How Place Matters to Health

How does Place Matter to the health of the public and the health of an individual?

I have a catch-phrase answer I use that says simply “Because Everything Happens Somewhere.”  This deceptively simplistic response actually hides a fair amount of complexity.  Where a person lives, where they spend many hours working during a year, and how they travel to and from their home and work all greatly impact their health and well-being.  Let’s look at a few examples.

Environmental Hazards

 Air quality can impact individual and population health.  Fine particles from automobiles, power plants, wood burning, industrial processes, and diesel powered vehicles such as buses and trucks may adversely impact air quality.  Research suggests deleterious effects including asthma, bronchitis, acute and chronic respiratory symptoms such as shortness of breath and painful breathing, and premature deaths (EPA).

HealthLandscape Community HealthView Data for Particulate Matter

Another example is a remnant of the Cold War and a byproduct of the Nuclear Arms race.  The U.S. has hundreds of factories and research facilities with potentially hazardous nuclear waste, the true health impact of which will not be known for many years.  You can learn more about these "Waste Lands" in this project of the Wall Street Journal.

Access to Healthcare Providers

Not everyone has equal access to health care providers, including primary care physicians, specialists, hospitals, specialty services, and pharmacies.  The HealthLandscape Healthcare Workforce Mapper can be used to learn where there are shortages of physician and non-physician providers.

Family Medicine Population to Provider Ratio, by County

Thinking Beyond the Individual

Place and the environmental can also have indirect, long-term effects on the health of people through the cascading impact on the food chain.  You may remember recent stories from the town of  Ribeauville in France, where beekeepers found their hives were producing blue and green and various colored honey.  It was discovered that the bees had begun feeding on waste from a local candy factory that was producing treats dyed in colors of bright red, blue, green, and yellow.  These dyes had been collected by the bees and deposited in the honey.  This colorful episode was not considered an immediate health concern -- though the honey was an economic loss because of the unnatural coloring.  However, it provides stark evidence of the impact environmental conditions miles away may have on the food chain and subsequently the health of people who consume that food.

Learning to Think Spatially

OK, so, how do I orient my thinking to recognize the possibilities of space and place on health?  Learning to think spatially is an ongoing process, but there are a few concepts that will help you start down the path to lifetime learning.

As a start, you should always consider What (Location), Where (Patterns among multiple Locations), and When (Temporal Relations -- how those Location(s) and Patterns changes over time).

• What is the population you are studying?  Are you interested in individual congestive heart failure patients, failing students, older homes likely to have used lead-based paints?
• Where are they in relation to one another and related locations?  How close are patients to clinics or hospitals, what is the travel (time or distance) to the nearest primary care provider, is there suitable public transportation in areas where households are less likely to have cars or areas of high traffic congestion?
• How have these conditions changed over time?  What is the impact of the opening (or closing) of a primary care office, the loss of adequate bus transportation, the loss of specialized equipment or treatment services in a section of the city?

Learning to THINK spatially is an ongoing process, and we haven’t even talked about how to use Geographic Information Systems, or GIS, to help wrangle some of these concepts and ideas into manageable analysis and meaningful visualizations.  Take an opportunity to visit us at HealthLandscape (and sign up for one of our webinars) to see how GIS can help you understand how Place Matters to the health of your community.

Mark Carrozza
Director
HealthLandscape

Hospital Value-Based Purchasing (VBP) Explorer

The Affordable Care Act has recently funded several innovative programs aimed at improving Medicare quality while reducing costs.  A key part of these efforts is to link Medicare payment to the quality of care rather than the quantity, with the goal of moving away from fee-for-service payment models.

