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Applying Data Warehousing to Community Health Assessment WITS99 Keynote Address

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WITS'93 - Orlando (Hevner and Kamel) WITS'94 - Vancouver (De and Woo) ... Sentinel Events. Infectious Diseases. Health Resource Availability. Behavioral Risk Factors ... – PowerPoint PPT presentation

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Title: Applying Data Warehousing to Community Health Assessment WITS99 Keynote Address


1
Applying Data Warehousing to Community Health
Assessment WITS99 Keynote Address
  • Alan R. Hevner
  • University of South Florida
  • ahevner_at_coba.usf.edu

2
Preface - WITS Retrospective
  • As we approach 2000, a quick look back
  • WITS91 - Boston (Ram and Wang)
  • WITS92 - Dallas (Storey and Whinston)
  • WITS93 - Orlando (Hevner and Kamel)
  • WITS94 - Vancouver (De and Woo)
  • WITS95 - Amsterdam (Jarke and Ram)
  • WITS96 - Cleveland (Ernst and Sen)
  • WITS97 - Atlanta (Segev and Vaishnavi)
  • WITS98 - Helsinki (Bubenko and March)
  • WITS99 - Charlotte (Narasimhan and Sarkar)

3
Outline
  • Research Motivation - Community Health
    Measurement and Assessment
  • The CATCH Methodology
  • A Data Warehousing Solution
  • Data Dissemination Modes
  • Community Health Decision Making
  • A CATCH Demonstration

4
Acknowledgements
  • Co-Principal Investigators
  • James Studnicki - College of Public Health, USF
  • Don Berndt - College of Business Admin., USF
  • Research Staff
  • Center for Health Outcomes Research Staff
  • Doctoral and Masters Students
  • Funding
  • U.S. Dept. of Commerce TIIAP Grant
  • Bear Stearns Research Laboratory
  • Florida Communities

5
Research Motivation
  • U.S. has the Highest Per Capita Health
    Expenditures in the World
  • Low Rank of U.S. as defined by Health Status
    Indicators
  • Transition from a Disease to Health focus and
    from a Treatment to a Prevention strategy
  • Health Priorities defined by Political Agendas
    and the Managerial Objectives of Health
    Organizations rather than Objective Evaluation
  • Pluralistic, Non-Integrated Health Care Systems
  • No Single Organization is Responsible for the
    Health of the Community
  • No Uniform Method to define the Health of the
    Community which is Universally Accepted and
    Consistently Applied

6
Community Health Planning
  • Institute of Medicine (IOM) 1988 Report on the
    Future of Public Health
  • Recommends a regular and systematic collection,
    assemblage, and analysis of information on the
    health status and needs of communities.
  • IOM 1997 Report on Using Performance Monitoring
    to Improve Community Health
  • Calls for a Community Health Profile which can be
    used to support priority setting, resource
    allocation decisions, and the evaluation of
    health program impacts.

7
Collaborative Health Decision Making
  • Multi-Sector Community Health Stakeholders
  • Health Organizations
  • Public Sector Agencies
  • Medical Care Providers
  • Businesses
  • Religious Community
  • Educational Institutions
  • Government Agencies
  • Decisions must be based on Unbiased, Timely
    Information

8
CATCH Methodology
  • Comprehensive Assessment for Tracking Community
    Health (CATCH)
  • Project initiated in 1991
  • 14 Florida County Applications
  • Marion County, Indiana (Indianapolis)
  • Potential Regional, National, and International
    Applications

9
Indicator 1 Indicator 2 . . . Indicator i .
CATCH Methodology
State Favorable Unfavorable
State Averages
F I L T E R S
Fav/Fav Indicators
Fav/Unfav Indicators
Fav. Peer Unfav.
Indicator 1 Indicator 2 . . . Indicator i . .
1. Indicator i 2. Indicator j , . .
Indicator 1 Indicator 2 . . . Indicator i .
Unfav/Fav Indicators
Health Challenges
Peer Community Averages
Community Health Indicators
Prioritized List of Community Health Challenges
CATCH N-Dimensional Comparison Matrix
Additional Health Standard Comparisons
10
Data Collection and Analysis
  • Ten Indicator Groups
  • Demographics
  • Socioeconomic
  • Maternal and Child Health
  • Social and Mental Health
  • Physical Environmental Health
  • Health Status Morbidity/Mortality
  • Sentinel Events
  • Infectious Diseases
  • Health Resource Availability
  • Behavioral Risk Factors

11
Priority Filters
  • Number Affected
  • Economic Impact
  • Availability of Efficacious Intervention
  • Magnitude of Difference
  • Trend Analysis

12
Peer Comparison
  • Peer
  • CRITERIA Hillsborough Group
    Duval Orange Polk
  • Population
  • lt Age 18 24.86 25.41
    26.58 24.84 24.46
  • Population
  • gt Age 64 12.71 13.01
    11.27 11.51 18.37
  • Non-white
  • Population 15.32 21.13
    27.20 19.08 14.76
  • Families Below
  • Poverty Level 9.5 9.0
    9.8 7.8 9.4
  • Source Florida County Comparisons 1995

