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Update on CDC’s National Environmental Public Health Tracking Program

Update on CDC’s National Environmental Public Health Tracking Program. Judith R. Qualters, PhD Chief, Environmental Health Tracking Branch Division of Environmental Hazards and Health Effects National Center for Environmental Health Centers for Disease Control and Prevention June 4, 2008.

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Update on CDC’s National Environmental Public Health Tracking Program

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  1. Update on CDC’s National Environmental Public Health Tracking Program Judith R. Qualters, PhD Chief, Environmental Health Tracking Branch Division of Environmental Hazards and Health Effects National Center for Environmental Health Centers for Disease Control and Prevention June 4, 2008

  2. Environmental Public Health Tracking • Pew Commission Study • America’s Environmental Health Gap • Congressional funding • Program initiated, 2002 • Mission: To provide information from a nationwide network of integrated health and environmental data that drives actions to improve the health of communities

  3. Tracking = Surveillance

  4. 2002 to 2006: Building Capacity and Demonstrating Utility

  5. CDC’s Tracking Program, 2008

  6. Tracking Network: At-A-Glance A web-based information system that exists at the local, state, and national level that serves the public, environmental public health agencies, health care providers and researchers Functions: • Provide Nationally Consistent Data and Measures • Describe and Discover Data • Exchange Data • Provide Data Management and Analysis Tools • Inform and Interact with the Public

  7. Network Goes Live in 2008! Building the National Network: • Design principles • Re-use existing software and infrastructure • Metadata for everything • Adopt standards that exist • Provide a flexible framework for Network • Iterative Process • Involves partners • Continues beyond 2008

  8. Grantee A Public/Policy Makers 90 90 90 90 GRANTEE GATEWAYAND CLIENT 80 80 80 80 70 70 70 70 60 60 60 60 GRANTEE DATA East 50 50 East East East 50 50 Report PUBLIC PORTAL West West West West 40 40 40 40 North North North North 30 30 30 30 20 20 20 20 1st Qtr 10 10 10 10 ||||. | ||| | ||||| - |||||| | ||| ||| | | | |. ||||. | ||| | ||||| - |||||| | ||| ||| | | | |||||. | |||| ||||| ||| |||||| | ||| ||| | | | 0 0 0 0 2nd Qtr 1st Qtr 2nd Qtr 4th Qtr 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr 1st Qtr 2nd Qtr 4th Qtr 1st Qtr 2nd Qtr 4th Qtr 3rd Qtr 3rd Qtr 3rd Qtr 3rd Qtr 4th Qtr CDC Registered Users SECURE PORTAL TOOLS, METHODS, AND OTHER RESOURCES NATIONAL DATA REPOSITORY Grantee Tracking Portals PHIN Sender PHIN Sender ________________________________________________________________________________________________________________________ ______________________________________________ EPHTN Secured Report Asthma Report » DOH Data » State Specific SAS Code Tools Methods ________________________________________________________________________________________________________________________ ______________________________________________ __________________________________________________________________________________________________________________________________ __________________________________________ _______________________________________________________________ EPHTN Public » NCM » MD » KM » Tools » Links NCM Light AVR NCDMs DATA CLASS; INPUT NAME $ AGE HEIGHT WEIGHT; If age < 13 then group = else group = 'teen'; logwt = log10(weight); /* transform variables */ rootht= sqrt(height); ___________________________________________________________________________________ ____________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________ WA ||||. | ||| | ||||| - |||||| | ||| ||| | | | |. ||||. | ||| | ||||| - |||||| | ||| ||| | | | |||||. | |||| ||||| ||| |||||| | ||| ||| | | | OR NCM NM ________________________________________________________________________________________________________________________ ______________________________________________ .EXE EN Client EN Client Asthma Data by State » NCDMs » Metadata » Links » Tools Grantee B METADATA SERVICES GRANTEE GATEWAYAND CLIENT MetadataRegistry Other CDC Data GRANTEE DATA MD Creation Search EPHTN Profiles MD Registry Find NATIONAL GATEWAY PHIN Receiver DataProcessing MD Records Submit EN R-n-R EPHTN Partner Grantee Tracking Portals PARTNER INTERFACES ________________________________________________________________________________________________________________________ ______________________________________________ Asthma Report » DOH Data » State Specific __________________________________________________________________________________________________________________________________ __________________________________________ _______________________________________________________________ EN Node PARTNER DATA ___________________________________________________________________________

  9. National Public Portal • Place to disseminate information • Provides the public and policy makers with integrated one-stop access to health and environment information • Allows for feedback and input from information users Under Development!

