Data, Metrics, and Evaluation Dora Barilla, DrPH, MPH

Michael Knecht, MDiv

Imagine…

Increased flexibility

and being proactive

Imagine…

Holistic in understanding

the community’s problems and

capacity

Imagine…

Approaching information as an asset not a

cost

Imagine…

Increase our communication and interaction

with our communities

 Vision:  Create  a  real-­‐)me  community  health  management  system  to  provide  geographically  enabled  health  u)liza)on  informa)on  to  influence  strategic  resource,  pa)ent  care,  and  popula)on  health  decisions.  

Community  Health  Management  System  

Census Demographics Health Status Indicators Service Utilization Provider Network Design Variability Market Potential

Health Data View

Community Resources

Optimum Minimal

Provider Supply

Over Under

Health Status

High Low

Moving the Community Needle

Admissions

Type % of Tot Status

Medicare 23%

Medicaid 12%

BlueCross 5%

Uninsured 1%

Health Status Admissions Re-Admissions Health Indicators

Re-Admissions

Chronic Disease Management

Re-admissions

ED Treat & Street

Expected ER Caseloads

Mortality Rates

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Community Health Management System

Welcome Dora Barilla Today is Thursday, July 26, 2012

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At-a-Glance (last 24 hrs)-ED only

M&M Billed Charges $1,223,600

No-Pay Charges $707,250

Discharges w 6+ Meds 85% $33,000

Homeless ED Patient 2

ED Visits Sent Home 69 % $19,500

Priority Areas

Loma Linda University and Loma Linda University Health System has identified three priority areas in

the Inland Empire for 2013-2015 to help improve the health of the communities most in need of health

improvement. Together we are much greater than the sum of our parts and thank you for helping us

move towards greater collaboration.

1. San Bernardino

ED Visits by Cause

Health Indicators

230,00

7,587

1,945,112

89,778

1,200,110

234,000

223,000

145,112

3,346,782

75%

65%

65%

65%

71%

70%

75%

69%

Frequent Flyers 4

Low Birth Weight

Life Expectancy

Infant Mortality Rate

Religion

RFEI

Obesity/BMI

Asthma

Diabetes

Hypertension

Mental Health

Substance Abuse/Violence

Stroke

Suicide

Heart Disease

Cancer

Respiratory Disease

Injury

Diabetes

Hypertension

Healthy Living Map

Variable Description (By County 2005-2009)

AA Alcohol Consumption by Adults

AP Air Pollution Rate

AT Alcohol Consumption by Teens

AAD Average Age at Death (in years)

FA Rate of Felony Arrests

S Smoking

HI Percent with Health Insurance

P Percent of Poverty

GY Graduation Year

I Per Capita Personal Income

GR Percent of High School Graduates

PC Prenatal Care Rate

OB Obesity Rates

E Exercise Rates

Model Specification AADit= α + β1AAit+ β2ATit+ β3HGRit+ β4FAit+ β5HIit+ β6Pit + β7GYit + β8Iit+ β9PCit+ β10OBit + β11Eit + β12Sit + β13APit + εit

Jason Gurtovoy

Regression Results – County Level

AAD = -.006FA + .016E + .007P -.015PC + .028GR + .016AA + .003I - .025AT + .016HI - .027OB + .866GY - .15AP - 1668.956

R2 = .5529 χ2 = 58.22

p-value < 0.000

Ranking (Top 8)

R Policy Variables (Effect on Average Age at Death)

Coefficient

P-Value

1 Graduation Rate .028 .001

2 Obesity -.027 .002

3 Graduation Year .866 .004

4 Alcohol Consumption by Adults

.16 .006

5 Alcohol Consumption by Teens

-.25 .018

6 Income .003 .043

7 Health Insurance .016 .056

8 Air Pollution -.015 .126

Dashboard of Health (County of San Bernardino)

Low

Moderate High

Severe

The model is the engine of the dashboard which guides the arrow.

The model is flexible and can be easily updated, modified, and changed.

The arrow will move when new information becomes available.

Runs on continuous interval.

We can look at the effects of shocks in the region.

We can see how different policy effects will move the dashboard.

Intuitive way to internalize the health of the county

Health System Service Area

Census Tract …7301 $1,173,626 in charges (2nd largest dollar amount in a single census tract) 687 Patients 31% No Religious Affiliation 21% Roman Catholic 20% Non-Denominational 18% Protestant 9% Other religion 1% Unknown 34% Ages 18-34 33% Ages 34-84 32% Ages 0-17 36% White/Caucasian 32% Native Am/Ind 27% Afro-American

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System-wide CHMS Infrastructure

•  Leadership support •  GIS software on internal server •  GIS competency •  POS address validation •  Internal cloud-based data and

report storage

System-wide CHMS Infrastructure

•  De-identified community health data published on web (CB)

•  Identify key metrics for tracking

population health improvement •  System-wide culture of decision

making based on real-time GIS enabled data, and displayed in a usable format

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Reversing Obesity Trends* Among U.S. Adults BRFSS, Now

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2013

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2014

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2015

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2016

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2017

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2018

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2019

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2020

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults BRFSS, 2021

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2022

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2023

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2024

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2025

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2026

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2027

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2028

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2029

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2030

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2031

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2032

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2033

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2034

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2035

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2036

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Reversing Obesity Trends* Among U.S. Adults BRFSS, 2037

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Dora Barilla, DrPH, MPH, CHES Michael Knecht, MDiv

Jason Gurtovoy (909) 558-3842