Nelson Adekoya, DrPH Centers for Disease Control and Prevention

1. CDC Assessment InitiativeAccessing, Interpreting, and Communicating Information for Public Health Decisions Nelson Adekoya, DrPH Centers for Disease Control and Prevention National Center for Public Health Informatics 1

2. Background • Mission of Public Health — To provide conditions in which people can be healthy by applying scientific and technical knowledge to prevent disease and to promote health • Governmental Role — Assessment, policy development, and quality assurance 2

3. Why Assessment Is Necessary • Without accurate information on the health status of a society, we cannot make decisions regarding which concerns to prioritize, which policies might be the most effective, or which interventions should be implemented 3

4. Assessment Initiative • Cooperative agreement to enhance capacity of state and local health departments to use data for developing policy and ensuring that needed health services are provided 4

5. Cooperative Agreement • States working through local health jurisdictions and communities to — • Improve access to data • Improve skills to accurately interpret and understand data • Improve effective usage of data 5

6. Why Perform Assessments? • Assessments answer — • What are the major health problems? • What population groups are at risk? • How are the risks distributed geographically? • What services are available? • Are health resources adequate? • What do local citizens see as health concerns? • What do health providers see as health concerns? 6

7. Benefits of Assessment • Increased resources • Better decision making • Ability to be proactive • Increased visibility • Improved collaboration/cooperation • Improved services • Improved community perception of local health jurisdictions • Increased awareness of public health concerns • Decreased influence of politics on health priorities 7

8. AI: The First 5 Years • First funding cycle — September 1992–1997 • Administered by NCHS • Seven States Funded • IA, ME, NC, OH, OR, TX, and UT • Objectives • Improve ability to assess progress toward HP 2000 objectives • Use resulting information for policy and program development 8

9. AI: The First 5 Years • Results • State data systems evaluated • Access to and use of health data by local agencies increased • Training and technical assistance on data analysis and interpretation provided • CDC Guidelines for Evaluating Surveillance Systems 9

10. The First 5 Years — Lessons Learned • Importance of . . . • Collaboration with new partners • Effective communication between program managers and data analysts • Use of simple, consistent formats for data presentation 10

11. The First 5 Years — Lessons Learned • Importance of . . . • Building technical expertise at the local level • Integration of assessment activities with all other state health department activities • Advisory groups helpful in the integration process 11

12. AI: Second Funding Cycle September 1997–2002 • Administration transferred to EPO • Focus on Partnerships • With Managed Care • With Medicaid • With Community Organizations and Other Groups • Six States Funded • MN, NY, MO, MA, OR, and NC 12

13. AI: Second Funding Cycle • Objectives • Year 1 • Establish consortia of partners and develop 5-year strategic plan • Years 2–5 • Implement plan • Disseminate health assessment information • Evaluate processes used 13

14. AI: Second Funding Cycle Key Accomplishments — States • Managed Care Partnerships • MN — Linking administrative claims data regarding pregnant women to birth records • Assessing relationship of maternal morbidity to birth outcomes • MA — Used BRFSS data to identify health plan affiliation of respondents • Provided profiles of health risk behaviors for the general population versus MCO enrollees 14

15. AI: Second Funding Cycle • Key Accomplishments — States • NC — Collaborated with Healthy Carolinians to develop a comprehensive Community Health Assessment Guide 15

16. AI: Second Funding Cycle • Key Accomplishments — States • NY — Completed a comprehensive CHA review, analyzing results from 56 counties • Distributed a summary of strengths, barriers, and opportunities for action • Currently developing an electronic community health assessment (CHA) “Clearinghouse” • MO — Developed an Internet-based data dissemination system that allows interactive querying of health data sets 16

17. AI: Second Funding Cycle • Key Accomplishments — States • Medicaid Partnerships • OR — • Compiled state Medicaid files • Used to assess preventive services, clinical outcomes, and health status of Medicaid recipients throughout Oregon • Completed a Medicaid BRFSS • Using Medicaid data to develop a diabetes disease registry 17

