Mapping High-Risk Areas for COVID-19

HealthLandscape has developed a set of online mapping tools (Mapping High Risk Areas for COVID-19) to help states and metropolitan areas identify high risk populations for severe illness from COVID-19. The tools are based on the number of COVID-19 cases by county and factors that may increase the risk of severe illness from COVID-19¹, including the following: 

•          Ages 65 and older,
•          Reside in nursing homes or long-term care facilities,
•          Chronic lung disease or asthma,
•          Heart conditions,
•          Immunocompromised, which include undergoing cancer treatment or smokers,
•          Severe obesity,
•          Diabetes, and 
•          Chronic Kidney Disease.

In addition to other populations at risk such as people with disabilities, people experiencing homelessness, and pregnant women, research shows that racial/ethnic minorities are more adversely affected.² 

Mapping High Risk Areas for COVID-19 features a county-level mapping tool that allows users to layer risk factors such as diabetes and asthma with demographic and race and ethnicity data to identify high risk counties. Users can also explore relationships between risk factors, the number of COVID-19 cases, and social determinants of health. A similar tool maps COVID-19 risk factors at the ZIP Code Tabulation Area (ZCTA) level for metropolitan areas, allowing for smaller area analysis and targeting of high-risk populations.

Mapping High Risk Areas for COVID-19 also allows users to create a COVID-19 Patient Profile by uploading ZIP code level counts of COVID-19 cases, hospitalizations, or deaths. The Profile tool will create a service area map of the user’s COVID-19 population, while linking the ZIP codes to dozens of health and social determinants of health measures. Users can then explore the community characteristics of areas being hardest hit by the COVID-19 pandemic.

In addition to the mapping resources described above, users can map the locations of hospitals, nursing homes, and other health care resources and, if available, can upload other sources of relevant data (such as testing locations). This allows users to explore the relationship between areas hardest hit by COVID-19, areas that are potentially most at risk for severe illness from COVID-19, and the location of resources to combat the virus.

For more information on using Mapping High Risk Areas for COVID-19, please register for one our webinars at https://www.healthlandscape.org/webinar-training.cfm.  

Current webinar schedule (all times Eastern):

• COVID-19: Linking COVID-19 Data to Social Determinants of Health in Your Community using HealthLandscape
• Thursday, 5/14/2020, 2:00 PM
• Tuesday, 5/19/2020, 2:00 PM
• Wednesday, 6/3/2020, 2:00 PM
• COVID-19: Mapping High-Risk Areas in Your Community using HealthLandscape
• Thursday, 5/14/2020, 1:00 PM
• Tuesday, 5/19/2020, 1:00 PM
• Wednesday, 6/3/2020, 1:00 PM

1. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html
2. https://www.commonwealthfund.org/blog/2020/covid-19-more-prevalent-deadlier-us-counties-higher-black-populations

Potential Impact of Family Medicine Practice Closures During COVID-19 Pandemic

Background

In the shadow of the COVID-19 pandemic, family physicians are concerned about their ability to keep practices open despite stay-at-home orders issued by governors, patient concerns about visiting doctors’ offices, limited access to personal protective equipment, and potentially being reassigned to hospital-based care. These and other factors may lead to drastic reductions in practice hours and staff.

Methodology

The "Coronavirus Pandemic-Related Potential Family Medicine Office Closures and Economic Impact, April through June 2020" visualization (https://healthlandscape.org/covid19/) presents a “what-if” family physician attrition scenario. Data sources include the National Plan and Provider Enumeration System (NPPES)[1], the American Medical Association (AMA) Physician Economic Impact Study[2] and the Robert Graham Center Social Deprivation Index (SDI)[3]. Initial family physician counts by U.S. county were derived from the February 2020 NPPES including all Family Medicine typologies. Initial total number of jobs supported by the physicians and the amount of wages and salaries were derived from the AMA Physician Economic Impact Study. We used estimates shown in Table 3 in each of the state reports to calculate the number of jobs per family physician and the wages and salaries attributable to family physicians. State-by-state reports are available online[4]. These multipliers were then applied to counts of family physicians from the NPPES and summed to get estimated Jobs and Wages & Salaries numbers.

The model assumes 3-4% attrition (loss) of individual family physicians each week. In the model, each county loses a minimum of three percent of its family physicians per week. An additional amount of attrition is factored in based on SDI scores which range from 0 to 100, with larger scores indicating more deprivation. SDI is included because populations with higher SDI scores may have higher community risk. No additional attrition above the 3% is included for counties that have an SDI score of 0, while a county with an SDI score of 100 will have the maximum level of 4% attrition. For example, attrition rates for counties with an SDI score of 43 were adjusted to 3.43%.

