January 15, 2020 | 2:00 p.m. ET

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Agenda

• Emerging Opportunities for NCCOR

• Steering Committee Update

• Spotlight CORD 3.0 and CODI

▪ Dr. Raymond King, CDC

• NCCOR Year in Review

• Other NCCOR Activities

• Announcements

• Calendar Reminder

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Emerging Opportunities for NCCOR

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• New members:

▪ Andrew Bremer, MD, PhD

▪ Heather Hamner, PhD, MS, MPH

• Departures:

▪ Rachel Ballard, MD, MPH

▪ Kathleen Watson, MS, PhD

• March Member Meeting theme is Early Childhood

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Steering Committee Update

Childhood Obesity Data Initiative (CODI):

Linking Clinical & Community Systems

Ray King, PhD, MSc

Epidemiologist/Informaticist

NCCDPHP EHI WORK GROUP

The findings & conclusions in this presentation are those of the presenter and not necessarily those of CDC

Division of Nutrition, Physical Activity, and Obesity

Agenda

• Background/problem

• CODI solution

• CODI pilot

• Highlights

• Accomplishments & ongoing work

Childhood Obesity: Background

> 13 million children in US have

obesity

• > 4 million with severe obesity

Kids don’t grow out of obesity

• Kids who are overweight in kindergarten

are four times more likely to have obesity

by 8th grade

• 90% of adolescents with obesity become

adults with obesity

Childhood Obesity: Recommendations

U.S. Preventive Services Task Force • Screen children using Body Mass Index (BMI)

• Offer/refer children with obesity to weight management programs

National Academy of Medicine • Provide obesity prevention in multiple settings

American Academy of Pediatrics• Screen for food insecurity

• Refer to community food assets

• Tiered clinical care with community linkages

Data Challenge

Data issues

• Small samples, cross-

sectional, single setting or

system

• Factors that influence health

outcomes & interventions

Data problem to address

• Patient-level linked

longitudinal data across

programs, settings & systems

The CODI Solution

Individual-level, linked longitudinal records

• Healthcare – e.g., height, weight, blood pressure

• Intervention – clinical & community weight management programs

• Determinants of health – individual & community

• Administrative – e.g., payer reimbursement

CODI: Collaborative & Scope

CODI

COLLABORATIVE

CODI Pilot: Denver, Colorado

CODI: High-level timeline

CODI: Surveillance & Research

Questions1. When is obesity screening (measuring BMI)

occurring? In what settings? What actions does it

trigger, including comorbidity screening?

2. What “dose” and characteristics of weight

management interventions are associated with

effectiveness?

3. What is the cost and cost effectiveness of weight

management intervention?

4. What is the prevalence of obesity among children

aged 2–19 years and trends overtime within small

geographic areas?

CODI: Common Data Model (CDM)

Broader access to standardized data

• PCORnet CDM

• CHORDS CDM

• OMOP CDM

• Ancillary tables

CODI: Common Data Model

B. CODI Record Linkage

Data Model

A. CODI Research Data Model

1. Standard

clinical

concepts

PCORnet (CDM): Demographics, Encounters,

Providers, Diagnoses, Lab Values, Prescriptions,

Procedures, and Vital Signs

2. Leveraging

other data

models

CHORDS*: Census Data -

Location & Population-level

Demographics

OMOP**:

Cost Data

3. New

concepts for

CODI

CODI ancillary tables: Programs, Sessions, Asset

Delivery, Alerts, Family History, & Referrals

*CHORDS = Colorado Health Observation Regional Data Service

**OMOP = Observational Medical Outcomes Partnership

Record linkage table:

Record linkage

CODI: Privacy-Preserving Record Linkage

Link records across systems & sectors while protecting PII

• PII encoded in secure, private format behind organizations firewalls; only

secure hashes are shared

• Semi-trusted third party links records & generates LINK_IDs

• All organizations receive LINK_IDs to link records in response to

research queries

Semi-Trusted Third Party

Organization A:

Personally Identifiable Information (PII)

Organization B:

Personally Identifiable Information (PII)

CODI: EHR Data Reconciliation

Representative BMI

• EHR Big data cleaning

• Methodology – Daymont plus

• Automated

• Which data point?

