Use of GIS technology to inform planning efforts through visualization of community level data in Hawaii

Presented byDonald Hayes, MD MPHCDC Assigned EpidemiologistHawaii Department of HealthFamily Health Services DivisionOct 16, 2015

Acknowledgments Pat Heu and Linda Chock, FHSD Chief -- acting Annette Mente, FHSD Planner Catherine Sorensen, FHSD Office of Primary Care

and Rural Health Division of Reproductive Health, CDC Maternal and Child Health Bureau, HRSA

Use of Data Increase awareness about particular

issue Grant applications Identify new research questions Identify Gaps in the data Prepare for legislation and policy work Program Evaluation Where should limited funds get

distributed

Some datasets in Hawaii

Birth Certificate

Death Certificate

Behavioral Risk Factor Surveillance System

Pregnancy Risk Assessment Monitoring SurveyYouth Risk Behavior Surveillance

Youth Tobacco SurveyBirth Defects

Women, Infant, and Children

Newborn Metabolic Screening

Newborn Hearing Screening

Early Intervention Services

Hawaii Household Survey

JABSOM National children studySchool Data

Emergency room data

EMS Transport Data

Injury Data

Cancer Registry

Fetal Deaths

Family Planning

Medicaid

Children with Special Health Needs

Breastfeeding survey

Perinatal Support Services

Child Death Review

ImmunizationEmergency Preparedness

Primary Care Contracts

Health Insurance Claims Data

Medical Outpatient Records

Electronic Health Records

Some FHSD Data Products Primary Care Data Book PRAMS Trend and County Reports FHSD Profiles Health Status of Children in Hawaii Perinatal and Title V Fact Sheets Birth Defects Surveillance Reports Journal Articles– Child Obesity, Adverse Birth Outcomes, Postpartum

Depression, Intimate Partner Violence, Breastfeeding, Physician Screening, Chronic Disease and Birth Outcomes, Adverse Childhood Events, Oral Health Services Utilization…..

Most reports are online at hawaii.gov websiteAll DOH and older FHSD: http://health.hawaii.gov/about/publications/Starting 2015, but still on all DOH: http://health.hawaii.gov/FHSD/publications/

Evaluation and Feedbackhttp://health.hawaii.gov/fhsd/evaluation-forms-2

Primary Care Needs Assessment (PCNA) Data Book Health and socio-economic indicators by

Community in Hawaii Multiple Data Sources

Census, ACS Vital Statistics BRFSS Hospital Discharge

Tables/Maps highlight differences Need Community Involvement

Background 1990-1994 Primary Care Access Plan Present Population Based Surveillance Data by

Community Improve awareness and discussion Facilitate data to action Initial MCH focus, starting in 2005 expansion to reflect

primary care

Diverse Audience including Health Policy Makers Legislators Planners Public

Distribution Hard Copy Online PDF

Summary Overview Summary Tables

(all indicators)

Chapter 1 Introduction

Chapter 2 Primary Care

Office Designations

Chapters 3-8 Indicators

Primary Care Areas Defined

• More detail on 3 largest areas (Ewa, E. Honolulu, W. Honolulu)- 11 new areas

• 2010 Census Tract Changes

Hospital Locations

Community Health Centers

Health Professional Shortage Areas

Methodology Census tract data aggregated into 35

communities in the State of Hawaii, County and State level.

For BRFSS data, Zip Codes converted to areas based on Missouri Data Center Zip code to census tract estimates

Hospital discharge data, priority was census tract information, but conversion used based on zip code for those without

SAS, SUDAAN software was used to create an Excel document for use in ArcGIS

2009 Version

2012 Version

2009 vs. 2012

Proportion of Population 65 years and over State: 14.0%

[13.3% in 2000]

7.7% in Mililani 8.1% in Kapolei-Makakilo

19.7% in Waikïkï-Pälolo 20.1% in Hawai‘i Kai-

Kaimuki

Socio-economic Indicators (Chapter 3)

Ratio = 2.6

Proportion of Population Native Hawaiian State: 21.3%

[19.8% in 2000]

11.3% in Waikïkï-Pälolo 11.3% in Airport-Moanalua

57.4% Häna 58.5% in Wai‘anae 61.8% in Moloka‘i

Ratio = 5.5

Proportion of Adult Population Uninsured State: 7.1%

3.5% in Hawai‘i Kai-Kaimuki 3.8% in McCully-Makiki

14.8% in Ka‘ū 15.7% in South Kona 19.4% in Häna

Ratio = 5.5

Proportion of Children in Households Receiving Assistance State: 17.2%

4.2% in Hawai‘i Kai-Kaimuki

4.7% in Lähainä

43.0% in Puna 49.2% in Wai‘anae

Ratio = 11.7

Infant Mortality Rate (per 1,000 live births)

State: 6.0

3.9 in Makawao 4.2 in Wailuku 4.2 in Köloa

10.1 in Wai‘anae 12.4 in North Kohala

Maternal and Infant Health (Chapter 4)