Results

On March 31, 2020, there were 138,707 family physicians, whose practices supported 1,872,907 jobs, including those of the physicians, for a total of $154,283,373,121 in wage and salaries. At that time, 750 counties had population to family physician ratios greater than 3,500:1. Using constant losses across the time period, there will be 58,025 fewer family physicians working in their practices, resulting in a total job loss of 784,133 and lost wages and salaries of $64,645,325,573. Furthermore 1,841 counties would have population to family physician ratios greater than 3500:1.

About HealthLandscape

HealthLandscape develops, administers, and markets geospatial analysis software tools and professional services. HealthLandscape has extensive experience in GIS applications relating to health centers and primary care and works closely on all projects as a team. Mark Carrozza, MA; Jene Grandmont, MA; Dave Grolling, MS; Jessica McCann, MS; Jennifer Rankin, PhD; Michael Topmiller, PhD.

About the Robert Graham Center

The Robert Graham Center aims to improve individual and population healthcare delivery through the generation or synthesis of evidence that brings a family medicine and primary care perspective to health policy deliberations from the local to international levels. Jack Westfall, MD.

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[1] https://download.cms.gov/nppes/NPI_Files.html. Data accessed February 17, 2020.

[2] https://www.physicianseconomicimpact.org/. Accessed March 16, 2020.

[3] https://www.graham-center.org/rgc/maps-data-tools/sdi/social-deprivation-index.html. 2017 SDI uses data from 2013-2017 American Community Survey.

[4] For an example, see the Ohio report: https://www.physicianseconomicimpact.org/pdf/FullStateReports/OH-Study.pdf.

Global Health and the World Health Mapper

Today, half the world’s population cannot access essential health services. Millions of women give birth without help from a skilled attendant; millions of children miss out on vaccinations against killer diseases, and millions suffer and die because they can’t get treatment for HIV, TB, and malaria. In 2019, this is simply unacceptable.

Statement by WHO Director-General on World Health Day 2019

HealthLandscape has developed the World Health Mapper as part of the American Academy of Family Physicians (AAFP) Center for Global Health Initiatives (CGHI)  The CGHI aims to support AAFP members' professional efforts to be globally engaged, and promote family medicine and population-based, patient-centered, primary health care on a global scale.

The World Health Mapper includes international health measures of Key Health Indicators, Healthcare Spending, Workforce, Child Health, and the distribution of Global Family Medicine.  The Mapper draws data primarily from the World Bank, as well as detailed data on the reach of Global Family Medicine training culled from AAFP data stores.

The World Health Mapper is a powerful tool for visualizing and understanding global health
data, including a variety of country-level health indicators that can be displayed using maps, tables, bar charts, trend graphs, as well as the ability to examine relationships between two indicators with side- by-side comparison maps.



I had a great time introducing the World Health Mapper at the 2019 AAFP Global Health Summit held October 9-12 in Albuquerque, New Mexico.  Our presentation was well attended and participants offered suggestions on additions to the tool, including not only more statistics, but also substantive information about health and social conditions "on the ground" in each country. Students, residents, and others can use these data when considering international training and residency programs. I appreciate their feedback and we're reviewing their suggestions for inclusion in an update to the World Health Mapper.


This was the first Global Health Summit I had attended, and I was really blown away by the excitement and passion attendees and presenters had for their work.  I saw two days of thought provoking presentations, but what stuck out in my mind was a Friday morning session "Practicing Global Health in Your Own Backyard", presented by Leopoldine Matialeu and Regina Wang from the University of California, San Diego.  They demonstrated how, with a range of immigrants, asylum seekers, or refugees already living in the US, it is possible to design and implement a residency curriculum that addresses patients from different backgrounds and cultures, without the need to traveling to other countries.  This was very exciting and we're brainstorming at HealthLandscape about how we can use HealthLandscape tools to support similar efforts around the U.S.






I admit, it was also very cool that (serendipitously?) the Global Health Summit overlapped somewhat with an international balloon festival being held in Albuquerque that same week.  I didn't get a chance to go over to the festival, but the wind was kind enough to send some of the balloons over our way early one morning.  Beautiful!