One such innovative program funded by the Affordable Care Act is the Hospital Value-Based Purchasing (VBP) program. The Hospital VBP program adjusts hospital payments for Medicare based on performance across four domains of quality: clinical processes of care, patient experience of care, outcomes (includes mortality rates and patient safety indicators), and efficiency (Medicare spending per beneficiary).  While evaluation of initial data indicates that the program has been successful, with the majority of hospitals showing improved care and outcomes for Medicare beneficiaries (see http://blog.cms.gov/2014/12/18/cms-releases-data-on-quality-to-help-patients-choose-providers/), it is unclear how hospital performance varies across states or regions.

Map view showing rollover windows displaying scores for clinical processes of care, patient experience of care, outcomes, efficiency, spending, and total performance

HealthLandscape created the Hospital Value-Based Performance (VBP) Explorer as an interactive mapping tool that allows users to visualize the geographic variation of the four quality domain scores, spending scores, and total performance score for hospitals in California, Florida, Illinois, Michigan, North Carolina, New Jersey, and New York.  Hospitals are displayed as points colored red (lowest quartile of hospitals), yellow (second and third quartile of hospitals), or green (fourth quartile of hospitals), allowing users to quickly compare performance across hospitals.  Users can also filter the data displayed on the map based on whether hospitals received a penalty for having a low total performance score or excess readmissions. In addition, users can use the Stats tool to perform statistical analyses to explore relationships between hospital performance scores and population health indicators for the county in which the hospital is located.

Stats tool showing relationship between total performance score by hospital and county-level percent renter occupied housing for the county in which a hospital is located

You can use the Hospital Value-Based Performance (VBP) Explorer at:
http://www.healthlandscape.org/HVBPExplorer/map.cfm

To learn more about the Population Health Mapper, join one of regular webinars at

http://www.healthlandscape.org/Webinar-Training.cfm

Place matters to personal and population health.

Place matters to personal and population health.  The social determinants of health have begun to shape public health and policy interventions and neighborhood socioeconomic and demographic characteristics play significant roles in influencing health outcomes. 

The continued realization that place matters has led to the emergence of the field of population health, which includes health determinants, health outcomes, and links between the two.  The Robert Graham Center, the policy arm of the American Academy of Family Physicians, recently hosted a forum focused on population health, with experts from New Mexico and North Carolina offering their perspectives on how to address the social determinants of health.  Dr. Arthur Kaufman, the vice chancellor for community health at the University of New Mexico Health Sciences in Albuquerque, discussed how practices in New Mexico’s university system are beginning to take note of the importance of social determinants that are often ignored, such as low education or poor living conditions.  Kaufman also mentioned the critical role of community health workers in helping physicians reach and assist community members dealing with financial or social issues.  Dr. L. Allen Dobson, Jr., president and CEO of Community Care of North Carolina (CCNC), described how CCNC is linking their data with real-time pharmaceutical data to create risk scores for patients.  Dobson noted how these data have been essential for reducing hospital admissions and readmissions by allowing physicians to reach patients before patients reach the hospital.  See future Primary Care Forum topics.

Issues remain, however, as to what determinants and outcomes are most important to measure, as well as the availability of these data at relevant geographies. In response to this, the Centers for Disease Control and Prevention (CDC) created a resource guide of the most frequently recommended health outcomes and determinants, the Community Health Assessment for Population Health Improvement. The guide breaks down the data into two domains, Health Outcomes and Health Determinants, and then separates dozens of indicators into several categories, including Mortality, Morbidity, Health Care, Health Behaviors, Demographics, Social Environment, and Physical Activity.

Using this guide as a framework, HealthLandscape created the Population Health Mapper which includes the majority of the Health Outcome and Health Determinant Metrics identified in the report at the county level.

The Population Health Mapper allows users to select metrics from the seven categories and use a slider bar to set thresholds. By default, thresholds are set at values that represent national benchmarks.  The tool will highlight those counties that are outside of the national benchmark, or will incrementally shade or remove counties depending on how the user modifies the thresholds for selected indicators.  Darker gradations of color will indicate which counties are outside of the established thresholds for multiple indicators.  Users can also view a histogram that shows the number of counties outside of thresholds by the number of indicators, allowing users to quickly filter by the number of indicators that are outside of the established thresholds.

