August 22, 2007
7:00 a.m. 8:30 am – 9:00 am Welcome Moderator: Nelson Adekoya Speakers: Robert Martin, Centers for Disease Control and Prevention Barry Nangle, National Association for Public Health Statistics and Information Systems Speaker: Nelson Adekoya, Centers for Disease Control and Prevention Speaker: Steve Solomon, Centers for Disease Control and Prevention Registration Opens Room Ballroom
9:00am – 9:20 am 9:20am – 10:20 am
Assessment Initiative Overview and Update Moderator: Tom Savel Keynote Address Moderator: Barry Nangle BREAK Poster Session
Ballroom
Ballroom
10:20 am -10:50 am
10:50 am – 12:20 pm
Organizer: Nelson Adekoya Plenary 1 Health Disparities Organizer: Nelson Adekoya Moderator: Nelson Adekoya
Speakers: Debra Karch, Centers for Disease Control and Prevention Ali Mokdad, Centers for Disease Control and Prevention Ron Anderson, Centers for Disease Control and Prevention Mary White, Centers for Disease Control and Prevention
Ballroom
12:20 pm – 1:30 pm 1:30 pm – 3:00 pm
LUNCH – On Your Own Concurrent Session 1 The Role of Public in Participation Health (GIS) - DD Organizer: Russell Kirby Moderator: Lois Haggard Concurrent Session 2 Community Health Research 1 -ADT Organizer: Nelson Adekoya Moderator: John Anderton Concurrent Session 3 Community Health Assessment Practice in Rural Communities – Practice Organizer: Chris Abarca Moderator: Chris Abarca Speakers: Russell Kirby, University of Alabama at Birmingham Nicholas Jones, Centers for Disease Control and Prevention Michael Barndt, Nonprofit Center of Milwaukee Speakers: Joe Campo, Washington Department of Health (C-section) #1 Sue Ellen Bennett, Columbus Health Department, on minority health Gerard Rushton, University of Iowa see Speakers: Julia Joh Elligers, National Association of City and County Health Officers Susan Mitchell, Health Planning Council of Southwest Florida Jeff Feller, WellFlorida Council Theresa Teti, Roosevelt Health Council, New Mexico Capital Center
Capital South
Atlanta 5
3:00 p.m. – 3:30
BREAK
p.m. 3:30 p.m. – 5:00 p.m.
Concurrent Session 4 Probabilistic Linkage Tools and Applications - DD Organizer: Gulzah Shah Moderator: Denise Love Concurrent Session 5 Open Source and Public Domain Options for Web Based Data Dissemination Systems - Process Organizer: Sigrid Economou Moderator Sigrid Economou Concurrent Session 6 Public Health Tools for Training, Assessment and Intervention Planning - Process Organizer: Susan Elder Moderator: Susan Elder Adjourn
Speakers: Gulzar H. Shah, National Association of Health Data Organizations Larry Cook, The Intermountain Injury Control Research Center Susan G. McBride, Dallas Fort Worth Hospital Council Speakers: Cavin Capps, Census Bureau Carl Kinkade, Centers for Disease Control and Prevention Mark Puckett, Centers for Disease Control and Prevention
Capital Center
Capital South
Speakers: Cate Bohn, New York State Department of Health Mike Stoto, Georgetown University Julie Claus, Transtria, LLC
Atlanta 5
5:00 p.m.
