters
Number AffectedEconomic ImpactAvailability of Efficacious InterventionMagnitude of DifferenceTrend Analysis
PeerCRITERIA Hillsborough Group Duval Orange Polk
% Population < Age 18 24.86% 25.41% 26.58% 24.84% 24.46%
% Population > Age 64 12.71% 13.01% 11.27% 11.51% 18.37%
% Non-white Population 15.32% 21.13% 27.20% 19.08% 14.76%
% Families Below Poverty Level 9.5% 9.0% 9.8% 7.8% 9.4%
Source: Florida County Comparisons 1995
Peer Comparison Peer Comparison
Comparison MatrixComparison Matrix
FAVORABLE UNFAVORABLE
INDICATOR CO PEER ST Socioeconomic
Maternal &Child health
InfectiousDisease
Health Status
Sentinel Events
ResourceAvailability
Physical/Environmental
Social & Mental
Behavioral Risk
CATEGORY% Labor forceunemployed
5.2% 5.8% 6.6%
% Labor force unemployed
Tuberculosiscases
Infant mortality:non-white
12.6 14.4 11.9
Colorectal cancer
Licensed hosp. beds 5.9 4.7 4.5
0.31 0.25 0.57
Drowningfatalities
11.3 10.8 12.3
Drowning fatalities 2.4 2.0 2.7
Late stagecervical cancer
Cervical cancerlate stage
51.3 41.7 45.6
STATE
PEER
FAV
UNFAV
Challenges:
Further Screening
Infant mortality:non-white
Domestic
viol. cases 1041.0 1041.8 864.1Current smokers 24.8 26.9 23.1
Priority Filters Priority Filters
Avoidable Hosp.:
Asthma
Low birthweight
Gonorrhea cases
Stroke
Cervical cancer:
%late stage
Pneumonia/
Influenza
SAMPLE HIGH PRIORITY AREAS
Availability Economic Number of Magnitude Trend of Impact People of Direction Efficacious Affected Difference andIntervention Magnitude
SCREENSPRIORITIZATION
Social and Mental HealthINDICATORS COMPARED TO STATE & PEER VALUES
Social and Mental HealthINDICATORS COMPARED TO STATE & PEER VALUES
STATE
FAVORABLE UNFAVORABLEChild maltreatment Burglary offenses
Elderly abuse Forcible sex assaults FAVORABLE Homicide AA mortality Crude homicide rate: total Crude homicide rate:non-white Illegal drug sales Domestic violence cases P Crude suicide rate: white Simple assaults E Aggravated assaults E Illegal drug possession R Crude homicide rate: white
Suicide AA mortality Crude suicide rate: total,
non-whiteUNFAVORABLE Intentional injury AA mortality
Alcohol related motor vehicle accidents Alcohol related motor vehicle
mortality Psychiatric admissions % w/ good mental health
AA = Age Adjusted
Indicator Fact SheetIndicator Fact Sheet
16
48
80
90 91 92 93 94
0
20
40
60
80
County Peer Florida
1994 AIDS CASES, Incidence rate per 100,000 population
FIVE YEAR TREND ANALYSIS
INDICATOR: AIDS CASES
KEY: Thick line = County value, Thin line = Florida value
1990 1991 1992 1993 1994________________________________________________________________
County: 19.5 24.6 26.2 55.3 27.6Florida: 29.6 41.5 41.7 77.2 61.5
Source: PHIDS
December 11, 1999 17WITS'99 Keynote Address
CATCH Data Warehouse
Manual CATCH LimitationsLabor-Intensive and Slow
Four months per report
Longitudinal Trend Analyses are Cost ProhibitiveExtension of County Reports to State, National,
and International ReportsKnowledge Discovery Potential not Realized
CATCH Data Warehouse Solution
December 11, 1999 18WITS'99 Keynote Address
Data Warehouse Challenges - Construction
Data CollectionData SourcesData QualityExtraction, Transformation, and Transportation
Data Warehouse DesignStar Schemas
Data StagingSizing and CleansingQuality Assurance
December 11, 1999 19WITS'99 Keynote Address
