There is a world of difference between a spreadsheet with a list of patient names and addresses and a map of a county with clusters of diabetic or asthmatic patients. That’s what public health officials and care coordinators in North Carolina are finding out from their early use of the North Carolina Community Health Information Portal (NC-HIP), a web-based mapping application designed to allow researchers to generate new insights from existing public and private databases.
Last week I had the privilege of getting a tour of the new tool’s capabilities from Deb Aldridge MSN, RN-BC, quality improvement director for Community Care of Southern Piedmont, and Charlene Wong, principal analyst for Community Care of North Carolina. (CCNC provides population management and supports medical homes for 1.4 million Medicaid beneficiaries, individuals eligible for both Medicare and Medicaid, privately insured employees and uninsured people.) NC-HIP is the result of collaboration between CCNC, Health Landscapes, North Carolina Institute for Public Health and the Robert Graham Center of the American Academy of Family Physicians.
“We really wanted to engineer a way for public health departments to be able to conduct community needs assessments, which they are required to do every three years,” Aldridge said. “We are looking at how health departments can knit closer together with the relevant hospitals in their community to come up with a collaborative way to complete the needs assessment, but also develop specific interventions for their communities.”
Data layers available include:
• U.S. Census Bureau
• DHHS Health Indicators Warehouse
• Centers for Medicare and Medicaid Services Chronic Conditions Warehouse
• Institute of Medicine
• Robert Wood Johnson Health Indicators
• Healthy People 2020 and Healthy NC 2020 Indicators
• Medicaid claims
• CCNC chart review measures
“The most powerful upgrade we have made since the inception of the tool is the ability for end-users to upload their own data and geomap it against other measures or metrics in the tool itself,” Aldridge said.
The key is getting folks to look at data in a geographic format, Aldridge stressed. People are very familiar to looking at data in spreadsheets, tables or pie graphs. “It creates a different dialog when you can actually visualize the data geographically. You can start to see dim spots or hot spots for different measures, she said, or corresponding counties or ZIP codes that have similar issues, which may lead to asking new or different questions you hadn’t asked before.
Wong said that drilling down to different levels may show things that aren’t immediately apparent. One popular use is to study the distribution of chronic conditions among the Medicaid population based on claims data. If you just look at county data, for instance, Wake County, where Raleigh is located, looks better than many counties in terms of diabetes, but as Wong zoomed in closer, and changed the display from county to census track, she was able to highlight pockets of areas of higher diabetes prevalence. “The tool gives you that picture and allows you to drill down to show a magnified picture of the diabetes burden within a county. It can tell public health providers and clinical providers to make sure they don’t neglect certain areas.”
Wong said care managers are using the tools to map emergency department use combined with asthma rates to determine where more resources need to be allocated. Others involved in patient-centered medical homes can color coded them to identify where there are very few medical homes as well as places where the certification is expiring to encourage them to renew.
Aldridge said many local public health officials have praised the tool as a one-stop shop that has all these data sources that they used to have to search many web sites for.
In Stanley County, where Aldridge resides, she walked local public health officials through how to upload their own data and urged them to ask a question of the data. They only had one pregnancy resource center in the whole county, but they had a list of addresses of all the recipients of pregnancy resource services. They uploaded that data to see how they map out across the county. They started to see pockets of underserved areas in the county and it drove them to present to their board the need for another temporary or a few-days-a-week resource location site in two areas of the county. “So this health director said to me, there is really no way we would have known that there was an opportunity had we not been able to geographically represent where all our recipients lived and look at better coordinating the resources and the services we provide,” Aldridge said.
Aldridge also uploaded the addresses of 2,000 priority asthma patients in her region to see if there were any clusters. “One of the biggest reasons I reached out to my local health department is that I was seeing clusters of asthmatic patients within certain housing blocks,” she said. “So I wanted to talk to them about whether there was an opportunity to inspect the buildings to make sure there are no environmental issues producing the asthma in these patients. So being able to geographically look at clusters in a neighborhood really has been a powerful way to digest the data in a different way,” she said. They were absolutely interested in investigating that. Just opening up that dialog is great opportunity to build relationships that had not been there before.”