scholarly journals Using Electronic Health Records for Public Health Hypertension Surveillance

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Timothy D. McFarlane ◽  
Brian E. Dixon ◽  
P. Joseph Gibson
Keyword(s):  
Public Health ◽  
Population Health ◽  
Structured Data ◽  
Health Programs ◽  
Community Based ◽  
Marion County ◽  
Prevalence Estimates ◽  
Electronic Health ◽  
Data Elements ◽  
And Control

ObjectiveTo assess the equivalence of hypertension prevalence estimates between longitudinal electronic health record (EHR) data from a community-based health information exchange (HIE) and the Behavioral Risk Factor Surveillance System (BRFSS).IntroductionHypertension (HTN) is a highly prevalent chronic condition and strongly associated with morbidity and mortality. HTN is amenable to prevention and control through public and population health programs and policies. Therefore, public and population health programs require accurate, stable estimates of disease prevalence, and estimating HTN prevalence at the community-level is acutely important for timely detection, intervention, and effective evaluation. Current surveillance methods for HTN rely upon community-based surveys, such as the BRFSS. While BRFSS is the standard at the state- and national-level, they are expensive to collect, released once per year, and their confidence intervals are too wide for precise estimates at the local level. More timely, frequently updated, and locally precise prevalence estimates could greatly improve the timeliness and precision of public health interventions. The current study evaluated EHR data from a large, mature HIE as an alternative to community-based surveys for timely, accurate, and precise HTN prevalence estimation.MethodsTwo years (2014-2015) of EHR data were obtained from the Indiana Network for Patient Care for two major health systems in Marion County, Indiana, representing approximately 75% of the total county population (n=530,244). These data were linked and evaluated for prevalent HTN. Six HTN phenotypes were defined using structured data variables including clinical diagnoses (ICD9/10 codes), blood pressure (BP) measurements (HTN = ≥140mmhg systolic or ≥90mmHg diastolic), and dispensed HTN medications (Table 1). Phenotypes were validated using a random sample of 600 records, comparing EHR phenotype HTN to HTN as determined through manual chart review by a Registered Nurse. Each phenotype was further evaluated against BRFSS estimates for Marion County, and stratified by sex, race, and age to compare EHR-generated HTN prevalence measures to those known and in current use for chronic disease surveillance. Comparisons were made using the two one-sided statistical test (TOST) of equivalence, wherein the null hypothesis is the BRFSS and EHR prevalence estimates are different by +/-5% and the alternative is estimates differ by less than +/-5%. Rejection of the null resulted in the conclusion of equivalence of the estimates for use in population/public health.ResultsIn general, the performance of the EHR phenotypes was characterized by high specificity (>87%) and low to moderate sensitivity (range 25.4%-95.3%). The false positive rate was lowest among the phenotype defining HTN by both clinical diagnosis and BP measurements (0.3%), and sensitivity was greatest for the phenotype combining all three structured data elements (95.2%). The prevalence of HTN in Marion County, Indiana (2014-2015) for the EHR sample (n=530,244) ranged between 13.7% and 36.2%, compared to 28.4% in the BRFSS sample (Table 1). Only one EHR phenotype (≥1 HTN BP measurement) demonstrated equivalence with BRFSS prevalence at the county level (difference 0.9%, 90% CI for difference -2.3%-4.0%). HTN prevalence by sex, race, age, sex and age, and sex and race (n=120 comparisons) failed to demonstrate equivalence between EHR and BRFSS measures in all but two comparisons, both among females aged 18-39 years. Differences between EHR and BRFSS HTN prevalence at the subgroup level varied but were particularly pronounced among older adults. As suspected, HTN prevalence precision was improved in the EHR sample with the largest subgroup 95% CI width of 0.7% for male African Americans compared to the BRFSS sample 95% CI width of 29.6%.ConclusionsThe applicability of the tested HTN phenotypes will vary based upon which EHR structured data elements are available to public health (i.e., ICD10, vitals, medications). We found that HTN surveillance using a community-based HIE was not a valid replacement for the BRFSS, although the HIE-based estimates could be readily generated and had much narrower confidence intervals.ReferencesMozaffarian D, et al. Heart Disease and Stroke Statistics — 2016 Update. Circulation. 2016; 133: e38-e360.Yoon S, Fryar C, Carroll M. HTN Prevalence and Control Among Adults: United States, 2011–2014. NCHS Data Brief No. 220. 2015; Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention, US Dept of Health and Human Services. 

