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Community Health Assessment Basics

Community Health Assessment Basics. NMDOH Community Health Assessment Program (CHAP). Overview. Community Health Assessment What is it? Common data sources used Measurement basics Common public health measures NM-IBIS Query system Indicator reports and community snapshots.

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Community Health Assessment Basics

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  1. Community Health Assessment Basics NMDOH Community Health Assessment Program (CHAP)

  2. Overview • Community Health Assessment • What is it? • Common data sources used • Measurement basics • Common public health measures • NM-IBIS • Query system • Indicator reports and community snapshots New Mexico Department of Health

  3. Public Health Assessment • The core functions of government in public health: • to develop policy that supports the health of populations, • to assure access to health care and the quality of that care, and • to assess the health status of the population. Institute of Medicine; Committee for the Study of the Future of Public Health; Division of Health Care Services (1988) The Future of Public Health. Washington, D.C.: National Academies Press. New Mexico Department of Health

  4. Epidemiology • Epidemiology, "the study of what is upon the people," is derived from the Greek terms: • epi = upon, among • demos = people, district • logos = study Downloaded on 11/25/08 from http://en.wikipedia.org/wiki/Epidemiology New Mexico Department of Health

  5. Epidemiology Includes Assessment? • The field of epidemiology was initially concerned with providing a methodological basis for the study and control of population epidemics. Now, however, epidemiology has a much broader scope, including the study of both acute and chronic diseases, the quality of health care and mental health problems. As the focus of epidemiologic inquiry has broadened, so has the methodology. New Mexico Department of Health

  6. Assessment Function of Public Health • Assessmentis the regular andsystematic collection, assembly, analysis, and dissemination of information about the health of a community. Institute of Medicine (1988) The Future of Public Health, National Academies Press. New Mexico Department of Health

  7. S.O.A.P Model New Mexico Department of Health

  8. Assessment “An understanding of the determinants of health and of the nature and extent of community need is a fundamental prerequisite to sound decision-making about health. Accurate information serves the interests both of justice and the efficient use of available resources. Assessment is therefore a core governmental obligation in public health.” (emphasis mine) Institute of Medicine (1988) The Future of Public Health, National Academies Press. New Mexico Department of Health

  9. Importance of Assessment • Without accurate information on the health status of a community and a clear understanding of the available resources, we cannot make informed decisions about which areas should have priority, which policies might be effective, or which interventions might be possible to implement. New Mexico Department of Health

  10. Commonly Used Data • Population-based: Covers the entire population. • Population-based: • Residents of New Mexico • Children in Mora County • Why are these NOT Population-based? • Clinic patients • WIC recipients New Mexico Department of Health

  11. Vital Records • Birth Certificates • Teen births • Low birthweight infants, preterm births • Adequate prenatal care • Death Certificates • Causes of death (diabetes, injury, heart disease) • Characteristics of decedents (person, place, time) New Mexico Department of Health

  12. Notifiable Diseases • State (tribal?) law determines which diseases are reportable. • Examples include: • Sexually transmitted (Chlamydia, HIV) • Vector borne (West Nile, Hanta Virus) • Food borne (E. coli, Salmonella) • Other (Influenza, meningitis) New Mexico Department of Health

  13. Disease Registries • Cancer Registry • Traumatic Brain Injury/ Spinal Cord Injury (TBI/SCI) • Chronic diseases (diabetes, asthma, hypertension) • Child blood lead New Mexico Department of Health

  14. Administrative Data • Inpatient Hospital Discharges • Diabetes • Influenza, pneumonia • Emergency Department Encounters • Injuries • Drug-induced • RPMS/IHS • Chronic conditions • Preventive clinical care New Mexico Department of Health

  15. Surveys • Behavioral Risk Factor Surveillance System (BRFSS) • Smoking • Physical Activity, overweight • Pregnancy Risk Assessment and Monitoring System (PRAMS) • Intendedness of pregnancy • Health care coverage for prenatal care • Youth Risk and Resiliency Survey (YRRS) • Drug use, smoking • Suicidal thoughts New Mexico Department of Health

  16. Census Bureau • Age, Sex, Race composition of the population • Geographic distribution of the population • POPULATION DENOMINATORS New Mexico Department of Health

  17. Measurement Basics • Example: Age Distribution of This Class. • On a blank sheet of paper, write your age. (If you don’t want to divulge your age, you can write a different age.) • Arrange yourselves in the back and sides of the classroom, from youngest to oldest. • Where there is more than one person of the same age, stand in front of one another. • Where there are gaps, with no person of a certain age, leave a space for that age. New Mexico Department of Health

