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CDC Assessment Initiative Accessing, Interpreting, and Communicating Information for Public Health Decisions. Nelson Adekoya, DrPH Centers for Disease Control and Prevention National Center for Public Health Informatics. Assessment Initiative Conference, August 22-24, 2007. Announcements.

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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

Assessment Initiative Conference, August 22-24, 2007


Announcements

  • Housekeeping

  • Kevin Kobishop (GM, Sheraton Hotel)

  • Contractor

  • Poster Sessions

  • Evaluation forms

  • Planning Committee Members


Comments from the 2006 Conference

  • Overall conference rating

    • relevance (3.6)

    • quality of materials distributed (3.6)

    • effectiveness of presentations (3.4)

    • networking opportunities (3.3)

    • meeting room (3.4)

    • hotel accommodations (3.2)

    • conference contractor (3.7)

  • Poster sessions

  • Parking fee

  • Presentations from non-AI funded States


Partners

  • National Association of Public Health Statistics and Information System

  • National Association of Health Data Organizations

  • Council of State and Territorial Epidemiologists

  • Behavioral Risk Factor Surveillance System

  • National Association of Chronic Disease Directors

  • Association of Schools of Public Health

  • National Association of County and City Health Officials

  • University of Alabama, Birmingham, Alabama


Welcome Address

  • Dr. Bob Martin, CDC

  • Dr. Barry Nangle, President, NAPHSIS


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

Assessment Initiative Conference, August 22-24, 2007


Presentation Objectives

  • Overview of the Assessment Initiative program (AI)

  • Summarize funding themes for funding cycles

  • Journal of Health Management and Practice special issue on health impact

  • Highlights from currently funded states


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 Roles — Assessment, policy development, and quality assurance


Why Assessment Is Necessary

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


  • Neither policy development nor assurance can be carried out well in the absence of excellent health assessment activities

  • Health assessment is a continuous process. It cannot be neglected for the urgent problem of the day


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


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


  • The AI program addresses

    • Healthy People 2010 focus area of Public Health Infrastructure

    • CDC’s Healthy Protection Goal of Healthy People in Healthy Places (to protect and promote people’s health, especially those at greatest risk from health disparities)


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

    • Objective

      • Improve ability to assess progress toward HP 2000 objectives


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

  • Objective

    • Disseminate health assessment information and evaluate processes used


  • 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

        • Community Health Assessment Practices


    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


  • Health Impact of AI Projects

    • Successful programs to improve health are needed for reporting a measurable progress toward the attainment of the Healthy People2010 objectives


    • Unfortunately, knowledge is limited regarding the net effects of the majority of health programs

      Or

    • Evidence-based information on effectiveness of policies and interventions is limited


    • Addressing this gap and systematically building evidence about what works will make possible

      • improving the effectiveness of spending and

      • bringing vital knowledge into the service of policymaking and program design


    • Knowledge gained from rigorous effects studies is in part a public good. The value of the effort can be multiplied if

      • collective efforts are used to identify policy questions of shared

        importance

      • studies are concentrated around priority concerns

      • studies are reliable and valid

      • study results are disseminated

      • research capacity is built


    Assessment Initiative Project: Call for Health Impact Research Proposals

    • MMWR Notice to Readers (MMWR Jan 19, 2007)

      Of particular interest are the effects of these assessments, and supporting tools (e.g., Web-based data-query systems) on health status, health outcomes, health behaviors, or health-system changes, including changes in policies, practices, or infrastructure


    Health Impact

    System Change (policies, practice, infrastructure, such as lab, workforce, surveillance)

    Health Status Change (mortality, morbidity, disability, disparities)

    Population-Based Change (income, knowledge)


    Evaluation Criteria

    • Relevance

      • Is the proposal relevant to the call for manuscripts?

      • Does it focus on the effects of CHAs and supporting tools, and especially effects on health status, health outcomes, health behaviors, and health-system changes?

    • Advancing knowledge and originality

      • Does the proposal advance knowledge, and is it original?

    • Clarity of methods and data

      • Are the methods and data described in the proposal clear?

    • Summative score

      • The scores for the three criteria for all relevant proposals (those that rank 1, 2, or 3 on relevance) are summed, yielding a range of summative scores ranging from 3 (low) to 9 (high)


    List of Accepted Manuscripts

    • Forty-one proposals were received

      Results of the averaged scores

      • Nine proposals received average summary scores of seven or higher. Of these nine proposals, eight had average relevance scores of 2.7 or higher.

      • Six proposals received average summary scores of 5.0-6.9. Five of these six proposals scored notably weaker on all three criteria.

      • Twenty-six proposals received average summary scores from 0-4.9.


    List of Accepted Manuscripts

    • Tools for evaluating the impact of CHAs

      • Wisconsin health rankings: community and media use of an annual health assessment (Kempf et al.)

