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Data to Action: A Public Health Example Within a Guiding Framework
Mathew Christensen, Ph.D.Vickie Thomson, M.A.
Colorado Department of Public Health and
Environment
What are we talking about? “Data to action,” simply means using
data to improve or guide our intervention Question: How can data improve a large
complex system-based intervention like newborn hearing screening?
Mass confusion, assumptions, and viewpoints…we all have similar questions. How do we get from point A to point B effectively?
Step 1. Recognize the big health outcome
or problem we are trying to move. Did you know? Newborn hearing
screening exists to improve language and brain development for children with a hearing loss.
Step 2. Understand that data do not move
health outcomes, interventions move health outcomes
Side Note: Interventions must have the capacity to be “effective” in moving the outcome. Otherwise, we will simply be using data to improve an ineffective intervention
Interventions move outcomes Data are simply used to guide and
improve interventions Data guide interventions
move outcomes Public health needs to integrate
data people program people move outcomes (i.e.,complementary skill sets)
Screening is an intervention? Early interventions such as amplification
and language stimulation improves language outcomes for children who are deaf and hard of hearing.
“Early” is key, when language centers in the brain are still forming and malleable
Newborn screening leads to early identification of hearing loss, so screening can be viewed as the first stage of a large system-based intervention
Colorado Infant Hearing Program
Factors that Affect Screening and Follow-up Rates
Analyzing an EHDI Program
Advisory Committee Improve follow-up Factors associated with missing the
screen, rescreen, & late diagnosis Data integration, hospital surveys Conclusions Plan and implement programmatic
changes for improvement
The Colorado EHDI Follow-up Program:A Historical Perspective
0
10
20
30
40
50
60
70
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1992-96
1999 2000 2001 2002 2003 2004
F/U
Factors that Influenced Improved Follow-up Rates
Pressure from the Pediatric Chapter Champion - Al Mehl, MD
Integration with the EBC Track from screening to diagnosis to early intervention Send accurate MONTHLY reports to hospital
coordinators Letter campaign to parents from missed, failed
screens (EBC provides demographic information)
Population Results from Hospital Screen
Births 2001-2004 204,694 Screened 200,666 (98 %) Failed 8,124 (4%) Rescreened 6,686 (82%)
Step 3. Understand where our intervention
needs improvement Newborn screening: 2% of birth
population in Colorado is not screened; 18% who failed the first screen missed the follow-up screen
Who are they? Can this be improved?
Step 4. Determine if we have useful and
credible data available to inform our intervention, or if they need to be collected
Note: Not all data are useful for improving or guiding interventions. Some data are simply used to monitor/track health outcomes in the population
Newborn screening data The Colorado Department of Public
Health and Environment has useful data to improve newborn hearing screening
56 birthing hospitals: vital statistics, birth certificates, and screening results for each infant born in the state…about 70,000 a year
Factors Initially Tested Mother’s age Mother’s education Mother’s weight gain Martial status Gestational age Mother Smoke Infant gender Race/ethnicity Hospital Year of birth Birth weight APGAR Scores Urban, rural, frontier populations
Step 5. Connect data analysis results to
specific recommendations for improving the intervention
The connection between the results and recommendations must be clear and transparent to build consensus/support
Screening results and recommendations Results: The 1,500 infants not screened
each year are much more likely to have poor health than the 98% who are screened
Infants in the NICU are also much more likely to have a hearing loss than infants in the well-baby nursery
Recommendation: NICU will develop policies and procedures to ensure these high risk infants get screened
USPSTF and NICU Screening “The USPSTF found good evidence that
the prevalence of hearing loss in infants in the newborn intensive care unit and those with other specific risk factors is 10-20 times higher than the prevalence of hearing loss in the general population of newborns. Both the yield of screening and the proportion of true positive results will be substantially higher when screening is targeted at these high-risk infants…”
Conclusions Lack of reporting results Early discharge Significant health problems Out of state residents (7%) Deceased
Screening results and recommendations Results: Follow-up screening disparities
exist for mothers with low education and Latina ethnicity
Recommendation: Hospital screening staff will receive education/training about improving access to care; successes of single “safety-net” hospital will be used to help other hospitals reduce barriers
Step 6. Understand that
changing/improving interventions often takes time and develops slowly
Is the intervention new or well-established? A big system or small?
Improving the intervention Disseminate/communicate results and
recommendations to everyone involved with intervention implementation/policies
Sometimes change is disruptive. Interventions always need some stability. Find a balance between retaining stability and implementing change.
Improving screening Journal publication and conference
presentations for broad dissemination
Colorado special health care needs newsletter, and coordination with the state’s audiologist and screening coordinator
Beginning stages of change taking shape
Conclusions and benefits When used correctly, data can be a
powerful tool to improve public health practice and ultimately outcomes
Recap: What is our outcome? Is our intervention based on
reasonable evidence? Where does the intervention need
improvement?
Conclusions cont. Do we have useful data? Can we connect clear
recommendations to the statistical results?
How much time and effort will it take to implement the changes?
Thought: I believe scientific methods has the power to improve the public’s health. Believe it.
Role of Public Health in EHDI Programs
Using science as a basis for decision-making and action;
Expanding the quest for social equity; Performing effectively as a service
agency; Making efforts outcome-oriented; and Being accountable * CDC Operating Principles for Program Evaluation
It Takes a Village to Raise an EHDI Program
External Advisory
Committee Internal
Administration Statisticians IT Professionals Program expertise
The Role of our Federal Partners
Continuing to ‘raise the bar’ for EHDI programs
Encourage data integration with newborn screening and immunization
Support the concept of the child health profile to ensure the Medical Home/PCP are informed of outcomes
Outcomes: Happy, Healthy Families Comprehensive Community Based Culturally
Competent Seamless Knowledgeable
Providers Parent to Parent
Support
Contact Information:[email protected]@state.co.us
Colorado Department of Public Health and Environment, PSD-
HCP A4,Cherry Creek Drive South,Denver CO, 80246