Representative geography

• Which geography gets credit?

CODI: Distributed Data Network Query

Leverage existing infrastructure

• Based on PCORnet and PopMedNet infrastructure

• Data coordinating center conducts record linkage and

assembles the longitudinal records

1

5

3

4

TTP

2

Significant accomplishments

✓ Collaborative of national and local stakeholders

✓ Research and surveillance questions finalized with local & national SMEs

✓ Programmatic environmental scan – clinical & community weight management programs

✓ Technical environmental scan – clinical & community partners

✓ Query architecture – distributed clinical & community network

✓ Research and identity management data models

✓ Privacy preserving record linkage solution for identity management

✓ Business process analysis of clinical and community childhood obesity processes

✓ Evaluation plan

✓ Data models implementation guide

✓ On-boarding community health partners

In progress

➢ Synthea – synthetic childhood obesity data

➢ Master sharing agreement – governance

➢ Local implementations of CODI common data models

➢ CHORDS/PCORnet comparison & methodology

➢ Privacy preserving record linkage solution testing

➢ FHIR solution - mapping to CODI common data model

➢ EHR data cleaning methodology, code, and tool

➢ EHR population health estimate methodology

➢ Evaluation tool development

➢ Distributed query development – PCORnet & CHORDS queries

CODI: Accomplishments

CODI 2.0: Spread & Scale

Objectives

• Scale and refine infrastructure

• Automated population of CODI Data Model

• Patient-level social determinants of health

• Governance strategy

• Implementation guide for additional use cases

Team Effort!!

Organization Name

HHS/ASPEPatient-Centered

Outcomes Trust Fund

Centers for Disease

Control and Prevention

Alyson Goodman

Raymond King

Nedra Garrett

Marissa Sucosky

Renee Porter

Pradeep Podila

Megan Harrison

Heidi Blanck

Suzianne Garner

Teresa Kinley

Children’s Hospital,

Colorado

Matthew Haemer

Angela Comer

Sara Deakyne Davies

Organization Name

Denver Public Health

Seth Foldy

Arthur Davidson

Kenneth Scott

Jessica Wallace

Duke University

Asheley Skinner

Sarah Armstrong

Harvard Pilgrim Jason Block

Kaiser Permanente

Matthew Daley

Mark Gray

Louisiana Public

Health InstituteThomas Carton

MassGeneral Hospital

for ChildrenLauren Feichtner

MITRE

Dawn Heisey-Grove

Peter Mork

Organization Name

MITRE

Andy Gregorowicz

John Rose

Daniel Chudnov

Keith Miler

Brook von Fricken

Colin Schieble

Public Health

Informatics Institute

Jim Jellison

Jim Mootrey

Emily Kraus

University Colorado

Denver

Toan Ong

Rachel Zucker

Yale University Mona Sharifi

Questions/Feedback

CODI@cdc.gov

2 0 1 9

NCCOR Strategic Planning Model

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NCCOR Strategic Planning Activities (NCCOR 2019–2020)

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• Feb 2019: NCCOR External Scientific Panel Meeting

• Mar 2019: Senior Leadership Briefing and NCCOR Member Meeting

• Jun 2019: NCCOR Member Meeting

• Sep 2019: NCCOR Member Meeting

• Oct 2019: GSCN conducted interviews with external experts and representatives from governmental organizations who are not currently involved in NCCOR

• Jan 2019: The interview results will be combined with insights from the Steering Committee to develop a survey for NCCOR members to further refine, rank, and prioritize ideas for future directions

• Mar 2020: GSCN will submit a final report on potential future directions for NCCOR in March 2020

Keeping Members Connected

• Senior Leadership Briefing: 10 years of NCCOR Accomplishments and Lessons Learned

• Two Member Meetings ▪ Lunch panel topics: Innovations Addressing Social Determinants of Health through