August 23, 2007 8:00 am – 9:30 am Reconvene Moderator: Poster Session Organizer: Nelson Adekoya Plenary 2 Sustaining Public Health Assessment Initiatives Organizer: Nelson Adekoya Moderator: Nelson Adekoya Speakers: Barry Nangle, National Association for Public Health Statistics and Information Systems Vince Fonseca, Texas Department of State Health Services Joseph Henderson, New York State Department of Health Michael Landen, New Mexico Department of Health Murray Hudson, South Carolina Department of Health Ballroom Nelson Adekoya
9:30 am -10:00 am 10:00 am – 11:30 am
BREAK Plenary 3 Methods for Measuring Health Disparities at the National, Regional and Local Level Organizer: Richard Klein Moderator: Annie Gjelsvik Plenary 4 New direction for CDC paperless Grant Application Process Organizer: Nelson Adekoya Moderator: : Priti Irani LUNCH – On Your Own Concurrent Session 7 Business Process Analysis: A Tool for Design of Web-Based Data Query Systems – Process Organizer: Chris Spice Moderator: Chris Spice Concurrent Session 8 Using the BRFSS as an evaluation tool - DD Organizer: Ruth Jiles Moderator: Ruth Jiles Concurrent Session 9 Community Health Research 2 – ADT Organizer: Nelson Adekoya Moderator: Corazon Halazan Speakers: Richard Klein, Centers for Disease Control and Prevention Allen Fremont, RAND Corporation Elsie Pamuk, , Centers for Disease Control and Prevention Marc Elliott, RAND Health Speaker: Beth Gardner, Centers for Disease Control and Prevention Ballroom
11:30 am – 12:15 pm
Ballroom
12:15 pm – 1:30 pm 1:30 pm – 3:00 pm
Speakers: Valerie Britt, Public Health Informatics Institute Tong Zheng, Utah Department of Health
Capital Center
Speakers:
Capital South
Speakers: Eugene Lengerich, Pennsylvania State University Joe Campo, Washington Department of Health (preventable hospitalization) #3 Beth Santhez, New Mexico Department of Health
Atlanta 5
3:00 p.m.– 3:30 p.m. 3:30 p.m.– 5:00 p.m.
BREAK Concurrent Session 10 Vital Statistics System: Past, Present, and Future - ADT Organizer: Jan Markowitz Moderator: Concurrent Session 11 Community Health Research 3 - ADT Organizer: Nelson Adekoya Moderator: Cate Bohn Speakers: Garland Land, National Association for Public Health Statistics and Information Systems Daniel Friedman, Consultant Speakers: Phyllis Reed, Washington Department of Health (space-time clusters) Michelle Groux, Columbus Health Department, Jay Buchner, Rhode Island Department of Health Lou Saadi, Kansas Department of Health Speakers: Sara McLafferty…from Kirby Russell Mark Salling, Cleveland Center for Community Solutions…from Annie Capital Center
Capital South
5:00 p.m.
Concurrent Session 12 Health Assessment: GIS and methodological issues - DD Organizer: Kirby Russell Moderator: Kirby Russell Adjourn
Atlanta 5
August 24, 2007 8:00 am – 9:30 am Reconvene Plenary 5 Estimating State Medicaid Costs for Leading Chronic Diseases Organizer: Chris Maylahn Moderator: John Robitscher BREAK Plenary 6 Current Assessment Initiative funded state (accomplishments and future plans) Organizer: Nelson Adekoya Moderator: Nelson Adekoya Nelson Adekoya Speakers: Diane Orenstein, Centers for Disease Control and Prevention Eric Finkelstein, Research Triangle Institute Joel Cohen, Agency for Healthcare Research and Quality Speakers: Annie Gjelsvik, RI Department of Health Priti Irani, New York Department of Health Chris Abarca, Florida Department of Health Susan Elder, Missouri Department of Health Christie Spice, Washington Department of Health Lois Haggard, Utah Department of Health Mark White, Centers for Disease Control and Prevention
Ballroom
9:30 am -10:00 am 10:00 am – 11:30 am
Ballroom
11:30 am – 11:45 am
Closing Remarks Adjourn
Descriptions: Day 1 Wednesday, August 22, 2007 -Welcome - Host and co-sponsor will welcome attendees to the conference -AI Overview – Session will provide an overview of the Assessment Initiative program since inception in 1992 and also highlight accomplishments -Plenary 1 – There continue to be disparities in health, despite Department of Health and Human Services attention. Various organizations/agencies are doing what they can to reach Healthy People 2010 objectives. The objectives have been achieved in several instances but in some we have not. Panelists will discuss what could be done to accelerate the achievement of major objectives to improve the health of the minorities. Presentations will address conditions such as Heart diseases, diabetes, cancer, and injuries and their effects on minorities. -Concurrent 1 - In this session, we will explore the potential of PPHGIS as a tool for enhancing community health assessment and involving more participants in the process. The session will begin with an overview of PPHGIS and its origins growing out of the PPGIS movement of the late 1990s. Presenters will discuss the computer systems and informatics challenges to implementing PPHGIS, what decisions must be made in constructing an H-GIS that truly enables public involvement, and some examples from existing applications drawn from around the country. -Concurrent 2 – This session will consist of research efforts in