Community Health Status Indicators (CHSI) Module 2

Community Health Status Indicators (CHSI)

Module 2Nancy Allee, MLS, MPH, AHIPDeputy Director, Health

Sciences LibrariesUniversity of Michigan

Webinar, January 27, 2010

Health Indicators, Part II

Health indicators: 4-part series• Part I: “Health Indicators: Overview”• Wednesday, January 20th, 1:00pm EST

– Understand the variety of health indicators, their data sources, their key attributes, context and use – Presenter: Cheryl Wold, Wold & Associates

• Part II: “Community Health Status Indicators (CHSI)” • Wednesday, January 27th, 1:00pm EST

– Learn to navigate and use the Community Health Status Indicators (CHSI) effectively to find county-level data

– Presenter: Nancy Allee, Deputy Director, Health Sciences Libraries, University of Michigan • Part III: “Practical Approaches for Using Health Indicators” • Wednesday, February 3rd, 1:00pm EST

– Discover ways in which librarians can become more engaged with others in improving the health of their communities and become knowledgeable about ways in which CHSI data can be used in working with the public health practice community

– Presenter: Nancy Allee, Deputy Director, Health Sciences Libraries, University of Michigan • Part IV: “Examples of Important New Indicator Projects” • Date/Time: To Be Announced

– Become familiar with several important indicator efforts including State of the USA, MATCH, and two local level examples

– Presenter: Cheryl Wold, Wold & Associates

• Registration: http://www.nlm.nih.gov/nichsr/healthindicators/


Today’s presentationFocus on: the Community Health Status Indicators

Goal: Learn to navigate and use the Community Health Status Indicators effectively to find local data

accessing searching mapping generating county-level reports

Question: How can librarians engage with the public health workforce and local communities in using health indicator resources for quality improvement?


Presenter’s backgroundNancy Allee ([email protected])

Degrees in Library Science & Public Health

MLA CE’s –Community Health Status Indicators–Evidence Based Public Health–Public Health 2.0 (Social Media)

NLM & Partners in Information Access –Chair: Public Health Training Subcommittee–Project Director: Public Health Information & Data Tutorials project & developer of Evidence Based Public Health Module

Past chair of the Public Health / Health Administration Section of the Medical Library Association


What is public health?• Prevents epidemics and the spread of disease• Protects against environmental hazards• Prevents injuries• Promotes and encourages healthy behaviors• Responds to disasters and assists communities in recovery• Assures the quality and accessibility of health services

• Source: Public Health Functions Steering Committee, Fall 1994.


10 Essential Public Health Services• Monitor health status to identify community health problems• Diagnose and investigate health problems and health hazards in the

community• Inform, educate, and empower people about health issues• Mobilize community partnerships to identify and solve health problems• Develop policies and plans that support individual and community health

efforts• Enforce laws and regulations that protect health and ensure safety• Link people to needed personal health services and assure the provision of

health care when otherwise unavailable• Assure a competent public health and personal health care workforce• Evaluate effectiveness, accessibility, and quality of personal and population-

based health services• Research for new insights and innovative solutions to health problems

• Source: Public Health Functions Steering Committee, Fall 1994. http://www.health.gov/phfunctions/public.htm


What is CHSI (Community Health Status Indicators)?

A collection of nationally available health indicators for counties, helping to present a “total picture” of local health.

A resource for monitoring and analyzing community health status and its determinants at the county level.

The goal of CHSI is to give local public health agencies another tool for improving their community’s health by identifying data resources and facilitating the setting of priorities.

CHSI supports the mission and goals of public health, the 10 essential public health services, Healthy People 2010 initiatives, and evidence-based policy and research.

Partners• Federal partners

– Agency for Toxic Substances and Disease Registry (ATSDR)– Centers for Disease Control and Prevention (CDC)– Health Resources Services Administration (HRSA)– National Library of Medicine (NLM)

• Private partners– Association of State and Territorial Health Officials (ASTHO)– Johns Hopkins University Bloomberg School of Public Health– National Association of County and City Health Officials

(NACCHO)– National Association of Local Boards of Health (NALBOH)– Public Health Foundation (PHF)– Robert Wood Johnson Foundation (RWJF)