  18. Mode: 37 Median: 41.5 Mean: 48.8 Age Distribution Histogram New Mexico Department of Health

  19. Age Distribution Histogram New Mexico Department of Health

  20. Distribution “Curve” New Mexico Department of Health

  21. Distribution “Curve” New Mexico Department of Health

  22. The “Normal” Distribution New Mexico Department of Health

  23. Measurement and “True Scores” • Why do we look at data? • Sometimes we just use the number at face value. “If one obstetrician can serve 100 pregnant women and the births of their babies in a given year, and our community has had 883 births, on average, in the last 5 years, then we will need to ensure availability of 9 O.B.s for the women of this community.” New Mexico Department of Health

  24. Measurement and “True Scores” • More often, we use the data to tell us something about RISK. New Mexico Department of Health

  25. Measurement and “True Scores” • Which of these communities has the higher diabetes death risk? New Mexico Department of Health

  26. Measurement and True Scores • What has this got to do with measurement and true scores? • Each of the three communities in the previous examples has an underlying risk for diabetes death. • The risk varies in the 3 communities because of a variety of factors, including lifestyle (diet and exercise), medical care (diagnosis and disease management), and other factors. New Mexico Department of Health

  27. Measurement and True Scores • What has this got to do with measurement and true scores? • The OBSERVED number of diabetes deaths, and the diabetes death rates are a MEASURE of the diabetes death RISK. • The TRUE SCORE is the actual risk level. It can not be measured directly. We use death data to estimate the diabetes death risk. New Mexico Department of Health

  28. Measurement and True Scores • What has this got to do with measurement and true scores? • While the actual risk changes slowly, in response to changes in the contributing factors, the measure (observed diabetes deaths) can very considerably from year to year. New Mexico Department of Health

  29. --Break--

  30. Trend Lines for Two Communities New Mexico Department of Health

  31. Calculating Some Statistics • Counts • Incidence is the number of new cases (e.g., of disease) in a given period of time. • Prevalence is the number of existing cases (e.g., of a disease or risk factor) in a given period of time. New Mexico Department of Health

  32. Count • Get a count of the prevalence of green M&Ms in your sample. (Count the green M&Ms.) New Mexico Department of Health

  33. Calculating Some Statistics • Rate • A rate is a fraction, in which the numerator is the number of people (or M&Ms) among whom an event occurred during a certain period of time, and the denominator is the total number of people (or M&Ms) in the population at risk for the same period of time. Rates are typically multiplied by some factor of ten so that the result is a whole number. New Mexico Department of Health

  34. Example Formula # Green M&Ms Total # M&Ms in the package 8 25 = 0.32 Rate • Count the green M&Ms. • Count the total number of M&Ms. • Divide the number of green M&Ms by the total number of M&Ms. New Mexico Department of Health

  35. Calculating Some Statistics • Percentage • A percentage is a rate in which the quotient is multiplied by 100. • Using your green M&M prevalence rate, multiply it by 100 to get the percentage of green M&Ms in your sample. New Mexico Department of Health

  36. Confidence Interval • A confidence interval is a range around a measurement that conveys how precise the measurement is. • the possible range around the estimate • how stable the estimate is • A stable estimate is one that would be close to the same value if the measurement were repeated. • An unstable estimate is one that would vary from one measurement to another. New Mexico Department of Health

  37. Trend Lines for Two Communities New Mexico Department of Health

  38. Trend Lines for Two Communities New Mexico Department of Health

  39. Trend Lines for Two Communities New Mexico Department of Health

  40. Calculating a Death Rate New Mexico Department of Health

  41. Calculating a Death Rate • A rate has four components: • A specified time period. • The numerator, the number of people in whom an event occurred during a given period of time, and • The denominator, the total number of people in the population at risk for the same period of time. This is also referred to as the "person-years at risk." • A constant. The result of the fraction is usually multiplied by some factor of 10 (such as 100,000), so that the rate may be expressed as a whole number. New Mexico Department of Health

  42. The Numerator: Causes of Death • National Center for Health Statistics, 50 Leading Causes of Death • In order to provide a consistent ranking standard the NCHS (National Center for Health Statistics, part of the CDC) prepared a list of 113 selected causes of death. The NCHS 50 leading causes of death are taken from the list of 113. For more information about the NCHS rankings, see Cause of Death Ranking on the NCHS website. New Mexico Department of Health

  43. The Numerator: Causes of Death New Mexico Department of Health

  44. The Numerator: Causes of Death New Mexico Department of Health

  45. The Numerator: Causes of Death New Mexico Department of Health

  46. International Classification of Disease, Version 10 (ICD-10) New Mexico Department of Health

  47. The Numerator: Causes of Death New Mexico Department of Health

  48. Calculating a Death Rate New Mexico Department of Health

  49. Calculating a Death Rate • The calculation for the death rate for Heart Disease in Region 1 looks like this: • Do the division: • Multiply by the ‘constant’: New Mexico Department of Health

  50. Calculating a Death Rate New Mexico Department of Health

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