Mark Carrozza
Director
HealthLandscape

Impressions from URISA GIS-Pro 2019

Another year, another exciting time at Urban and Regional Information System Association’s (URISA) annual GIS-Pro conference. This time I traded the dry, desert landscape of Palm Springs (last year’s conference) for the overbearing humidity and heat of New Orleans. Not only was I looking forward to exploring a new city, but I attended this year’s GIS-Pro wearing two hats, one as a presenter, and one as chapter leader of one of URISA’s regional chapters. I was there to learn, connect, eat, have fun, and explore. One of the great things about working with HealthLandscape is that I have the opportunity to attend conferences like GIS-Pro, gain professional development, and present on the work that we do. 

Traditionally, the conference is preceded by a full-day array of workshops. This year, I attended one on GIS in program management, where I gained insight into strategic and implementation planning, financial management, and other challenges that program managers face in the geospatial world. At the plenary the next day, I learned about the Earth as Art program, where the University of Louisiana Lafayette is seeking to turn satellite imagery of the earth into high resolution art galleries. The keynote came from the NOAA Office for Coastal Management. They presented on their efforts to map the coast of the United States so that high resolution data can be readily available at the local level Working in a diverse industry like GIS, it’s easy to fall behind in topics that aren’t covered by my role at HealthLandscape. I see opportunities like conference plenaries to stay abreast of what’s being done at other organizations.

In one of the education sessions, the presenters explored various methods for employing GIS in the cloud. They spoke about best practices for creating data for cloud environments and how data and server management are changing. They demonstrated, through the use of Python programming, that cause and effect actions, called triggers, can be applied to databases so that processes can be automated. This was insightful to hear as the next day I would give a talk on improving workflows using programming in GIS. Over the past year, HealthLandscape has sought out ways to make certain tasks more efficient with the use of Python programming. From projects where the output is multiple maps showing the distribution of various health care specialties for each state to automating multi-step geocoding and processing tasks, HealthLandscape has been employing programming to optimize how we manage data and produce static map deliverables.

Over the last year I have been working to restart a once-dormant URISA local chapter. I attended GIS-Pro to represent the Chesapeake chapter to continue that effort. At each GIS-Pro, there is an annual chapter leader’s forum meeting with the URISA board of directors and other chapter representatives. This is an opportunity to bring up concerns, ask questions, and to hear from the board of directors about the changes that affect how chapters are administered. As a leader, I also took this meeting as an opportunity to learn how other chapters are being run and the struggles that they’re facing as they relate to membership retention, budgeting, governance, and education. On the last day of the conference I volunteered for the GIS-Pro 2020 conference planning committee. Since next year’s GIS-Pro will take place in Baltimore, Maryland, it will be an opportunity to connect with local GIS professionals and to show off the reinvigorated Chesapeake Chapter.

Laissez les bons temps rouler!

Dave Grolling

GIS Strategist

HealthLandscape

National Primary Care Week (NPCW) 2019 will be held October 7 – 11

This week marks the 20th year for National Primary Care Week, a week led by medical students with an interest in specializing in primary care. The week focuses on ensuring we have new health care providers interested in practicing primary care and addressing issues that many primary care providers encounter, including addressing health disparities.

HealthLandscape builds tools that may be helpful as you embark on National Primary Care Week, providing data to better understand healthcare workforce shortages and maldistribution as well as socioeconomic, demographic, and population health data. As you celebrate National Primary Care Week, visit these tools:

October 7: Building the Primary Care Workforce
Use the HealthLandscape Workforce Explorer (https://www.healthlandscape.org/workforceexplorer/) to look at data related to where providers of primary care practice across the U.S.and compare it to the population. What areas have high population to provider ratios? Is one primary care specialty carrying more of the primary care burden than others?

October 9: Your Primary Care: Getting into Residency
Use the HealthLandscape Residency Footprinter (https://www.healthlandscape.org/residency-footprint/) to look at the areas that are served by graduates of Family Medicine residency programs. Explore what areas would be underserved areas if we withdrew the graduates from a residency program to see the social impact Family Medicine has across the country.

October 10: Health Disparities Day of Action 

Almost all of the tools in the HealthLandscape stable have information on social determinants of health. Visit https://www.healthlandscape.org for a list of tools or visit these in particular:

• The Population Health Mapper (https://www.healthlandscape.org/populationhealth/) has county level data on social determinants of health that users can add to see what areas are cold spots for health- those areas where many SDOH factors stack up are the ones that are likely to have high health care needs.
  
• Similarly, the 500 Cities Mapper (https://www.healthlandscape.org/500cities/) does the same thing but at a census tract level for the 500 largest cities in the United States.