Hospital Discharge Star SchemaLOAD EVENT# ID* USERNAME* STATUS* STARTo ENDo PROCESSo VERSIONo TYPEo ROWS_PROCESSEDo ROWS_REJECTEDo DESCRIPTIONo NOTE
INDICATOR# ID* NAME* DESCRIPTIONo ABBREVIATIONo NOTEo TYPEo FREQUENCYo GEO_GRAINo TIME_GRAINo ELECTRONICo MULTIPLIERo ECO_IMPACTo EFFICACYo LAST_LOADo NEXT_LOAD
YEAR# YEARo HALF DECADEo DECADEo NOTE
RACE# ID* CATEGORYo ABBREVIATION
GENDER# ID* DESCRIPTION* ABBREVIATION
CT DISCHARGE* VALUE
COUNTY# ID* NAMEo MIL BASEo MIL BASE CNTo COASTALo REGIONo HEALTH DISTRICT* VITAL STATS ID
AGE# ID* AGE* UNITo CATEGORYo Y5 BANDo Y10 BANDo CUST BAND 1
load dimension
discharge fact
indicator dimension
discharge fact
age dimension
discharge fact
gender dimension
discharge fact
county dimension
discharge fact
year dimension
discharge fact
race dimension
discharge fact
December 11, 1999 20WITS'99 Keynote Address
ICD-9 Code Dimension Hierarchy
ICD9 PROC SECTION# ID* DESCRIPTION
ICD9 DX SECTION# ID* DESCRIPTION
ICD9 PROC CHAPTER# ID* DESCRIPTION
ICD9 DX CHAPTER# ID* DESCRIPTION
CCHPR PROCEDURE# ID* DESCRIPTION
CCHPR DX# ID* DESCRIPTION
ICD9 CODE# CODE* DISEASEo CATEGORY
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December 11, 1999 21WITS'99 Keynote Address
Data Warehouse Challenges - Operations
User InterfacesPerformanceSecurityBackup and RecoveryKnowledge Discovery
Data Mining
December 11, 1999 22WITS'99 Keynote Address
Data Dissemination Modes
Effective Presentation of CATCH Information to Community Decision Makers
Data Dissemination ModesPre-defined Reports Data BrowsingAd-hoc QueriesInternet Access
Hypertext Information ScreensDynamic Access to Data Warehouse
December 11, 1999 23WITS'99 Keynote Address
Community Group Decision Making
Research Field: IT Support for Group Decision Making
Research Question: How will communities make most effective use of the CATCH data for health care decision making?
Research Testbed: During 2000 we will provide CATCH reports to all 67 Florida counties.
December 11, 1999 24WITS'99 Keynote Address
Group Decision Making Issues Motivation of community to use data Presence of a champion for specific actions Size and make-up of the decision making group Speed of the decision making process Stakeholders around the table and their influence Resource constraints Political nature of the process Differential accesses to data among communities Ease of access and usefulness of the data Requests for customized analyses Information exchange patterns and practices
December 11, 1999 25WITS'99 Keynote Address
CATCH Data Warehouse Demonstration
Policy Question on Racial Disparity in Infant Mortality in Florida:
“What is the pattern of variation in infant mortality between whites and non-whites throughout Florida? What factors best explain this variation?”
December 11, 1999 26WITS'99 Keynote Address
Data Browsing Strategy
Produce a Table of Florida Counties and Infant Mortality Data
Sort and Graph the InformationCluster the Counties into Four GroupingsSelect Factors for Analysis and CorrelationPerform Further In-Depth Analyses
Data Mining Neural NetworksMultivariate Statistics
December 11, 1999 27WITS'99 Keynote Address
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ConclusionsThe Application of Data Warehousing Technology to
Community Health Care can make a Social Contribution
Technical Research ChallengesCollaborative Group Decision Making: What factors are
associated with effective community use of CATCH data?