Risk Attitudes and Behavior Among Norwegian Adolescents

2005 ◽  
Vol 10 (1) ◽  
pp. 25-38 ◽  
Author(s):  
Hilde Iversen ◽  
Torbjørn Rundmo ◽  
Hroar Klempe
Keyword(s):  
Public Health ◽  
Traffic Safety ◽  
Behavior Modification ◽  
Health Programs ◽  
Risk Attitudes ◽  
Community Based ◽  
Public Health Programs ◽  
The Core ◽  
And Behavior ◽  
Attitudes And Behavior

Abstract. The core aim of the present study is to compare the effects of a safety campaign and a behavior modification program on traffic safety. As is the case in community-based health promotion, the present study's approach of the attitude campaign was based on active participation of the group of recipients. One of the reasons why many attitude campaigns conducted previously have failed may be that they have been society-based public health programs. Both the interventions were carried out simultaneously among students aged 18-19 years in two Norwegian high schools (n = 342). At the first high school the intervention was behavior modification, at the second school a community-based attitude campaign was carried out. Baseline and posttest data on attitudes toward traffic safety and self-reported risk behavior were collected. The results showed that there was a significant total effect of the interventions although the effect depended on the type of intervention. There were significant differences in attitude and behavior only in the sample where the attitude campaign was carried out and no significant changes were found in the group of recipients of behavior modification.

Teaching Graduate Students to Evaluate Public Health Programs Through Community-Based Learning

2019 ◽  
Vol 6 (2) ◽  
pp. 119-127
Author(s):  
Brenda M. Joly
Keyword(s):  
Public Health ◽  
Program Evaluation ◽  
Core Competency ◽  
Learning Opportunities ◽  
Lessons Learned ◽  
Health Programs ◽  
Community Based ◽  
Public Health Programs ◽  
Public Health Professionals ◽  
Community Based Learning

Public health professionals are increasingly called on to demonstrate program evaluation skills, a core competency for the field. Learning opportunities that are connected to community organizations with identified evaluation needs give students meaningful opportunities to build and test new skills. When thoughtfully implemented, community-based learning benefits both the student and the community, yet there are several important considerations for designing a course that incorporates this feature. This article describes one approach for teaching graduate public health students how to conceptualize and write a comprehensive program evaluation plan for a community agency, based on the needs, priorities, and capacity of that agency. Lessons learned and recommendations for adopting this model are discussed.

scholarly journals Opportunities at the intersection of work and health: Developing the occupational data for health information model

2020 ◽  
Vol 27 (7) ◽  
pp. 1072-1083
Author(s):  
Stacey Marovich ◽  
Genevieve Barkocy Luensman ◽  
Barbara Wallace ◽  
Eileen Storey
Keyword(s):  
Public Health ◽  
Patient Care ◽  
Health Information ◽  
Population Health ◽  
Information Model ◽  
Classification Systems ◽  
Health It ◽  
It Systems ◽  
Value Sets ◽  
Data Elements

Abstract Objective The study sought to develop an information model of data describing a person’s work for use by health information technology (IT) systems to support clinical care, population health, and public health. Materials and Methods Researchers from the National Institute for Occupational Safety and Health worked with stakeholders to define relationships and structure, vocabulary, and interoperability standards that would be useful and collectable in health IT systems. Results The Occupational Data for Health (ODH) information model illustrates relationships and attributes for a person’s employment status, retirement dates, past and present jobs, usual work, and combat zone periods. Key data about the work of a household member that could be relevant to the health of a minor were also modeled. Existing occupation and industry classification systems were extended to create more detailed value sets that enable self-reporting and support patient care. An ODH code system, available in the Public Health Information Network Vocabulary Access and Distribution System, was established to identify the remaining value sets. ODH templates were prepared in all 3 Health Level 7 Internationalinteroperability standard formats. Discussion The ODH information model suggests data elements ready for use by health IT systems in the United States. As new data elements and values are better defined and refined by stakeholders and feedback is obtained through experience using ODH in clinical settings, the model will be updated. Conclusion The ODH information model suggests standardized work information for trial use in health IT systems to support patient care, population health, and public health.