Ratio = 3.2

Proportion of Adults Who Are Obese State: 21.9%

13.2% in Hawai‘i Kai-Kaimuki

13.8% in Waialua

37.6% in Moloka‘i 43.5% in Wai‘anae

Morbidity-Risk Factors (Chapter 5)

Ratio = 3.3

Disease of the Heart Mortality Rate (per 100,000)

State: 135.2

72.3 in Mililani 97.4 in Hawai‘i Kai-

Kaimuki 109.1 in Hänalei

231.3 in Häna 260.4 in Wai‘anae

Mortality (Chapter 6)

Ratio = 3.6

Proportion of Adults with No Teeth Cleaning Within Past Year

State: 28.7%

18.4% in Hawai‘i Kai-Kaimuki

22.4% in Wahiawä 22.5% in McCully-Makiki

43.8% in Puna 47.6% in Wai‘anae 49.3% in Ka‘ū

Adult Oral Health (Chapter 7)

Ratio = 2.7

Proportion of Admissions with a Substance Related Disorder State: 8.9%

4.3% in Waipahu 4.5% in Mililani 5.0% in Hickam-Pearl City

13.7% in South Kona 13.8% in North Kona 14.2% in Häna 17.0% in Lähainä

Mental Health and Substance Related Admissions (Chapter 8)

Ratio = 4.0

Example 1: Grant Application ACA Grant For Home Visiting Announced

Portion related to Needs Assessment (NA) NA a requirement for Title V agencies

Portion of NA completed by use of data from PCNA Data Book for identification of high risk communities (poverty, low birth weight, infant mortality, no high school diploma, unemployment, etc….)

Data contributed to multi-million dollar grant award

Example 2: Data and Budget CutsReduction in Primary Care Contracts in

response to executive memo FHSD Recommendation made to not eliminate or

drastically reduce the funding and develop contingency plans before any drastic change in funding.

Data used to justify higher risk in the areas served by the contracts (poverty, per-capita income, unemployed, no high school diploma,...)

No reduction

Example 3: Community Health Needs Assessment

Individual Hospital CHNA Data used throughout several of the hospitals CHNA to

comply with federal requirements for nonprofit hospital organizations related to ACA (to satisfy a requirement of a community health needs assessment) . Various indicators used (in addition to other data sources and outreach) including substance use and mental health hospitalizations, behavioral risk factors, socio-economic, and mortality data.

Example 4: Overlays

Department of Native Hawaiian Health, JABSOM. Assessment and Priorities for Health & Well-Being in Native Hawaiians & Other Pacific Peoples. Accessed online at http://www2.jabsom.hawaii.edu/native/comm_ulu-reports.htm

Example 5: Other known uses Journal Article referencesBook Article referencesMedical Practice Business PlanRural Health Nursing Resources

EvaluationFeedback

Paper Online

Evaluation Results Information from:

Community non-profits Government agencies Education Institutions

Use it for: Needs Assessment Planning Grant Resource/Facilities Planning

How use? Community Health Centers (CHC) need to update their needs

assessments (part of their federal grant application process) every 3 years. The PCNA data book provides valuable health information stratified by geographic regions that match up with CHC service areas. As such, the PCNA data book makes finding relevant health data so much easier and convenient.

Used specific topic information and shared as fact sheets related to division and maternal and child health priorities. This assisted in discussion with other partners and supported further partnerships and use of this book by others in the State.

Indicators selected demonstrate significant community level differences and highlight the importance of data visualization by geography. Consolidates multiple data sources into one document

How use? Use it to share information with stakeholders about community level

differences. Raises awareness and discussion of complex issues A lot of information that highlights the geographic disparities are

very useful. This resources provides comparative data across a range of topics from birth to death. It includes risk factor and socio-economic characteristics which are very useful in characterizing communities for potential grant opportunities.

Have used this in the request for information and request for proposal process in serving specific geographical areas and as reference materials for providers to use. Have incorporated in presentations for grantors on areas being served through women's, infant and maternal and child health contracts. Have referenced in discussions with public health stakeholders and collaborative planning activities. Have recommended to community stakeholders for use in their planning and other activities to serve those in need.

Ability to demonstrate service providers are located in appropriate high risk communities

Other information? Early Childhood indicators. The ability to look at an online version that allows you to

get estimates from multiple indicators for a community. What about being able to look at overlays and see if there are statistical differences/relationships between communities.

Hospitalization data, trends...Wouldn't it be great to see this on an interactive map or if it could be dumped or used with UDS mapper?

Homelessness Would like to see associations between the various indicators. For example, how

much of the heart disease deaths are due to poverty characteristics. Can these maps be interactive so I can just select a community and get a download of all the data for that particular community. I know the length of the book is a concern, but think you should consider showing these same indicators by other groups when possible (Race, education, language, insurance, employment, etc...). Thanks for the great resource and look forward to its continued evolution and usefulness. When is the next version coming out?