community health practice. For example, birth certificate data is used to outline case definitions for low risk and potentially preventable C-sections, describe the trends, and identify spatial clusters with higher than expected preventable C-section rates. In addition, using hospital discharge data, we apply a cost-to-charge ratio model to estimate and contrast costs between vaginal and C-section deliveries. By identifying these cases, their trends, the communities most at risk and the system-wide costs, we can raise awareness in communities and among policy makers, providers and payers, and initiate a conversation on appropriate use of limited health care dollars. In another research, data will be presented on disparities and methods for addressing data gaps, and how Columbus, Ohio is addressing these disparities including organizational internal assessment to determine whether and how programs collect data about customers' race and ethnicity; determine how programs assess and address the specific needs of racial and ethnic minorities in order to provide the most appropriate care; and assess strengths and weaknesses and identify gaps and opportunities related to addressing racial and ethnic health disparities. Lastly, given the increasing burden of cancer, the last presentation will discuss the mapping of cancer burdens for cancer control. Audience will understand that basic county level cancer incidence maps may have limitations,
and that alternative, more advanced mapping methods can be used to add value to cancer control and prevention efforts. Audience will learn about the following properties of cancer burden maps: spatial continuity of rates; ability to know the spatial basis of any rate observed and the ability to locate areas of interest in relation to cognitive knowledge of the map; and ability to know the reliability of the rate observed. -Concurrent 3. Presentations in this session will highlight the unique challenges, opportunities, and promising practices associated with community health assessment and health improvement planning in rural settings. Session Objectives include increase awareness of unique aspects of community health assessment practice in rural settings, collect best practice examples, tips and tools for application in rural practice of community health improvement planning, and gain better understanding of leveraging resources and maximizing collaborative efforts towards improving health outcomes in rural communities. -Concurrent 4. The session will highlight the tools and techniques, practices and lessons learned. The learning objectives will be for participants to learn about tools used in probabilistic linkage, available resources; examples of uses in public health, barriers, etc. -Concurrent 5 - Commercial software is costly, and licensing and maintenance fees can be prohibitive for public health agencies. Public domain software, such as "Government Off The Shelf" (GOTS) systems, and "Open Source" software are available for free, and often have active communities of support. However, there are still costs for adapting these systems for customized data analysis needs, and costs for operating these systems. Panelists will describe such systems as options available to public health agencies, and discuss the probable costs for starting up and operating these solutions. Learning Objectives include (1) Why consider open source and pubic domain Information Technology (IT) solutions? (2) What approaches are available as public domain products? Open Source products?, and (3) what probable costs occur when implementing a "free" open source or public domain system? -Concurrent 6. Presentations in this session will describe and demonstrate Assessment Initiative-supported tools for evidenced-based public health practice that have received wide interest from public health professionals. Three web-based resources will be highlighted. Attendees will become familiar with on-line resources for evidence-based training, assessment and intervention planning; improve their understanding of the evidence-based public health framework as it applies to strategies for health improvement at the community level; increase knowledge of how to use evidence to guide community health decision-making and intervention planning; and enhance awareness of a wide variety of information sources and practical tools for assisting local health professionals and communities in intervention planning, implementation, and evaluation. Day 2 -Plenary 2 – The plenary session will discuss how successful public health projects are selected in the health department, how success was defined, how funds were obtained to sustain the projects (institutionalization), ongoing evaluation of the projects, etc. This topic is of particular importance given the dwindling funding for several public health programs. Participants need to know how experts such as our panelists have been successful as public health practitioners in the environment we found ourselves today. -Plenary 3 – This workshop provides an update on emerging methods and issues related to measurement and assessment