scholarly journals The Public Health Reach of High Fluoride Vehicles: Examples of Innovative Approaches

2016 ◽  
Vol 50 (Suppl. 1) ◽  
pp. 61-67 ◽  
Author(s):  
Marisol Tellez ◽  
Mark S. Wolff
Keyword(s):  
Public Health ◽  
Health Care Providers ◽  
Preventive Services ◽  
Health Programs ◽  
Main Concern ◽  
Care Providers ◽  
Medical Providers ◽  
Community Based ◽  
Public Health Programs ◽  
High Fluoride

Fluorides and sealants have been shown to reduce caries in populations, making fluoride interventions a large part of the dental public health effort. Although public health programs have traditionally focused on fluoride vehicles delivering less than 1,000 ppm of fluoride, more recent efforts have shifted toward the use of high fluoride vehicles such as varnishes and prescription toothpastes. In the USA, states are developing innovative strategies to increase access to dental services by using primary care medical providers to deliver early preventive services as part of well-child care visits. Currently, Medicaid programs in 43 states reimburse medical providers for preventive services including varnish application. Still, there is uncertainty about the cost-effectiveness of such interventions. In many resource-strained environments, with shortages of dental health care providers, lack of fluoridated water and lower dental awareness, it is necessary to develop sustainable programs utilizing already established programs, like primary school education, where caries prevention may be set as a priority. Dental caries among the elderly is an ongoing complex problem. The 5,000-ppm F toothpaste may be a reasonable approach for developing public health programs where root caries control is the main concern. Fluoride varnish and high concentration fluoride toothpaste are attractive because they can easily be incorporated into well-child visits and community-based geriatric programs. Additional research on the effectiveness and costs associated with population-based programs of this nature for high risk groups is needed, especially in areas where a community-based fluoride delivery program is not available.

scholarly journals Development of an electronic health records datamart to support clinical and population health research

2020 ◽  
pp. 1-6
Author(s):  
Jillian H. Hurst ◽  
Yaxing Liu ◽  
Pamela J. Maxson ◽  
Sallie R. Permar ◽  
L. Ebony Boulware ◽  
...  
Keyword(s):  
Clinical Research ◽  
Population Health ◽  
Contextual Information ◽  
Data Resource ◽  
Level Data ◽  
Duke University ◽  
Electronic Health ◽  
Data Tables ◽  
Data Elements ◽  
Future Work

Abstract Introduction: Electronic health record (EHR) data have emerged as an important resource for population health and clinical research. There have been significant efforts to leverage EHR data for research; however, given data security concerns and the complexity of the data, EHR data are frequently difficult to access and use for clinical studies. We describe the development of a Clinical Research Datamart (CRDM) that was developed to provide well-curated and easily accessible EHR data to Duke University investigators. Methods: The CRDM was designed to (1) contain most of the patient-level data elements needed for research studies; (2) be directly accessible by individuals conducting statistical analyses (including Biostatistics, Epidemiology, and Research Design (BERD) core members); (3) be queried via a code-based system to promote reproducibility and consistency across studies; and (4) utilize a secure protected analytic workspace in which sensitive EHR data can be stored and analyzed. The CRDM utilizes data transformed for the PCORnet data network, and was augmented with additional data tables containing site-specific data elements to provide additional contextual information. Results: We provide descriptions of ideal use cases and discuss dissemination and evaluation methods, including future work to expand the user base and track the use and impact of this data resource. Conclusions: The CRDM utilizes resources developed as part of the Clinical and Translational Science Awards (CTSAs) program and could be replicated by other institutions with CTSAs.

scholarly journals Development of a community-based hearing loss prevention and control service model in Guangdong, China

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Chang Liu ◽  
Anshi Wang ◽  
Yanlin Huang ◽  
Yan Zhang ◽  
Hongke Ding ◽  
...  
Keyword(s):  
Public Health ◽  
Hearing Loss ◽  
Prevention And Control ◽  
Health Knowledge ◽  
Sensorineural Deafness ◽  
Public Health Issue ◽  
Service Model ◽  
Loss Prevention ◽  
Community Based ◽  
And Control