You can use the Population Health Mapper at:

http://www.healthlandscape.org/PopulationHealth/map.cfm

To learn more about the Population Health Mapper, join one of regular webinars at

http://www.healthlandscape.org/Webinar-Training.cfm

HealthLandscape's Accountable Care Organization (ACO) Explorer

As part of the Affordable Care Act, new models of health care delivery have been developed with the objective to improve the quality of care while reducing costs.  Accountable Care Organizations (ACOs), which are made up of groups of doctors, hospitals, and other health care providers that coordinate care for Medicare beneficiaries, are being touted as potential solutions for the inefficiency and fragmentation of the U.S. healthcare system. One of the early Medicare ACO programs, the Medicare Shared Savings Program (MSSP), has shown promising results. ACOs in the MSSP have experienced improvements in the majority of quality measures while generating cost savings (see http://blog.cms.gov/2014/12/22/acos-moving-ahead/).

In order to compare how ACO performance varies geographically, HealthLandscape developed the ACO Quality Explorer, which is a spatial visualization tool for data from the 211 ACOs taking part in the MSSP.  The ACO Explorer allows users to visualize 33 quality measures organized into five domains: patient/caregiver experience, care coordination/patient safety, preventive health, at-risk population diabetes, and at-risk population heart-related measures. Each ACO is given a site score based on the percentage of quality measure benchmarks set by the Centers for Medicare and Medicaid that the ACO has met. ACOs are displayed as points on the map colored green (4 or more domains with all measures at or above thresholds), yellow (2 or 3 domains with all measures at or above thresholds), or red (less than 2 domains with all measures at or above thresholds), allowing users to quickly compare different ACOs across a geographic area.  When users click on a specific site, they can view exploding rollover windows which contain data about the quality measures included in each of the five domains. In addition, users can use the Stats tool in the ACO Quality Explorer to perform statistical analyses to explore the relationship between ACO quality metrics for an ACO and population health indicators for the county in which an ACO is located.

To access the ACO Explorer, see http://www.healthlandscape.org/ACOExplorer/map.cfm

Want to Learn More?

Learn more about HealthLandscape with our online Webinars and Training

In-depth instruction on using HealthLandscape tools and additions to our ever-growing data library

Register Here 

The Nursing Home Explorer: Spatial Visualization of Nursing Home Compare

Consumers who are considering placing a loved one in a nursing home have important questions about nursing home safety and quality. Fortunately, the Centers for Medicare and Medicaid have created Nursing Home Compare, which is an online database that contains quality data for all nursing homes certified under Medicare and Medicaid. Nursing Home Compare provides a star-ratings system of nursing home characteristics such as health inspections, staffing, quality measures, and overall quality. Consumers can use Nursing Home Compare to make a side-by-side comparison of the star ratings for up to three different nursing homes.

Map view showing star-ratings for nursing homes in northern Kentucky (filtered by state), and rollover windows for nursing home address and nursing home characteristics star-ratings

HealthLandscape created the Nursing Home Explorer to provide a user-friendly spatial visualization tool for Nursing Home Compare data for nursing homes in Ohio, Kentucky, and Indiana. Each nursing home is displayed as a red, yellow, or green point on the map based on its overall quality star-rating, allowing users to quickly compare the quality of neighboring nursing homes. When a user moves their mouse over a point, the nursing home name, address, and the star-ratings for the nursing home’s staffing, health inspections, quality measures, and overall ratings are displayed in windows on the screen. Users are able to filter the selection of nursing homes displayed on the map by ownership, provider type, or state, and have the option to view the data displayed on the map in a table format. In the Stats tab, users can examine the correlation between nursing home characteristics and community demographic and health data for the county in which the nursing home is located. The Nursing Home Explorer is a very useful tool for quickly comparing multiple nursing homes in Ohio, Kentucky and Indiana, and provides an important spatial visualization component for Nursing Home Compare data. 