of health disparities. This year‟s session will highlight how the approaches used to monitor disparities in Healthy People 2010 and other commonly used approaches in the literature can produce seemingly conflicting conclusions about health disparities among racial/ethnic and socioeconomic subgroups. We will also consider the different approaches to measuring disparities across ordered groups (such as income or educational attainment) and the interpretational and practical implications of the different methodologies. In addition, we will explore enhancements to and improved accuracy of indirect methods to estimate race/ethnicity and related disparities. Finally, we will demonstrate use of indirect estimates and emerging GIS interactive mapping tools by plans participating in the National Health Plan Collaborative to examine disparities at the regional and local level. Participants will (1) learn about the various decision points that need to be addressed when considering how disparities will be measures (2) learn how different valid measures of disparities can produce different conclusions (3) learn how disparities are monitored in Healthy People 2010 (4) learn the different approaches to measuring disparity across ordered groups, and the practical implications of the different approaches (5) learn how surname and geocoding approaches can be combined to capitalize on the advantages of each, and (6) learn how imputed race/ethnicity can be used to estimate racial/ethnic disparities -Plenary 4 – Staff from the CDC Procurement and Grants Office will review the Find and Apply of Grants.gov, the Federal government‟s single online portal to find and apply for Federal grant funding. We will also go over the benefits of registering in eRA Commons, allowing grantees and applicants to electronically receive application and award information. This HHS-supported website serves 26 federal grantmaking agencies and provides grantees a way to easily find and apply for grants and cooperative agreements. Additionally, Grants.gov provides grantee assistance such as templates, registration instructions, checklists, tutorials, customer support and all necessary application forms. Responses to grants are now being submitted via www.grants.gov . States and organizations interested in applying for grants must be familiar with this development. -Concurrent 7. Identifying functional requirements is a critical stage in the development of all information systems including the webbased data query systems many states have built to facilitate the practice of community health assessment. Recently, the Public Health Informatics Institute and the National Association of County and City Health Officials developed a new approach to systematic, collaborative requirements gathering. The Robert Wood Johnson Foundation is funding 31 local and state health departments to implement the BPA approach through the Common Ground initiative. In this session, the presenters will introduce BPA and discuss its application to
web-based data query systems. Participants will understand the basic principles of BPA; and understand the application of BPA to development/acquisition decisions for web-based data query systems. -Concurrent 8 – This session will focus on the use of BRFSS for community health assessment and local level policy development, implementation, and evaluation. The session will include topics such as SMART BRFSS, adapting BRFSS to meet community needs or special BRFSS surveys, and using BRFSS as an evaluation tool. -Concurrent 9- Session will features series of health researches to include the use of maps for comprehensive cancer control to enable audience to understand the use of disease mapping in comprehensive cancer control, and to appreciate new interactive, Internet-based approaches to disease visualization. The Agency of Health Care Research and Quality (AHRQ) has established a number of indicators on quality of care. A subset of these indicators address community-based concerns defined as “preventable hospitalizations” and include hospitalization rates for adult asthma, diabetes complications, perforated appendix, and hypertension to name a few. Using inpatient hospital discharge data geocoded to the ZIP code level we have identified communities and regions at increased risk for these preventable hospitalizations. Additionally, using a cost-to-charge ratio model we have estimated the costs associated with these hospital admissions. Since insurance plans may affect these hospitalization rates, variations are also assessed by payer type (Medicaid, Medicare, HMO, self-pay, etc.) By identifying the costs, regions and payers associated with preventable hospital admissions we can begin to better target those communities most in need. Partnering with local hospitals, foundations to perform local BRFSS type assessment (N>2000) using this data to examine Gender, Race, economic, and geographic disparity and disseminating this data to the community (designing useful electronic documents, meeting data needs of partners agencies, our own programs & others in the community and making sure