Abstract Background Hearing loss is a prevalent sensorineural disorder and a major public health issue in China. It is suggested that half of all cases of hearing loss can be prevented through public health measures. However, national strategies for hearing healthcare are not implemented well in Guangdong and some other regions in China. Methods To develop a community-based service model for the prevention and control of hearing loss in Guangdong, we integrated the model with multiple maternal and child healthcare models, and set up a series of clinical programs along with an optimum timeline for the preventive measures and intervention treatments to take place. A total of 36,090 families were enrolled in the study, including 358 high-risk families and 35,732 general-risk families. Results The study lasted for 6.5 years, and 30,769 children were born during that period. A total of 42 children were born with congenital deafness; 17 of them were born into families with advanced genetic risks for hearing loss, 9 were born with specific medical conditions, and 16 were born into general-risk families. About one third of them were diagnosed prenatally, others were diagnosed within 3 months of age, and 72% of them received interventions initiated before 6 months of age. 13 children presented with delayed hearing loss; 9 of them were diagnosed with delayed hereditary sensorineural deafness in neonatal period, and 4 were diagnosed within 3 months after onset. Timely interventions were provided to them, with appropriate referrals and follow-ups. Beside these, 80 families were identified with genetic susceptibility to aminoglycoside ototoxicity. Detailed medication guides were provided to prevent aminoglycoside-induced hearing loss. Moreover, through health education and risk reduction strategies, the prevalence of TORCH syndrome decreased from 10.7 to 5.2 per 10,000. Additionaly, the awareness rates of health knowledge about hearing healthcare significantly increased in the cohort. Conclusions Adapting national strategies for local or district projects could be an important step in implementing hearing loss prevention measures, and developing community-based service models could be of importance in carrying them out.

scholarly journals Assessment of the infection prevention and control learning needs of Ottawa community-based healthcare providers

2019 ◽  
pp. 135-140
Author(s):  
Geneviève Cadieux ◽  
Abha Bhatnagar ◽  
Tamara Schindeler ◽  
Chatura Prematunge ◽  
Donna Perron ◽  
...  
Keyword(s):  
Public Health ◽  
Professional Development ◽  
Best Practices ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Healthcare Providers ◽  
Infection Prevention And Control ◽  
Learning Needs ◽  
Community Based ◽  
And Control

Background: Under the Health Protection and Promotion Act and Infection Prevention and Control (IPAC) Complaint Protocol, Ontario public health units are mandated to respond to IPAC complaints about community-based clinical offices. From 2015 to 2018, Ottawa Public Health noted a seven-fold increase in IPAC complaints involving medical and dental settings. In response, we sought to assess the IPAC learning needs of our community-based healthcare providers. Specifically, our objectives were to assess: 1) clinical practice characteristics, 2) current IPAC practices, 3) IPAC knowledge, 4) barriers/facilitators to adherence to IPAC best practices, and 5) preferred IPAC professional development activities. Methods: An anonymous online survey targeting Ottawa community-based healthcare providers was disseminated through multiple methods including through Ottawa Public Health’s (OPH) subscription-based e-bulletin to physicians. The short survey questionnaire included Likert-scale, multiple choice, and open-ended questions. Data collection began in August 2018; a descriptive analysis was conducted using data extracted on January 19, 2019. Results: Our findings suggest that medical respondents may not be as aware of IPAC practices in their clinic as dental respondents were. Familiarity with IPAC best practice documents was also higher among dental respondents, as compared to medical respondents. IPAC knowledge-testing questions revealed that more medical than dental respondents knew the appropriate use of multi-dose vials, and that few medical respondents knew the IPAC best practices for point-of-care glucose monitoring equipment. Respondents recognized the importance of adhering to IPAC best practices to prevent healthcare-associated infections; however, lack of evidence and cost were selfreported barriers to adherence to IPAC best practices. Over half of all medical and dental respondents surveyed were interested in a voluntary audit of their IPAC practices to help meet their IPAC professional development needs. Conclusions: Findings from this needs assessment helped describe current IPAC practices and knowledge, identify barriers and facilitators to adherence to IPAC best practices, and understand the learning preferences of Ottawa community-based healthcare providers. This information will be instrumental in planning future IPAC capacity-building activities and tailoring these activities to specific professional groups in Ottawa and potentially beyond.

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