LeadershipInfrastructureDecision-Making ProcessPublic/Private Sector Cooperation
December 11, 1999 40WITS'99 Keynote Address
Appendix:CATCH Data Indicators
December 11, 1999 41WITS'99 Keynote Address
Data IndicatorsDEMOGRAPHIC CHARACTERISTICS
% Total population by gender% Total population by age% Total population by race% Population rural% Labor force by genderMedian AgeNet migrationLive births per 1,000 populationDeaths per 1,000 population
December 11, 1999 42WITS'99 Keynote Address
Data Indicators
SOCIOECONOMIC CHARACTERISTICS Non-graduates of high school High school dropouts Per capita income Labor force unemployed Persons below poverty level WIC eligibles Medicaid eligibles % Medicaid births HMO enrollment % enrolled in a health plan Families with children < age 18 below poverty level Population receiving food stamps Students eligible for free/reduced lunch program %Low income persons with access to dental care
December 11, 1999 43WITS'99 Keynote Address
Data IndicatorsMATERNAL AND CHILD HEALTH
Infant Mortality Child mortality Neonatal mortality Post neonatal mortality Low birthweight Very low birthweight Perinatal condition mortality Birth Defects Mortality % Live births w/1st trimester prenatal care % Live births w/3rd trimester prenatal care % Live births w/ no prenatal care Live births to mothers < age 15 Live births to mothers age 15 - 17 Live births to mothers age 18 - 19 Repeat births to teens
December 11, 1999 44WITS'99 Keynote Address
Data Indicators
PHYSICAL ENVIRONMENTAL HEALTH Salmonella cases Campylobacter cases Shigella cases Rabies in animals Lead poisoning Fluoridated water Firearm fatalities Drowning fatalities Poisoning fatalities Bicycle fatalities Contaminated wells Septic tank repair permits Enteric disease cases: total and in children < age 6 Foodborne and waterborne outbreaks Motor vehicle mortality - age adjusted Unintentional injury mortality - age adjusted
December 11, 1999 45WITS'99 Keynote Address
Data Indicators
INFECTIOUS DISEASE AIDS incidence, cumulative cases, & mortality HIV seropositivity Infectious Syphilis cases Congenital Syphilis cases Gonorrhea cases Chlamydia cases Hepatitis A and B cases Meningitis cases Tuberculosis cases Tuberculosis mortality - age adjusted % Vaccinated by kindergarten
December 11, 1999 46WITS'99 Keynote Address
Data IndicatorsSOCIAL AND MENTAL HEALTH
Alcohol Related motor vehicle accidents & mortality Assaults: Forcible sex, Burglary, Simple and Aggravated Juvenile delinquency rates Suicide - crude & age adjusted Intentional injury - age adjusted Homicide - crude & age adjusted Child Abuse, Elderly Abuse - reported and confirmed cases Domestic Violence - Reported cases Mental health of adults: days/month w/o good mental health Hospitalization rates for:
Baker Act, Psychoses, Depression, Alzheimer's Disease, Alcohol abuse &
Drug abuse
December 11, 1999 47WITS'99 Keynote Address
Data IndicatorsHEALTH STATUS INDICATORS
Morbidity CasesMelanoma Prostate cancerBreast cancer Cervical cancerColorectal cancer Lung & bronchus cancer Smoking related cancers
Age Adjusted Mortality Rates (Crude)Chronic liver disease & cirrhosis (crude) Melanoma Pneumonia/Influenza (crude) Breast cancerDiabetes Mellitus (crude) Cervical cancerCardiovascular disease Colorectal cancerHeart disease (crude) Lung/smoking rel. cancer Stroke (crude) Preventable cancerC.O.L.D. Prostate cancerYPLL All cancers (crude)
December 11, 1999 48WITS'99 Keynote Address
Data IndicatorsSENTINEL EVENTS
Vaccine Preventable DiseasesMeasles RubellaMumps Pertussis
Late Stage CancersBreast cancer cases - % late stageCervical cancer cases - % late stage
Avoidable HospitalizationsAsthma Immunizable conditions Cellulitis Malignant hypertension Congestive heart failure Perforated/bleeding ulcerDiabetes PneumoniaGangrene PyelonephritisHypokalemia Ruptured appendix
December 11, 1999 49WITS'99 Keynote Address
Data IndicatorsHEALTH RESOURCE AVAILABILITY
Licensed Beds Hospitals Nursing homes
Licensed ProfessionalsDoctors Dentists
RNs LPNs
Pharmacists Dieticians
Nurse Midwives Psychologists
Opticians/optometrists
Ratio of Medicaid Eligibles to Participating Physicians
December 11, 1999 50WITS'99 Keynote Address
Data IndicatorsBEHAVIORAL RISK FACTORS
MammogramsPap smearsBlood pressure screeningCholesterol screeningSmokingObesitySeat Belt Use & Child Seat UseBicycle Helmet UseCheck-up in last yearHealth Care Foregone due to cost