Although aggregating the data based on population of each district, sometimes for some of the work that we do and information that we need, stratifying it further by ethnic background in each district will be very useful for us. Also, having a group on Micronesian (or maybe just Pacific Islander without Native Hawaiian) will also be useful as these groups are one of the special populations that FQHCs serve and data on this group would be useful (although I am not sure if their sample size would be sufficient to add them as another category). It would also be useful to add new indicators that the federal government is looking more into such as prediabetes.

Closing Comments Reports have helped raise awareness of data and issues Building capacity in health department Gradually increasing comfort and skills in GIS Opportunity to look at community level indicators based

on several data sources Geographic Disparities shown

- Some may be explained by race distribution- Others may be explained by age distribution- Others may be explained by poverty- What about other factors?

Additional analyses needed Superimposing two-three maps? Controlling for age, race/ethnicity and other factors

Partners want more so it is not just a static PDF/document Next revision to PCNA currently in process

Data Management

Data Analysisand

Interpretation

Data Collection

Data Presentationand

Translation

Socio-economic Indicators (Chapter 3)• Race (2010 Census)

- Alone- Alone or in

combination

In addition to Native Hawaiian and Filipino in 2009 data book, added White, Japanese, and Chinese in 2012 data book.

Primarily Multiple Race population in Hawaii• Chinese (73% are in combination)• Native Hawaiian (72%)• Filipino (42%)• Japanese (41%)• White (40%)

Proportion of Population Filipino State: 25.1%

[22.8% in 2000]

7.0% in Hawai‘i Kai-Kaimuki

45.6% Lïhu‘e 54.4% Waipahu 63.9% Läna‘i

Socio-economic Indicators (Chapter 3)

Ratio = 9.1

Primary Care Service Areas

Proportion of Adults with High Blood Pressure State: 28.4%

11.7% in Häna 22.3% in South Kohala 22.5% in Köloa 22.6% in Lähainä

32.5% in Hilo 32.6% in Wai‘anae 35.4% in Waialua 36.7% in Lïhu‘e

Morbidity-Risk Factors (Chapter 5)

Ratio = 3.1

Stroke Mortality Rate (per 100,000) State: 38.2

22.1 in ‘Ewa-Kalaeloa 22.8 in Mililani

49.5 in Hilo 56.4 in Waimea 67.8 in Läna‘i

Mortality (Chapter 6)

Ratio = 3.1

Unintentional Injury Mortality Rate (per 100,000)

State: 28.7

10.0 in Mililani 18.4 in Hickam-Pearl City 19.3 in ‘Ewa-Kalaeloa

48.7 in South Kona 52.1 in Waialua 58.6 in Wai‘anae

Mortality (Chapter 6)

Ratio = 5.9

Proportion Admissions w/ Delirium/Dementia Disorder State: 8.4%

4.3% in Moloka‘i 4.5% in Ka‘ū

11.8% in Waikïkï-Pälolo 11.9% in McCully-Makiki 14.8% in Hawai‘i Kai-Kaimuki

Mental Health and Substance Related Admissions (Chapter 8)

Ratio = 3.4

Proportion of Households with Linguistic Isolation State: 6.2%

0.3% in Häna 0.9% in Makawao

14.4% in Ala Moana- Nu‘uanu

21.1% in Downtown-Kalihi

Ratio = 70.3

Proportion of Adults Who Smoke State: 16.1%

9.9% in Hawai‘i Kai-Kaimuki

11.0% in Hänalei

25.3% in N Kohala 25.9% in Ka‘ū 26.0% in Wai‘anae

Ratio = 2.6

Cancer Mortality Rate (per 100,000)

State: 134.7

90.2 in Häna 91.9 in Mililani 95.2 in ‘Ewa-Kalaeloa

173.1 in Waimea 177.0 in Moloka‘i 197.0 in Wai‘anae

Ratio = 2.2

Proportion of Admissions with a Mood Disorder

State: 6.1%

3.1% in Moloka‘i 3.2% in Läna‘i 3.4% in Häna

8.0% in Hänalei 9.1% in Hilo 10.9% in Puna

Ratio = 3.5

Proportion of Civilian Labor Force Unemployed State: 4.6%

2.3% in Hawai‘i Kai-Kaimuki 2.3% in ‘Ewa-Kalaeloa

9.7% in Ka‘ū 13.5% in Moloka‘i

Ratio = 5.9

Example 2: Data and Budget Cuts June 28-30, 2011: Reduction in Primary Care

Contracts in response to executive memo FHSD Recommendation made to not eliminate or drastically

reduce the funding and develop contingency plans before any drastic change in funding. Data used to justify higher risk in the areas served by the contracts. (Gordon Takaki and Pat Heu, 2011 FHSD Meeting)

July 7, 2011: No reduction

Example 2: PCNA June 2010: ACA Grant For Home Visiting

Announced Portion related to Needs Assessment (NA) NA a requirement for Title V agencies

Sept 2010: Deadline for Needs Assessment Portion of NA completed by use of data from

PCNA Data Book for identification of high risk communities(Cindy Hirai led effort).

Data contributed to multi-million dollar grant