Stats view showing correlation between overall star-ratings for nursing homes and percent Age 65 & older below 100% of federal poverty level at the county level (for the county in which the nursing home is located) in Kentucky

To access the Nursing Home Compare Explorer, see http://www.healthlandscape.org/NursingHomeExplorer/map.cfm 

Want to Learn More?

Learn more about HealthLandscape with our online Webinars and Training

In-depth instruction on using HealthLandscape tools and additions to our ever-growing data library

Register Here 

For more information about Nursing Home Compare, see http://www.medicare.gov/nursinghomecompare/About/What-Is-NHC.html

Medicare Data Portal

Increased availability of health data through the U.S. Government’s Open Data Initiative has provided researchers, policymakers, and the general public with access to dozens of new datasets.  Despite the increased availability, the data are often cumbersome to work with and few tools exist that present the data in ways that are useful for the public and decision-makers.


We created a web-based data visualization and mapping tool, the Medicare Data Portal, to simplify access to this rich data source.

Comparison map where HRRs with high prevalence of Diabetes and low A1C Testing are displayed in Red

The Medicare Data Portal engages decision-makers and researchers with county and Hospital Referral Region (HRR) data from the Centers for Medicare & Medicaid (CMS) Geographic Variation database and the Chronic Conditions Warehouse.  The tool allows users to visualize health outcome, cost, and demographic data for the Medicare population using maps, graphs, and trend charts.  Users also have the ability to examine the relationship between two indicators (for example, Inpatient Costs and Diabetes) with side-by-side maps and a comparison tool that uses percentiles to visualize the relationship between variables.

The Medicare Data Portal can also be used simultaneously with other tools to explore relationships between hospital-level indicators and county and HRR-level Medicare indicators.  The portal can be used as a resource for policymakers and researchers concerned with Medicare spending and the relationships between Medicare costs and health outcomes.

Where can I try it?

Visit HealthLandscape at http://www.HealthLandscape.org

Select "Medicare Data Portal" from the HealthLandscape Tools

Want to Learn More?

Learn more about HealthLandscape with our online Webinars and Training

In-depth instruction on using HealthLandscape tools and additions to our ever-growing data library

Visualizing Global Health

Global health issues have received increased attention due to the Ebola outbreak, with President Obama recently asking Congress for $6 billion in the fight against the crisis. While the Ebola outbreak is serious and has resulted in thousands of deaths, a number of other diseases, such as HIV/AIDS and Tuberculosis, continue to plague countries throughout the world. Other health issues, including infant mortality, a shortage of doctors and nurses, and a lack of healthcare spending also play critical roles in shaping population health throughout the world. As researchers and policymakers continue to grapple with these issues, it is becoming increasingly important that relevant data and tools are easily accessible that can help shed light on these issues. One such tool is the World Health Mapper, a free web-based mapping and data visualization tool.

The World Health Mapper (http://www.healthlandscape.org/worldhealth/hlplayer.html) allows users to visualize data related to demographics, vital statistics, child and infant health, disease prevalence, and healthcare capacity & expenditures for countries across the world in the form of maps, charts, and graphs. Users also have the ability to examine the relationship between two indicators with side-by-side maps and a comparison tool that groups countries based on percentiles.

For example, the map shows the relationship between health care spending per capita and infant mortality, where red countries have high spending (70th percentile or greater) & low infant mortality (30 percentile or below), and light blue countries have low spending (30th percentile or below) and high infant mortality (70 percentile or greater).

The data come from a variety of sources, most notably the World Development Indicators Catalog produced by the World Bank and the Organization for Economic Co-operation and Development (OECD) Health Database.  In addition, the World Health Mapper contains data about the state of Family Medicine around the globe. 

The World Health Mapper is also available at the Center for Global Health Initiatives and the Robert Graham Center.