the data reaches agencies/government for program planning and policy). We are now working on our 3rd iteration of this process. -Concurrent 10. This session will highlight the changes that have occurred in the vial statistics system in the past 25 years. Objective national and state performance measures will be presented on the performance, resources and uses of the vital statistics system in the past 25 years. The session will also include a presentation on the current efforts to improve the timeliness, quality and availability of vital statistics data. -Concurrent 11. This session will present various researches at the community level. A critical component of presenting data on the health disparities among different racial and ethnic groups via a Web Query System is evaluating and ensuring the quality of the underlying data. The quality of data items for race and/or ethnicity were evaluated for death certificates, and cancer registry and hospital discharge data. At the conclusion of the presentation, participants would be able to identify issues relating to collecting accurate race/ethnicity data, and describe how measures of health disparities may be impacted by the underlying data collection methods. Another presentation will describe air pollutants and cardiovascular mortality. Air pollutants are a well recognized cause of increased cardiovascular mortality. In this presentation we briefly review the literature, and describe how we applied the spatial scan statistic to daily death certificate data geocoded to the census tract level to identify poor air quality associated mortality clusters in both space and time. While the media is quick to carry stories of increased mortality rates during peak summer months, specific high risk communities have not been identified, and air inversions associated with air pollution can occur year round. By identifying communities at-risk and the time periods throughout the year when communities are at increased risk, we can begin to better plan for addressing the immediate needs of the most vulnerable populations, as well as raise awareness of health risks associated with poor air quality and further the conversation on remediation. Another research extracted data from private health insurance database to provide the tobacco program with estimated costs of acute heart attacks for use in testimony to support a state ban of smoking in public places. -Concurrent 12 - Presentations in this session will focus on different methods of geocoding which can result in generation of different rates. Issues around geocoding methods, the resulting difference in rates and different public health interpretations that can stem from inconsistent geocoding methods will be discussed. Examples from community health assessments will be presented. Day 3 - Plenary 5 – To describe the development of a tool, called a Chronic Disease Cost Calculator, to 1) consistently estimate the state costs of selected chronic diseases among Medicaid beneficiaries; and 2) assist policy makers to better understand the impact of chronic diseases and the potential benefits of chronic disease interventions to reduce the impact. The calculator was developed by the Research Triangle Institute with support from the Centers for Disease Control and Prevention. An econometric approach was utilized to construct a model using data from the Medical Expenditure Panel Survey, as well as Medicaid claims data from four states, to isolate annual per person and aggregate costs for heart disease, congestive heart failure, hypertension, stroke, diabetes and cancer by payer. State estimates can be generated by selecting the default values in the model. States can customize the estimation procedure by inputting state Medicaid data on actual costs. The costs estimated using this calculator provide information for state policy makers to determine the economic burden of these diseases in their state and realize potential cost savings from focusing proven interventions on these diseases -Plenary 6 – This plenary session is devoted to the successes and accomplishments of the AI funded states. Although each presentation is unique, when examined in tandem, they provide unique futures of what AI is aimed to accomplish: access to health data, enhancing skills in analyzing data, and using results for policy-making. Presenters will be available to provide in-depth discussion of their programs for those interested in specific community health assessment project.
Session Themes: Data Dissemination – Topics dealing with the distribution of timely, accurate, and easily accessible health data Applied Data Techniques – Topics dealing with analyzing data and applying the results to the assessment process Community Health Assessment Outcomes – Benefits, products, and impacts of community health assessment, such as, success stories, improved health outcomes, policy development (outcomes) Community Health Assessment Process – Topics dealing with the „how-to‟ of CHA at the state and local levels. (process) Community Health Research – Various topics dealing with research efforts in the community