Uses of & users of CHSI and health indicators

• Uses of– Public policy– Public health

programs– Interventions– Partnerships– Research– Grants– Publications

• Users of– Public health officials– Public health workers– Librarians– Academics– Government agencies– Nonprofit organizations– General public– Anyone with an interest

in local public health data


CHSI data sources• Air Quality Reporting System & Toxic Release Inventory

(EPA)• Behavioral Risk Factor Surveillance System (BRFSS)• Centers for Medicare & Medicaid Services • Harvard Initiative on Global Health• Infectious Diseases Reporting System (CDC)• National Vital Statistics System (CDC) • Substance Abuse and Mental Health Services

Administration (SAMHSA)• U.S. Census Bureau & Bureau of Labor Statistics -

Current Population Survey


CHSI & evidence-based decision-making

• Comparison to peer and other U.S. counties• Symbols

– Apple = favorable status– Magnifying glass = unfavorable status


What are indicators?

• An indicator is “a summary measure that aims to describe in a few numbers as much detail as possible about a system to help understand, compare, predict, improve, and innovate.”

• Source: – The Good Indicators Guide

http://www.apho.org.uk/resource/item.aspx?RID=44584


What are health indicators?

• A health indicator is “a characteristic of an individual, population, or environment which is subject to measurement and can be used to describe one or more aspects of the health of an individual or population.”

• Source: – Definition of Wellness web site

http://www.definitionofwellness.com/dictionary/health-indicator.html


What is the “community” in Community Health Status Indicators?

• Individual counties – data for 3,141 U.S. counties

• Peer counties– counties similar in population size and other

selected characteristics (e.g. poverty level, age distribution, density)


Some myths about health indicators• Only local indicators are relevant for local people.• Unless the data are perfect, the indicator is useless.• Measurement eliminates uncertainty and argument.• Only a few indicators are needed to understand how

a system is working.




Some truths about health indicators• Indicators only indicate – they are not the whole

story.• Indicators are ideally linked to quality

improvement.– “Measurement is necessary for improvement but is

not sufficient on its own.” • David Pencheon, The Good Indicators Guide

– “I am not interested in measurement per se. I am obsessed by improvement and the role measurement has in that process.”

• Don Berwick, Institute for Healthcare Improvement




CHSI health indicators

• Demographics• Summary measures of health• National leading causes of death• Measures of birth and death• Relative health importance• Vulnerable populations• Environmental health• Preventive services use• Risk factors for premature death• Access to care

Source: http://www.communityhealth.hhs.gov/Companion_Document/CHSI-Data_Sources_Definitions_And_Notes.pdf



• Demographics– Population size– Poverty level– Population by age– Population by race/ethnicity



• Summary measures of health– Average life expectancy– Rates of death– Self-rated health status– Average unhealthy days



• National leading causes of death– Complications of pregnancy/birth– Birth defects– Injuries– Homicide – Cancer– Suicide– Heart disease– HIV/AIDS



• Measures of birth and death– Birth

• Low birth weight, very low birth weight, premature births

– Death• Infant mortality, breast cancer, colon cancer,

coronary heart disease, homicide, stroke



• Relative health importance– Highlights favorable and unfavorable health

status between peer counties and the U.S. in general



• Vulnerable populations– Have no high school diploma– Unemployed– Severe work disability– Major depression– Recent drug use



• Environmental health– Clean air, water, land, waste disposal– Data on infectious diseases– Standards for pollutants and toxic chemicals



• Preventive services use– Pap tests, mammograms, colonoscopy,

vaccines



• Risk factors for premature death– Lack of exercise– Poor nutrition– Obesity– High blood pressure– Smoking– Diabetes



• Access to care– Number of uninsured– Number of Medicare enrollees– Number of primary care physicians– Health professional shortage areas


Peer counties

88 strata or peer groups defined in CHSI, using 5 factors:

• Frontier status• Population size• Poverty quartiles• Median age• Population density


How can I access the CHSI web site?http://www.communityhealth.hhs.gov/

CHSI: “Home”


CHSI: “About the data”


CHSI: “Data details”


CHSI: “About the project”


CHSI: “How to use your county’s report”


CHSI: “Partners”


CHSI: “Resources”


CHSI: “Resources” cont’d


CHSI: “NLM resources”