13
Comparison Matrix
INDICATOR CO PEER ST
CATEGORY
Labor force unemployed
Socioeconomic Maternal Child
health Infectious Disease Health
Status Sentinel Events Resource Availability
Physical/ Environmental Social
Mental Behavioral Risk
5.2
5.8
6.6
STATE
Infant mortality non-white
12.6 14.4 11.9
FAVORABLE UNFAVORABLE
Tuberculosis cases
0.31 0.25 0.57
Labor force unemployed
Infant mortality non-white
FAV
Colorectal cancer
11.3 10.8 12.3
Cervical cancer late stage
PEER
51.3 41.7 45.6
Challenges
Drowning fatalities
Late stage cervical cancer
UNFAV
Licensed hosp. beds
5.9 4.7 4.5
Drowning fatalities
2.4 2.0 2.7
Domestic viol. cases
1041.0 1041.8 864.1
Further Screening
Current smokers
24.8 26.9 23.1
14
Priority Filters
PRIORITIZATION
SAMPLE HIGH PRIORITY AREAS
SCREENS
Avoidable Hosp. Asthma Low
birthweight Gonorrhea cases Stroke Cervical
cancer late stage Pneumonia/ Influenza

Availability Economic Number of
Magnitude Trend of
Impact People of
Direction Efficacious
Affected Difference
and Intervention Magnitude
15
Social and Mental Health INDICATORS COMPARED TO
STATE PEER VALUES

  • STATE
  • FAVORABLE
    UNFAVORABLE
  • Child maltreatment? Burglary offenses
  • Elderly abuse Forcible sex assaults
  • FAVORABLE ?????Homicide AA mortality Crude
    homicide rate total
  • Crude homicide ratenon-white
  • Illegal drug sales Domestic
    violence cases
  • P Crude suicide rate white
    Simple assaults
  • E Aggravated assaults
  • E Illegal drug possession
  • R Crude homicide rate white
  • Suicide AA mortality
  • Crude suicide rate total,
  • non-white
  • UNFAVORABLE Intentional injury AA mortality

16
Indicator Fact Sheet
INDICATOR AIDS CASES
1994 AIDS CASES, Incidence rate per 100,000
population
FIVE YEAR TREND ANALYSIS
KEY Thick line County value, Thin line
Florida value
1990 1991 1992 1993 1994 ________________________
________________________________________ County
19.5 24.6 26.2 55.3 27.6 Florida 29.6 41.5 41.7 7
7.2 61.5
Source PHIDS
17
CATCH Data Warehouse
  • Manual CATCH Limitations
  • Labor-Intensive and Slow
  • Four months per report
  • Longitudinal Trend Analyses are Cost Prohibitive
  • Extension of County Reports to State, National,
    and International Reports
  • Knowledge Discovery Potential not Realized
  • CATCH Data Warehouse Solution

18
Data Warehouse Challenges - Construction
  • Data Collection
  • Data Sources
  • Data Quality
  • Extraction, Transformation, and Transportation
  • Data Warehouse Design
  • Star Schemas
  • Data Staging
  • Sizing and Cleansing
  • Quality Assurance

19
Hospital Discharge Star Schema
20
ICD-9 Code Dimension Hierarchy
21
Data Warehouse Challenges - Operations
  • User Interfaces
  • Performance
  • Security
  • Backup and Recovery
  • Knowledge Discovery
  • Data Mining

22
Data Dissemination Modes
  • Effective Presentation of CATCH Information to
    Community Decision Makers
  • Data Dissemination Modes
  • Pre-defined Reports
  • Data Browsing
  • Ad-hoc Queries
  • Internet Access
  • Hypertext Information Screens
  • Dynamic Access to Data Warehouse

23
Community Group Decision Making
  • Research Field IT Support for Group Decision
    Making
  • Research Question How will communities make most
    effective use of the CATCH data for health care
    decision making?
  • Research Testbed During 2000 we will provide
    CATCH reports to all 67 Florida counties.

24
Group Decision Making Issues
  • Motivation of community to use data
  • Presence of a champion for specific actions
  • Size and make-up of the decision making group
  • Speed of the decision making process
  • Stakeholders around the table and their influence
  • Resource constraints
  • Political nature of the process
  • Differential accesses to data among communities
  • Ease of access and usefulness of the data
  • Requests for customized analyses
  • Information exchange patterns and practices

25
CATCH Data Warehouse Demonstration
  • Policy Question on Racial Disparity in Infant
    Mortality in Florida

What is the pattern of variation in infant
mortality between whites and non-whites
throughout Florida? What factors best explain
this variation?
26
Data Browsing Strategy
  • Produce a Table of Florida Counties and Infant
    Mortality Data
  • Sort and Graph the Information
  • Cluster the Counties into Four Groupings
  • Select Factors for Analysis and Correlation
  • Perform Further In-Depth Analyses
  • Data Mining Neural Networks
  • Multivariate Statistics

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Conclusions
  • The Application of Data Warehousing Technology to
    Community Health Care can make a Social
    Contribution
  • Technical Research Challenges
  • Collaborative Group Decision Making What factors
    are associated with effective community use of
    CATCH data?
  • Leadership
  • Infrastructure
  • Decision-Making Process
  • Public/Private Sector Cooperation