18. AI: Second Funding Cycle • Key Accomplishments • Intramural Activities • Annual Conference (AI and NAPHSIS) • Publications • Assessment Initiative Supplement Issue of the Journal of Public Health Management and Practice (Dhara, et al.; 2002) 18

19. AI: Third Funding Cycle • September 2002–2007 • Administration: EPO and NCPHI/OD • Focus on production of effective assessment methods and practices that can be disseminated to and used by other states • Data Linkage • Data Dissemination Systems • CHA Practices 19

20. AI: Third Funding Cycle • Focus Area 1 —Improving data dissemination through development/enhancement of interactive data query systems • MO, UT, and RI • Focus Area 2 — Improving data usage by improvingcommunity health assessment practices • NY, WA, FL, and NM 20

21. AI: Third Funding Cycle • Key Accomplishments — States • NY — CompletedEpi lnfo/Epi Map tutorial (Asthma) http://www.cdc.gov/epiinfo/tutorials.htm • Completed Evidence-Based Online Course http://www.ebth.org • Developed an electronic CHA “Clearinghouse” • MO — Added and updated new profiles into their Internet-based data dissemination system that allows interactive querying of health data sets (e.g., BRFSS, ED data, Medicaid, Hospital Discharge, and injuries) 21

22. AI: Third Funding Cycle • Key Accomplishments — States • UT — IBIS-PH query system interface was coupled with SAS IntrNet software; demonstrated that Utah’s interface could be used by a state by using SAS IntrNet to run data queries • Successfully transferred IBIS technology to Arizona • WA — Built a shared vision for CHA through PH Leadership Forum (local health administrators and health officers) to educate leadership on value of CHA to their agencies and strategies for building capacity 22

23. AI: Third Funding Cycle • Key Accomplishments — States • RI — Health-Based Query System (BRFSS and YRBS data) • FL— Statewide implementation of the National Public Health Performance Standards Program (NPHPSP), a tool to improve PH infrastructure and performance at state and local levels 23

24. AI: Third Funding Cycle • Key Accomplishments — States • NM — Worked with tribal councils to strengthen community assessment • Worked with NM NEDSS steering committee to include tribal affiliation and residence fields 24

25. AI: Third Funding Cycle • Key Accomplishments — • NAHDO — Published white papers on statistical approaches; reducing disclosure risk in Internet-based data query system; HIPAA • NAPHSIS — Coordinated survey of states to assess current status of Internet-based data query system 25

26. AI: Third Funding Cycle • Key Accomplishments — • Assessment Initiative supplemental issue of the Journal of Public Health Management and Practice (March/April 2006) 26

27. Under Development . . . www.grants.gov • RFA — Improve state and local health information and data systems • Cooperative Agreements — Continuation funding (2006–2007) 27

28. Future Directions • Encourage publications of successful approaches in peer-reviewed journals • Encourage grass-roots education on assessment (sustainability) and advocate state support (formalize) • Foster growth and development in new states 28

29. Future Directions • Increase opportunities for states to collaborate and exchange information (e.g., site visits, annual conference, and regional conferences) • Continue collaborations with national organizations on related projects (NAHDO, NAPHSIS, APHA, and CSTE) to facilitate state-to-state transfer of system, expertise, and knowledge 29

30. Future Consideration • Develop or establish relationships with universities and research institutions • Begin development of cooperative agreements for the next 5-year cycle for the states • Consider “tiered” program announcement specifying different objectives for new versus previously funded states 30

31. Summary • Need for the AI will continue as . . . • Evidenced-based decision making is more widely accepted as the norm • Electronic data systems continue to advance • The concept of data integration evolves • Build on existing expertise, relationships, and accomplishments to pave the way for the future Assessment Initiative Making data more visible, accessible, and understandable!