  10. Under Development!

  11. National Secure Portal Supports secure communication and collaboration among multiple partners Integrates health, exposure, hazard, and other data Allows for sharing of methods, tools, and ideas Serves as drawing board for turning data into information

  12. Grantee Portal Comply with Section 508 standards Analysis Visualization & Reporting Support the means to generate visual displays of data, including maps, charts, tables, & graphs Data Content & Discovery Provide the capability to execute queries to obtain data Documentation Provide on-line documentation Metadata Allow for the search & discovery of metadata Secure Access Provide a secure login where users will be authenticated & authorized to use data & services Examples of State Network Requirements and Recommendations

  13. Collaborative Development Process CDC Standards & Network Development Workgroup Program Marketing & Outreach Workgroup Content Workgroup • Air • Water • Cancer • Lead • Birth Defects • CO Poisoning • Vital Statistics – Births • Hospitalizations • – Asthma/CVD • Network Architecture • Security • Geography & Locational • Referencing • Metadata • Health Disparities • Data Stewards • Outreach • Content Messaging Portal Analysis and Visualization Team

  14. Content Workgroup • NCDM recommendations to CDC • Identify, adopt/adapt/develop, pilot indicators/measures • Rationale • Data sources • Limitations • Future directions • How-to-guides • Data to support measures • Presentation • Public health messages

  15. Members Co-chaired by CA Tracking Program and NAPHSIS State and academic tracking grantees ASTHO, other state health depts. CDC Tracking Program Consult or review:CDC DRH; NCHS Surveillance goals Identify populations at risk for adverse reproductive outcomes and infertility Assist health providers in targeting medical care resources (e.g. prenatal care) Examine changes in temporal and spatial patterns of reproductive outcomes which may provide clues on contributing factors and etiology Vital Statistics - Birth Outcome Team

  16. Team Recommendations

  17. Geographic scale for national portal: county, state CDC Tracking Program obtain through NCHS Team Recommendations

  18. Issues Being Addressed • Communicating any difference between Tracking and standard VS measures • E.g. singleton vs. all births • Data used by State Tracking Programs • Options for generating measures for use on state portals • Multi-state analysis

  19. Members Co-chaired by NYC [ME] Tracking Program and CDC/APRHB State Tracking grantees RMPDC, Hartford Hospitals, other state health depts., NAHDO, VMMC CDC Tracking Program Surveillance goals Develop and implement a sustainable approach for national CO surveillance Standardize methodology for routine and disaster-related CO surveillance including the development of a standardized case definition and measures for surveillance Carbon Monoxide Team

  20. CO Team Recommendations – Vital Statistics Data • CDC Tracking Program obtain through NCHS

  21. Members Co-chaired by CDC Tracking Program and CDC/LPPB State/local/academic Tracking grantees State CLPPP CDC Tracking Program Surveillance goals Identify communities where children are at high risk for lead poisoning for the purposes of guiding & evaluating testing within those communities Understand spatial and temporal patterns of risk for lead poisoning at national, state, and local levels Evaluate testing of high risk children Recommendation: Number & % of children tested for lead poisoning prior to 36 mos of age (by birth year cohort) Childhood Lead Poisoning Team

  22. Example of Type of Data Needed for National Tracking Network Secure Portal: aggregate partially De-identified suppression Public Portal: fully de-identified

  23. Users want to perform: Rate readout tasks Pattern recognition tasks Pattern comparison tasks Time series tasks We want to: Enable and inform the user Convey uncertainty & comparability issues Minimize disclosure risk Public Portal: Providing Information, Protecting Privacy

  24. Data Re-release Plan • Guidance: CDC re-release policy; CDC-CSTE workgroup recommendations • Key principles in development: • Utility • Privacy • match or exceed current protection standards • meet data stewards requirements • Science • EPHT plan: • Prevent display of non-zero counts < 6 for geographic units with population < 100,000 and associated crude rates or percentages • Flag as unstable any rates with a RSE >30% • Or, as determined by DSA with national partner

  25. National Public Portal: Products and Procedures to Protect Privacy

  26. National Secure Portal • Federal IT Security Stds. • Registered users • Authentication – CDC Secure Data Network • Authorization – • Application Level – role based • Data access – role and use based • State provided data – approval by state • Federal/federally held data – as determined by DSA

  27. KNOWLEDGE INFORMATION ACTION DATA Tracking and Vital Statistics Partnership • Improved data • Better tools and methods • Available technical expertise/resources • Increased workforce capacity • Communications & outreach

  28. Weber County Hill AFB The Great Salt Lake Example: Methods and ToolsRapid Inquiry Facility (RIF) • Developed by Small Area Health Statistics Unit (SAHSU), Imperial College • Performs risk analysis around hazardous sources and disease mapping • No in-depth knowledge of GIS required • Empirical Bayes smoothing • Additional adjustment • Race/Ethnicity • Socio-Economic Indicators • Others • Can export data for use in WinBUGS and StaTScan Utah Weber & Davis County contaminated groundwater plumes

  29. Summary • Tracking data are essential to successful public health • Provides for better determination of the need for environmental health studies and public health interventions • Important to link people, programs, resources • Significant “up front” work • Requires a multi-tiered approach • Staged implementation

  30. For more information: www.cdc.gov/nceh/tracking Questions?

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