      • Environmental assessment as a tool to improve program delivery and evaluation (Lavinghouze, Price)

      • A Web-based tool for assessing and improving the usefulness of community health assessments (Stoto et al.)

      • Transforming the Pierce County cross-cultural collaborative through assessment capacity building (Garza et al.)

      • Applying the logic model to identify measures that track the effectiveness of community health assessment (Irani et al.)


    List of Accepted Manuscripts

    • Evaluations of broad impacts of CHAs

      • Taking community health assessment to the next level in North Carolina (Bobbitt-Cooke, Riley, Buescher)

      • Community health status assessment as a tool for mobilizing systems changes (Wendel, Felix)

      • Building community health assessment capacity in Washington State: an evaluation of assessment in action (Snyder, Spice)


    List of Accepted Manuscripts

    • Evaluating impacts of CHAs in specific programmatic areas

      • Building infrastructure and capacity for community health assessment and health improvement planning in Florida (Grigg et al.)

      • Role of assessment in promoting secondhand smoke policy in a local health jurisdiction (Gizzi et al.)

      • Using a community-based health survey as a tool for informing local health policy (Kruger)

      • Effective community health assessments in King County, Washington (Solet et al.)


    Health Impact Examples from AI States


    Rhode Island Assessment Initiative

    • Project: Web Access to RI Health Data Workshop

    • Health condition: Provide training to PH partners to increase their capacity to practice evidence-based PH

    • Activity: Through these workshops, AI staff offered training by using RI Web-based Query System through educational grant received by Brown University program in PH (Pfizer, Inc.)

    • Period: February 2006 - January 2007

    • Impact: >130 professionals have been trained


    Rhode Island Assessment Initiative

    • Project:Common Ground Grant

    • Health condition: Use RI Web-based Query System model to develop and strengthen chronic disease prevention and control in Rhode Island

    • Activity: The Rhode Island Health Department submitted a grant proposal to the Robert Wood Johnson Foundation to effectively develop, manage, and apply health information systems to improve chronic disease prevention and control

    • Period:August 2006

    • Impact:RI received a grant totaling $528,000 from Robert Wood Johnson Foundation (3 years)


    New York Assessment Initiative

    • Project:Online course, “From Evidence to Practice: Using a Systematic Approach to Address Disparities in Birth Outcomes”

    • Health condition:Broad range because it facilitates effective decision making related to intervention/policies

    • Activity:Development of online training course to address relevance of health data for decision making. NYU is using course to train nursing students

    • Period:April 2004

    • Impact:Strengthen concept of evidence-based PH and credible data based on pre-posttest results. NY has institutionalized course


    New York Assessment Initiative

    • Project:Understanding Impact of CHA

    • Health condition:Published data on CHA research are limited and lack of adequate CHA evidence-based evaluation research results in inability to meet community needs

    • Activity:Conducted a survey on CHA impact across jurisdictions (public health, health care, social services, and substance abuse agencies)

    • Activity Period:2002- 2004

    • Impact:Regional collaboration resulted in $2.4 million grant dollars from federal, and state governments. Additionally, in 2006, APHA approved resolution endorsing the needto evaluate CHA


    Florida Assessment Initiative

    • Project: Comprehensive Assessment Strategic Success

    • Health condition: Identification of dental services in a rural community in eastern Hillsborough County

    • Activity: Using a MAPP approach to CHA, the health department and partners used Web-based Query System to profile morbidity and mortality problems for this county

    • Activity Period: August 2004- March 2005

    • Impact: > 400 students (K-5) have received preventive services ($20,000 in donated services), enabling the county to meet FL objective to increase access to dental care services for prevention, early diagnosis, and intervention

    MAPP= Mobilizing for Action Through Planning and Partnerships


    Florida Assessment Initiative

    • Project: Comprehensive Assessment Strategic Success

    • Health condition: Morbidity and mortality from diabetes, asthma, and obesity in Pinellas County, Florida

    • Activity: Using a MAPP approach to CHA, the health department and partners used Web-based Query System to profile morbidity and mortality problems for this county

    • Period: 2003- 2004

    • Impact: Pinellas County Health department applied for CDC’s STEPS grant and received $1.5 million/year for 5 years for a countywide collaborative effort to reduce risk behaviors associated with tobacco use, lack of physical activity, and poor nutrition

    MAPP=Mobilizing for Action Through Planning and Partnerships


    Missouri Assessment Initiative

    • Project: Diabetes Community Data Profile

    • Health condition: Missouri Diabetes Prevention and Control Program data needs for decision making

    • Activity: Access to diabetes data at the county or regional level was a critical gap identified in Missouri. This prompted the development of a specific objective on diabetes-related data resources, and their inclusion in the web-based assessment tools

    • Period: 2005-2006

    • Impact: >70 local public health staff have been trained (36 local agencies) on how to use the profile tool for assessment and intervention planning. On the basis of a news release about the tool, a state representative is now using the information to educate his constituents on diabetes prevalence, risk factors, and preventive practices.


