Application of Area-level Data to Hospital-based Population Health Management
Abstract
Introduction: For chronic conditions such as asthma, it is increasingly evident that hospitals must develop service delivery systems that address patient needs in the context of their communities. Few studies examine how... [ view full abstract ]
Introduction: For chronic conditions such as asthma, it is increasingly evident that hospitals must develop service delivery systems that address patient needs in the context of their communities. Few studies examine how area-level data on social determinants of health can inform clinical practice, in order to improve population health. This study used local patient-level electronic health record (EHR) data to examine geographic variations in preventable adult asthma hospitalizations in relation to area-level social determinant indicators.
Methods: We conducted a retrospective cohort analysis from 2012 – 2014 on 2,328 asthmatic primary care patients (aged 18 to 64 years old) at an urban community teaching hospital. Those diagnosed with chronic obstructive pulmonary disease or sickle cell disease were excluded.
We created choropleth maps depicting contextual factors and hospitalizations by census tract (CT) including the concentration of poverty, residents in public housing, and minority population. We constructed an air quality buffer map outlining truck routes. For CT characteristics we used data from the American Community Survey, the US Department of Housing and Development and New York City Department of Transportation. Asthma hospitalization, defined by discharge diagnosis, was acquired from patients’ EHRs. Patient addresses were geocoded as point data and aggregated to the CT level. We conducted a hot spot analysis to assess whether hospitalizations clustered in CTs with poorer social determinant indicators.
Results: We found one hot spot corresponding to areas that are predominantly minority, have elevated levels of public housing, and cluster along truck route buffers. We saw no clear relationship between CT poverty and hospitalizations.
Discussion: Geographic variation in asthma admissions illuminates the multifaceted needs of the hospital’s local population. Understanding the association between the social environment and clinical care is essential to developing data-driven interventions that address the needs of the hospital’s target population.
Authors
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Heather A. Mavronicolas
(Department of Medicine, The Brooklyn Hospital Center)
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Nikita J. Chemparathy
(Department of Medicine, The Brooklyn Hospital Center)
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David A. Kapp
(Department of Medicine, The Brooklyn Hospital Center)
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Karina Christiansen
(Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health)
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Aracelis Z. Torres
(Department of Epidemiology, Cancer Epidemiology, Johns Hopkins Bloomberg School of Public Health)
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Jean G. Ford
(Department of Albert Medicine, Einstein Medical Center)
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Meng Ru
(Department of Medicine, The Brooklyn Hospital Center & Columbia University Mailman School of Public Health)
Topic Areas
II. Urban Health at the intersection of urban environment, social determinants and places , V. Health indicators, spatial analysis and mapping: new tools, new methods 5.1 Spatial ana
Session
SPH-UH-01E » Spatializing Urban Health (10:00 - Friday, 1st April, TBA)
Paper
ApplicationLocalDataAsthma_abstract_ISUH_version_Final_01.16.16MSdoc.doc
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