Economics, Transportation, Rural, and Housing Interventions

• Three Workshops ▪ COEB In-Person Meeting; Advancing Measurement of Individual Behaviors Related to

Childhood Obesity (AIM); Advancing Measurement for High-Risk Populations and Communities Related to Childhood Obesity)

▪ 108 attendees

• Four Member Calls ▪ Special presentations included an overview of the evaluation on NCCOR’s Measures

Registry and Measures Registry User Guides and an update from RWJF on their childhood obesity efforts

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• NCCOR engaged 82 outside experts in childhood obesity research through NCCOR meetings and workshops and the Connect & Explore webinar series

• External experts include:▪ Lida Chatzi, University of Southern California

▪ Stella Yi, NYU Langone Health

▪ Douglas Teti, Pennsylvania State University

▪ John Sirard, University of Massachusetts Amherst

▪ Peter Katzmarzyk, Pennington Biomedical Research Center

▪ Kate Glantz, Lyft

Engaging Experts

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• Explored how NCCOR can contribute to research on early childhood

• Began to identify common economic indicators and methods to make the business case for built environment and land use improvements to increase physical activity

• Discovered differences in applying, adapting, and developing measures for high-risk populations

• Explored how to measure sleep in relation to childhood obesity

• Learned how some social determinants of health, including housing, transportation, and economics, may influence childhood obesity

• Developed talking points to communicate NCCOR’s accomplishments to Senior Leaders

Exploring New Topics

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2019 Active Workgroups

• Additional Benefits of Walkability• Advancing Measurement of Diet and Physical Activity for Childhood

Obesity Research and Evaluation (JPB)• Catalogue of Surveillance Systems• Pilot Test of a Meta-Analytic Method: Childhood Obesity Evidence Base

(COEB) • Communicating to Leaders • Communications• Economic Impact of Built Environment Improvements for Physical Activity • Engaging Health Care Providers and Systems• SNAP-Ed Toolkit• Increasing Opportunities for Trail Use to Promote Physical Activity and

Health among Underserved Youth • Youth Active School Transportation Surveillance Initiative• Youth Energy Expenditure

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Improving Resources

NCCOR worked to create tailored products for many of our tools and resources geared towards specific audiences:

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• Students

▪ NCCOR created a student resource guide

• Teachers

▪ NCCOR created a fact sheet on the Youth Compendium geared towards classroom teachers and a fact sheet on the Measures Registry suite of resources for professors

Improving Resources

General

• Measures Registry Resource Suite fact sheet for grant proposals

• Teaser card for a guide on childhood adiposity

• Updated the NCCOR overview booklet and the Measures Registry overview booklet

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Launch of a New Tool!

Measure Registry Learning Modules are designed to complement the Measures Registry and Measures Registry User Guides

• 17 video modules

• Each module covers one of thefour domains of the Measures Registry: ▪ Individual diet

▪ Food environment

▪ Individual physical activity

▪ Physical activity environment

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Launch of a New Tool! (cont.)

• 12,286 page views since launching in September 2019

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Connecting the Field

• Held 2 Connect & Explore Webinars▪ From Purchase to Plate: Linking USDA Nutrition Data

with Retail Scanner Data to Assess the Healthfulness of America’s Food-at-Home Purchases Collaborating for Impact: Lessons Learned from NCCOR

▪ Measures Registry Learning Modules: Helping You Understand Measurement Concepts and Approaches for Diet and Physical Activity Research Innovations in Behavioral Design to Enhance Active Living and Healthy Eating

• Registered 386 individuals

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Connecting the Field• Presented and exhibited at 9 Conferences

▪ Active Living Research Annual Conference, February 17–20, Charleston, SC

▪ Society of Behavioral Medicine Annual Meeting, March 6–9, Washington, DC

▪ Healthy Eating Research, March 13–15, Detroit, MI

▪ Society for Public Health Education Annual Conference, March 26–29, Salt Lake City, UT