    Missouri Assessment Initiative

    • Project: Missouri Information for Community Assessment (MICA); an Assessment Initiative effort

    • Health condition: Provision of Web-based Data Query System for residents and adoption by other states

    • Activity: MICA is available to MO residents and has been adopted by VT, TX, KS, NJ, and Marion County, IN. Application updates, training and technical assistance were provided to adopter states.

    • Period: 2003-2006

    • Impact: MICASustainability Funding - USDA-WIC program; CDC Cancer Registry; MCH Block grant; Missouri Foundation for Health; CDC Diabetes Prevention and Control; Rural Health grant; CDC Heart Disease and Stroke Prevention


    Washington Assessment Initiative

    • Project: Washington State Assessment in Action (AIA)

    • Health condition: Local Health Jurisdictions conduct CHA, but capacity varies widely across the state because of lack of funding. The majority of public health funding is categorical.

    • Activity:The AIA grant Steering Committee set goals for increasing awareness among local public health officials of the uses and benefits of CHA

    • Period: 2005- 2006

    • Impact:Local health officials identified CHA as one of seven high priorities for public health funding. A bill was introduced to increase public health funding in WA State.


    New Mexico Assessment Initiative

    • Project: New Mexico Assessment Initiative

    • Health condition: The capacity to conduct community health assessment is minimal or nonexistent in many tribes in New Mexico

    • Activity:Through the AI, tribal health councils developed comprehensive community health profiles. These profiles have been used to prioritize health concerns, to develop community health improvement plans, establish action teams or subcommittees, or to seek resources

    • Activity Period: 2005- 2006

    • Impact:>100 tribal members have been trained in public health and epidemiologic concepts, using and interpreting data, and EpiInfo


    Utah Assessment Initiative

    • Project:IBIS Technology Transfer to Other States

    • Health condition:The lack of Web-based Query System impairs ability of states to implement community health activities.

    • Activity:Utah has successfully transferred IBIS to Alaska and Arizona (software installation, training, documentation, etc.)

    • Period:2004- 2006

    • Impact:Technology transfer resulted in >$1 million savings to CDC and the states

    IBIS= Indicator-Based Information System


    Utah Assessment Initiative

    • Project: Using IBIS To Identify Health Problem

    • Health condition: Salt Lake Valley used IBIS to access vital records to research teen pregnancy prevention project

    • Activity:City of Midvale discovered that among Utah’s 61 small population areas, Midvale had the highest rate of teen pregnancy among girls aged 10-14 years

    • Activity Period: 2004- 2006

    • Impact: IBIS data were used to document the problem and to involve city executives, including the Mayor, to provide intervention. News of the city’s problem and program were reported on local TV stations and in regional newspapers.


    Problems Encountered

    • Personnel

      • departmental reorganization

      • staff turnover, retirement

      • lack of FTE

    • Budget

      • contractors

      • categorical funding


    AI: Fourth Funding Cycle

    • September 2007–2012

      • Administration: NCPHI/OD

      • Focus on production of effective assessment methods and practices that can be disseminated to and used by other states

        • Data Dissemination Systems

        • CHA Practices


    Cooperative Agreement To Support State Assessment Initiatives (RFA-CDC-702)

    • Number of applications received = 22

    • Currently/previously funded states = 11

    • Nonpreviously/currently funded states = 11

    • Number of states selected for funding = 9

      • 4 new states (62% of available funds)

      • 5 previously/currently funded states (38% of funds)

    • Cooperative Agreement: $1.6M


    AI: Fourth Funding Cycle

    • Focus Area 1 —Improving data dissemination through development/enhancement of interactive data query systems

      • RI, MO, ILL, NH

  • Focus Area 2 — Improving data usage by improvingCHA practices

    • VA, FL, NM, AR, NC


  • Future Directions

    • Encourage publication of successful approaches in

      peer-reviewed journals (evidenced-based)

    • Encourage grass-roots education on assessment

      (sustainability) and advocate state support (formalize)

    • Foster growth and development in new states


    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


    Future Consideration

    • Develop or establish associations with universities

      and research institutions

    • Cooperative agreements:

      • Tiered program announcement specifying available funding amount for currently or previously funded

        states and states that have not been previously funded

    • Health Organizations


    Summary

    Assessment Initiative

    Promoting accessible, usable data for systematic practice

    • Need for 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

      • value of community-based assessment and planning is demonstrated

    • Build on existing expertise, associations, and accomplishments to pave the way for the future


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