Building Your Data ToolBox: Current Data Tools and How to Use Them
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The document discusses several data tools that can be used to analyze patient and community health data including the UDS Service Area Mapper, PRIME Registry, PHAsT, and UDSMapper.org. It describes how these tools can be used to map physician service areas, identify disease and outcome clusters, incorporate social determinant data, and facilitate partnerships between healthcare organizations and public health to improve population and community health. The final page recommends coordination across sectors to align measurement efforts and maximize the impact of data on policy development.
Building Your Data ToolBox: Current Data Tools and How to Use Them
- 1. Bob Phillips, MD MSPH ABFM Vice President for Research & Policy Building Your Data ToolBox: Current Data Tools and How to Use Them 2017 Practical Playbook National Meeting
- 3. The UDS Service Area Mapper in HealthLandscape
- 4. Proposed areas to target for new Centers (see attached data on population in these areas) Washington, DC Existing Health Centres and their Service Areas (yellow) Local use of UDSMapper to support a Governor’s special MUP designation
- 5. PRIME Registry PQRS Meaningful Use MOC Researchers Measure DevelopmentSocial Determinants & Community Engagement
- 7. What is PHAsT? Uses EHR and Community data to: –Map physician or clinic service area –Show clusters of disease –Show clusters of poor outcomes –Pull in social determinant data = poverty, less than high school ed., single parent household, unemployment –“Community Vital Sign”
- 9. 3 PHAsT Versions, one skin Fully imbedded in PRIME, draws on patient data: Address Diagnoses Quality measures Drop-in Data: Address No Data: choose census tracts Same Skin: All 3 look the same except the No Data and Drop-in Data users will see that they could do more with PRIME Social Determinant and Community Resource data
- 10. What can we do with it? Help think in terms of population and community Pull other data into understanding patients’ risks and resources Find partners in their shared geographies of care Become community leaders Partner with public health
- 11. The National Committee on Vital and Health Statistics Data are the critical foundation for policy development at the Federal, state, and local levels. The Measurement Framework provides a way to align otherwise ‐ independent measurement efforts for greater impact. Coordination within HHS, across Departments, and between public and private sectors is essential to achieve this potential. https://www.ncvhs.hhs.gov/wp- content/uploads/2017/04/Measuring-Health-at-the-Community- Level-Data-Gaps-and-Opportunities.pdf
Editor's Notes
- #6: Once physicians join the registry, the ABFM is looking at ways to even further add value for them—by incorporating social determinant data to get a broader view of the community in which they practice. We want to reduce the burden on you to collect the data, and then also make them more useful
- #8: The ABFM is proposing to work with the Robert Graham Center and HealthLandscape, its sister center in the AAFP, to develop the Population Health Assessment Tool (PHAsT). WE want to do for you what the UDSMapper did for health centers
- #9: Family physicians enrolled in the registry would have the option of using PHAsT to define their clinical service area, understand which neighborhoods are most dependent on them, look at disease and quality clusters (‘hotspots’), and to draw on social determinant data to develop community vital signs for patients, and to look at risk of poor health across their community.
- #10: The Robert Graham Center built related tools for Community Health Centers all over the country. The UDSMapper pulls on neighborhood data (Census and other sources) to help CHCs understand who they are serving and how social determinants stack up in those same neighborhoods
- #12: Value-based payments mean greater accountability for population health, and most family physicians lack tools or the ability to use their data to inform this role. Many family physicians are also frustrated by patients who cannot or won’t take their medication or change health behaviors, often because they don’t understand what is going on in their patients’ lives, or because they don’t know who to partner with in the community to help their patients. PHAsT aims to help family physicians do population health better, and to improve understanding of community supports. For example, PHAsT may help you recognize that most of your patients with diabetes and hemoglobin A1c above 9.0 live in neighborhoods that are unsafe for exercise and lack healthy food sources. With similar information, family physicians have partnered with a local YMCA, malls and armories to develop indoor walking club, diabetes peer-support group, or farmers market—or all 3. We know from experience that family physicians in community health centers have used these tools in clever ways, and now want all family physicians to have the same opportunity, especially when payments may soon be based on population health outcomes.