CHSI: Mapping & reports


CHSI sample search


Focus on Wayne County, MI


Demographics: Wayne County, MI


Summary measures of health: Wayne County, MI

National leading causes of death: Wayne County, MI

Measures of birth and death: Wayne County, MI


Relative health importance: Wayne County, MI

• Low Birth Wt. (<2500 g) • Very Low Birth Wt. (<1500 g) • Premature Births (<37 weeks) • Births to Women under 18 • Births to Unmarried Women • No Care in First Trimester • Infant Mortality • White non Hispanic Infant

Mortality • Black non Hispanic Infant

Mortality

• Hispanic Infant Mortality • Neonatal Infant Mortality • Post-neonatal Infant Mortality • Breast Cancer (Female) • Colon Cancer • Coronary Heart Disease • Homicide • Lung Cancer • Stroke

Unfavorable health indicators – both Peers and U.S.


Vulnerable populations: Wayne County, MI


Environmental health: Wayne County, MI


Preventive services use: Wayne County, MI


Preventive services use: infectious disease cases: Wayne County, MI

Risk factors for premature death: Wayne County, MI

Access to care: Wayne County, MI


CHSI reportsEach CHSI report includes data

on access and utilization of healthcare services, birth and death measures, Healthy People 2010 targets and U.S. birth and death rates, vulnerable populations, risk-factors for premature deaths, communicable diseases and environmental health.

In addition, the presentation of the data allows for comparisons of a county to its peer counties as well as U.S. rates and Healthy People 2010 targets.


Mapping


Mapping: major depression indicator

Peer counties: Wayne County, MI

• California– Los Angeles County– Orange County– San Diego County

• Florida– Miami-Dade County– Palm Beach County

• Illinois– Cook County

• New York– Bronx County– Queens County

• Texas– Bexar County– Dallas County


Peer county comparison: major depression Wayne County, MI and Cook County, IL

Another mapping example


Additional resources The July 2008 issue of Preventing Chronic Disease contains the

following articles that provide additional information about the Community Health Status Indicators project:

Kanarek N, Bialek R, Stanley J. Use of peer groupings to assess county public health status. Prev Chronic Dis 2008;5(3). http://www.cdc.gov/pcd/issues/2008/jul/07_0145.htm.

Metzler M, Kanarek N, Highsmith K, Bialek R, Straw R, Auston I, et al. Community Health Status Indicators Project: the development of a national approach to community health. Prev Chronic Dis 2008;5(3). http://www.cdc.gov/pcd/issues/2008/jul/07_0225.htm.

Heitgerd JL, Dent AL, Holt JB, Elmore KA, Melfi K, Stanley JM, et al. Community health status indicators: adding a geospatial component. Prev Chronic Dis 2008;5(3). http://www.cdc.gov/pcd/issues/2008/jul/07_0077.htm.

Sondik EJ. The goal of adequate data. Prev Chronic Dis 2008;5(3). http://www.cdc.gov/pcd/issues/2008/jul/07_0175.htm.

Additional resourcesCommunity Health Status Indicators Project Working Group. Data

Sources, Definitions, and Notes for CHSI 2008. Department of Health and Human Services, Washington, DC: 2008.

http://www.communityhealth.hhs.gov/Companion_Document/CHSI-Data_Sources_Definitions_And_Notes.pdf

CHSI GIS Analyst User DocumentationOctober 8, 2009http://gis.cdc.gov/chsi/chsi_help.pdf


Upcoming webinars• “Practical Approaches for Using Health Indicators” • Wednesday, February 3rd, 1:00pm EST

– Discover ways in which librarians can become more engaged with others in improving the health of their communities and become knowledgeable about ways in which CHSI data can be used in working with the public health practice community

– Presenter: Nancy Allee, Deputy Director, Health Sciences Libraries, University of Michigan

• “Examples of Important New Indicator Projects” • Date/Time: To Be Announced

– Become familiar with several important indicator efforts including State of the USA, MATCH, and two local level examples

– Presenter: Cheryl Wold, Wold & Associates

• Registration: http://www.nlm.nih.gov/nichsr/healthindicators/


Topic for February 3rd webinar

• How can librarians engage with the public health workforce and local communities in using health indicator resources for quality improvement?

• If you’d like to share your library’s experiences and project efforts successfully partnering with the public health community to improve health status: – send to [email protected]– include name & contact information and brief project

description– send by January 30 to be highlighted in upcoming webinar


Contact information

Nancy AlleeHealth Sciences Libraries

University of [email protected]


Documents

Community Health Status Indicators (CHSI) Module 2