40
Appendix CATCH Data Indicators
41
Data Indicators
  • DEMOGRAPHIC CHARACTERISTICS
  • Total population by gender
  • Total population by age
  • Total population by race
  • Population rural
  • Labor force by gender
  • Median Age
  • Net migration
  • Live births per 1,000 population
  • Deaths per 1,000 population

42
Data Indicators
  • SOCIOECONOMIC CHARACTERISTICS
  • Non-graduates of high school High school dropouts
  • Per capita income Labor force unemployed
  • Persons below poverty level WIC eligibles
  • Medicaid eligibles Medicaid births
  • HMO enrollment enrolled in a health plan
  • Families with children lt age 18 below poverty
    level
  • Population receiving food stamps
  • Students eligible for free/reduced lunch program
  • Low income persons with access to dental care

43
Data Indicators
  • MATERNAL AND CHILD HEALTH
  • Infant Mortality Child mortality
  • Neonatal mortality Post neonatal mortality
  • Low birthweight Very low birthweight
  • Perinatal condition mortality
  • Birth Defects Mortality
  • Live births w/1st trimester prenatal care
  • Live births w/3rd trimester prenatal care
  • Live births w/ no prenatal care
  • Live births to mothers lt age 15
  • Live births to mothers age 15 - 17
  • Live births to mothers age 18 - 19
  • Repeat births to teens

44
Data Indicators
  • PHYSICAL ENVIRONMENTAL HEALTH
  • Salmonella cases Campylobacter cases
  • Shigella cases Rabies in animals
  • Lead poisoning Fluoridated water
  • Firearm fatalities Drowning fatalities
  • Poisoning fatalities Bicycle fatalities
  • Contaminated wells Septic tank repair permits
  • Enteric disease cases total and in children lt
    age 6
  • Foodborne and waterborne outbreaks
  • Motor vehicle mortality - age adjusted
  • Unintentional injury mortality - age adjusted

45
Data Indicators
  • INFECTIOUS DISEASE
  • AIDS incidence, cumulative cases, mortality
  • HIV seropositivity
  • Infectious Syphilis cases
  • Congenital Syphilis cases
  • Gonorrhea cases
  • Chlamydia cases
  • Hepatitis A and B cases
  • Meningitis cases
  • Tuberculosis cases
  • Tuberculosis mortality - age adjusted
  • Vaccinated by kindergarten

46
Data Indicators
  • SOCIAL AND MENTAL HEALTH
  • Alcohol Related motor vehicle accidents
    mortality
  • Assaults Forcible sex, Burglary, Simple and
    Aggravated
  • Juvenile delinquency rates
  • Suicide - crude age adjusted
  • Intentional injury - age adjusted
  • Homicide - crude age adjusted
  • Child Abuse, Elderly Abuse - reported and
    confirmed cases
  • Domestic Violence - Reported cases
  • Mental health of adults days/month w/o good
    mental health
  • Hospitalization rates for
  • Baker Act, Psychoses, Depression, Alzheimer's
    Disease, Alcohol abuse Drug abuse

47
Data Indicators
  • HEALTH STATUS INDICATORS
  • Morbidity Cases
  • Melanoma Prostate cancer
  • Breast cancer Cervical cancer
  • Colorectal cancer Lung bronchus cancer
  • Smoking related cancers
  • Age Adjusted Mortality Rates (Crude)
  • Chronic liver disease cirrhosis
    (crude) Melanoma
  • Pneumonia/Influenza (crude) Breast cancer
  • Diabetes Mellitus (crude) Cervical cancer
  • Cardiovascular disease Colorectal cancer
  • Heart disease (crude) Lung/smoking rel. cancer
  • Stroke (crude) Preventable cancer
  • C.O.L.D. Prostate cancer
  • YPLL All cancers (crude)

48
Data Indicators
  • SENTINEL EVENTS
  • Vaccine Preventable Diseases Measles
    Rubella Mumps Pertussis
  • Late Stage Cancers
  • Breast cancer cases - late stage Cervical
    cancer cases - late stage
  • Avoidable Hospitalizations Asthma
    Immunizable conditions Cellulitis Malignan
    t hypertension Congestive heart
    failure Perforated/bleeding ulcer Diabetes
    Pneumonia Gangrene Pyelonephritis Hypo
    kalemia Ruptured appendix

49
Data Indicators
  • HEALTH RESOURCE AVAILABILITY
  • Licensed Beds Hospitals Nursing homes
  • Licensed Professionals
  • Doctors Dentists
  • RNs LPNs
  • Pharmacists Dieticians
  • Nurse Midwives Psychologists
  • Opticians/optometrists
  • Ratio of Medicaid Eligibles to Participating
    Physicians

50
Data Indicators
  • BEHAVIORAL RISK FACTORS
  • Mammograms
  • Pap smears
  • Blood pressure screening
  • Cholesterol screening
  • Smoking
  • Obesity
  • Seat Belt Use Child Seat Use
  • Bicycle Helmet Use
  • Check-up in last year
  • Health Care Foregone due to cost
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