If you have questions or comments, we’d love to hear from you. We’d also like to know how you found HealthLandscape tools useful (or not) as you use them to inform your National Primary Care Week work and beyond.




Jennifer Rankin, PhD
Senior Manager, Research and Product Services, HealthLandscape

HealthLandscape at NACHC CHI (and a busy fall!)

The HealthLandscape team was busy last month in Chicago! We attended the National Association of Community Health Centers (NACHC) Community Health Institute (CHI) alongside health center staff, executives and board members, state and regional Primary Care Associations (PCAs), and Health Center Controlled Networks (HCCNs). It’s the largest gathering of this audience each year and a great opportunity to interact with some of the 1,400 health center organizations that serve the United States. HealthLandscape was exhibiting, presenting, and training attendees on how to use the UDS Mapper.

What is the UDS Mapper? Health centers have, since the 1960s, served the underserved regardless of one’s ability to pay. Health centers funded under the Health Resources and Services Administration (HRSA) Bureau of Primary Health Care (BPHC) Health Center Program are required to report patient, clinical, and operational data each year into the Uniform Data System, or UDS. The UDS Mapper allows health centers and stakeholders to map these data and compare with available resources and population data. Health centers use the UDS Mapper to create service area maps for various grant opportunities, do strategic planning, perform needs assessments, and much more. At CHI, HealthLandscape was offering UDS Mapper demonstrations in the exhibit hall and one-on-one UDS Mapper trainings. We presented The UDS Mapper Identifies Health Center Opportunities to Support the Health Care Safety Net: The Case of Rural Hospital Closures and displayed a poster entitled Exploring Health Center Penetration in Medicare Spending Priority Areas.

Screenshot of UDS Mapper

We love to get out and talk about ways to use health and population data (especially geospatial data) to better understand and serve our communities. It’s a great opportunity to meet the people who use our tools and get feedback on how to make the tools better. To that end, we at HealthLandscape have already started our busy fall - watch for more information on our upcoming appearances:

• Family Medicine Experience (FMX), September 23-27, Philadelphia, PA
• Maryland Association of Community Health Centers (MACHC) Annual Conference, September 30 - October 1, Cambridge, MD
• URISA GIS-PRO, September 28 - October 2, New Orleans, LA
• Esri Health and Human Services Seminars, October 1 and 3, New York, NY and Raleigh, NC
• Nurse-Led Care Conference 2019, October 1-3, Nashville, TN
• AAFP Global Health Summit, October 7-12, Albuquerque, NM
• National Association of Community Health Centers (NACHC) Financial, Operations Management / IT (FOM/IT) Conference, October 24-25, Chicago, IL
• American Public Health Association (APHA), November 2-6, Philadelphia, PA
• North American Primary Care Research Group (NAPCRG), November 16-20, Toronto, ON
• Florida Association of Community Health Centers UDS Training, November 21-22, Orlando, FL

We’ll be presenting at these conferences on a variety of HealthLandscape tools, our research, and more. We hope to see you this fall!





Jessica McCann
User Engagement Specialist, HealthLandscape

HealthLandscape Joins Esri Partner Network

HealthLandscape has joined the Esri Partner Network as a Silver Tier Partner.  As Silver Partners, HealthLandscape joins a global community of geographic information system (GIS) specialists offering expertise, solutions, and services in ArcGIS and related products.

As a Silver Tier Partner, HealthLandscape receives exclusive communication and collaboration services, in addition to Esri software use and knowledge to better meet our customers’ needs. This benefits HealthLandscape clients in a number of key ways, including:

• Access to the full suite of Esri products for testing and developing new tools and functionality;

• Access to “early” knowledge of technology and product changes; and

• Access to industry leading experts and thought leaders within Esri and partners worldwide.

We are excited to join the Esri Partner Network and use its many benefits to support our customers. This partnership will also allow us to strengthen our offerings and Esri programs like the ArcGIS Living Atlas and ArcGIS Marketplace will allow us to highlight our capabilities and expand into additional markets.

Esri is a developer and marketer of proprietary GIS software, data, and online and professional services. The Esri Partner Network is a global network of partners that share a common vision, interests and goals with Esri; apply geospatial industry best practices; and employ innovative business strategies to deliver market-leading geospatial solutions and services based on Esri technology. Lean more about the Esri Partner Network at https://www.esri.com/en-us/about/esri-partner-network/overview

Mark Carrozza

Director, HealthLandscape