▪ The Future of Food and Nutrition Graduate Student Research Conference, April 6, Boston, MA

▪ DNPAO National Training, May 6–10, Atlanta GA

▪ Nutrition 2019, June 8–11, Baltimore, MD

▪ Childhood Obesity Conference, July 15–19, Anaheim, CA

▪ American Public Health Association Annual Meeting, November 2–6, Philadelphia, PA

• 597 Conference participants signed up for the e-newsletter

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• NCCOR Student Hub e-Newsletter

▪ 195 subscribers

• Reached out to 55 university contacts made at APHA

• Planning for student-focused Connect & Explore webinar

• NCCOR Student Hub website

▪ Coming soon!

Expanding Our Outreach

Growing NCCOR’s Student Audience

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Expanding Our Outreach

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• NCCOR general e-Newsletter (5,351 total subscribers)▪ 673 new subscribers in 2019

▪ Averaging 56 new subscribers monthly

• NCCOR Student Hub (195 total subscribers)▪ First edition of newsletter had 74 opens

Expanding Our Outreach

• 2,327 individuals follow NCCOR on Twitter▪ 203 added in 2019

• 697 individuals follow NCCOR on LinkedIn▪ 113 added in 2019

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• 619 individuals follow NCCOR on Facebook▪ 185 added in 2019

NCCOR by the Numbers

Webpage 2018 Page Views 2019 Page Views

NCCOR’s home page 43,473 35, 945

Tools

Catalogue of Surveillance Systems 5,730 4,581

Measures Registry 12,967 13,085

Measures Registry User Guides 26, 947 26,411

Measures Registry Learning Modules 12,284*

Youth Compendium of Physical Activities 15,509 22,689

Other pages

Webinars 7,401 4,961

Funding Opportunities 7,393 10,366

Total (all pages including those not listed) 272, 093 285,022

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*Data from September to December 2019

Questions?

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nccor.orgnccor.org

nccor.org/mrresourcesuite

MEASURES REGISTRY

A searchable database of more than 1,400 diet and physical activity measures

relevant to childhood obesity research

MEASURES REGISTRY USER GUIDES

Designed to complement the Measures Registry and provide an overview of

measurement, describe general principles of measure selection, and share

additional resources

MEASURES REGISTRY LEARNING MODULES

Consists of short, interactive videos to learn about the four domains of the

Measures Registry: individual diet, food environment, individual physical activity,

and physical activity environment. There are also quizzes to test your knowledge.

Measures Registry Resource Suite

MEASURES

REGISTRY

RESOURCE

SUITE

nccor.orgnccor.org

A list of 196 common activities in which youth participate and the estimated energy cost associated with each activity.

YOUTH COMPENDIUM OF PHYSICAL ACTIVITIES

nccor.org/youthcompendium

More NCCOR Tools

Visit nccor.org to see more free resources!

Provides one-stop access to over 100 publicly available datasets relevant to childhood obesity research.

CATALOGUE OF SURVEILLANCE SYSTEMS

nccor.org/css

• Additional Benefits of Walkability• Advancing Measurement of Diet and Physical Activity for Childhood Obesity

Research and Evaluation (JPB)• Catalogue of Surveillance Systems• Pilot Test of a Meta-Analytic Method: Childhood Obesity Evidence Base

(COEB) • Communicating to Leaders • Communications• Economic Impact of Built Environment Improvements for Physical Activity • Engaging Health Care Providers and Systems• Increasing Opportunities for Trail Use to Promote Physical Activity and Health

Among Underserved Youth • Youth Active School Transportation Surveillance Initiative• Youth Energy Expenditure

For updates on the progress of NCCOR’s workgroups, visit: http://nccor.org/internalresources

Other NCCOR Activities

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Announcements

• Member Meetings▪ March 26, 2020 (Washington, DC)

▪ June 11, 2020 (Atlanta, GA)

▪ September 17, 2020 (Washington, DC)

• Member Calls▪ April 15, 2020

▪ July 15, 2020

▪ November 18, 2020

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Calendar Reminder