Data to Action: A Public Health Example Within a Guiding Framework

Data to Action: A Public Health Example Within a Guiding Framework

Mathew Christensen, Ph.D.Vickie Thomson, M.A.

Colorado Department of Public Health and

Environment

What are we talking about? “Data to action,” simply means using

data to improve or guide our intervention Question: How can data improve a large

complex system-based intervention like newborn hearing screening?

Mass confusion, assumptions, and viewpoints…we all have similar questions. How do we get from point A to point B effectively?

Step 1. Recognize the big health outcome

or problem we are trying to move. Did you know? Newborn hearing

screening exists to improve language and brain development for children with a hearing loss.

Step 2. Understand that data do not move

health outcomes, interventions move health outcomes

Side Note: Interventions must have the capacity to be “effective” in moving the outcome. Otherwise, we will simply be using data to improve an ineffective intervention

Interventions move outcomes Data are simply used to guide and

improve interventions Data guide interventions

move outcomes Public health needs to integrate

data people program people move outcomes (i.e.,complementary skill sets)

Screening is an intervention? Early interventions such as amplification

and language stimulation improves language outcomes for children who are deaf and hard of hearing.

“Early” is key, when language centers in the brain are still forming and malleable

Newborn screening leads to early identification of hearing loss, so screening can be viewed as the first stage of a large system-based intervention

Colorado Infant Hearing Program

Factors that Affect Screening and Follow-up Rates

Analyzing an EHDI Program

Advisory Committee Improve follow-up Factors associated with missing the

screen, rescreen, & late diagnosis Data integration, hospital surveys Conclusions Plan and implement programmatic

changes for improvement

The Colorado EHDI Follow-up Program:A Historical Perspective

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1992-96

1999 2000 2001 2002 2003 2004

F/U

Factors that Influenced Improved Follow-up Rates

Pressure from the Pediatric Chapter Champion - Al Mehl, MD

Integration with the EBC Track from screening to diagnosis to early intervention Send accurate MONTHLY reports to hospital

coordinators Letter campaign to parents from missed, failed

screens (EBC provides demographic information)

Population Results from Hospital Screen

Births 2001-2004 204,694 Screened 200,666 (98 %) Failed 8,124 (4%) Rescreened 6,686 (82%)

Step 3. Understand where our intervention

needs improvement Newborn screening: 2% of birth

population in Colorado is not screened; 18% who failed the first screen missed the follow-up screen

Who are they? Can this be improved?

Step 4. Determine if we have useful and

credible data available to inform our intervention, or if they need to be collected

Note: Not all data are useful for improving or guiding interventions. Some data are simply used to monitor/track health outcomes in the population

Newborn screening data The Colorado Department of Public

Health and Environment has useful data to improve newborn hearing screening

56 birthing hospitals: vital statistics, birth certificates, and screening results for each infant born in the state…about 70,000 a year

Factors Initially Tested Mother’s age Mother’s education Mother’s weight gain Martial status Gestational age Mother Smoke Infant gender Race/ethnicity Hospital Year of birth Birth weight APGAR Scores Urban, rural, frontier populations

Step 5. Connect data analysis results to

specific recommendations for improving the intervention

The connection between the results and recommendations must be clear and transparent to build consensus/support

Screening results and recommendations Results: The 1,500 infants not screened

each year are much more likely to have poor health than the 98% who are screened

Infants in the NICU are also much more likely to have a hearing loss than infants in the well-baby nursery

Recommendation: NICU will develop policies and procedures to ensure these high risk infants get screened

USPSTF and NICU Screening “The USPSTF found good evidence that

the prevalence of hearing loss in infants in the newborn intensive care unit and those with other specific risk factors is 10-20 times higher than the prevalence of hearing loss in the general population of newborns. Both the yield of screening and the proportion of true positive results will be substantially higher when screening is targeted at these high-risk infants…”

Conclusions Lack of reporting results Early discharge Significant health problems Out of state residents (7%) Deceased

Screening results and recommendations Results: Follow-up screening disparities

exist for mothers with low education and Latina ethnicity

Recommendation: Hospital screening staff will receive education/training about improving access to care; successes of single “safety-net” hospital will be used to help other hospitals reduce barriers

Step 6. Understand that

changing/improving interventions often takes time and develops slowly

Is the intervention new or well-established? A big system or small?

Improving the intervention Disseminate/communicate results and

recommendations to everyone involved with intervention implementation/policies

Sometimes change is disruptive. Interventions always need some stability. Find a balance between retaining stability and implementing change.

Improving screening Journal publication and conference

presentations for broad dissemination

Colorado special health care needs newsletter, and coordination with the state’s audiologist and screening coordinator

Beginning stages of change taking shape

Conclusions and benefits When used correctly, data can be a

powerful tool to improve public health practice and ultimately outcomes

Recap: What is our outcome? Is our intervention based on

reasonable evidence? Where does the intervention need

improvement?

Conclusions cont. Do we have useful data? Can we connect clear

recommendations to the statistical results?

How much time and effort will it take to implement the changes?

Thought: I believe scientific methods has the power to improve the public’s health. Believe it.

Role of Public Health in EHDI Programs

Using science as a basis for decision-making and action;

Expanding the quest for social equity; Performing effectively as a service

agency; Making efforts outcome-oriented; and Being accountable * CDC Operating Principles for Program Evaluation

It Takes a Village to Raise an EHDI Program

External Advisory

Committee Internal

Administration Statisticians IT Professionals Program expertise

The Role of our Federal Partners

Continuing to ‘raise the bar’ for EHDI programs

Encourage data integration with newborn screening and immunization

Support the concept of the child health profile to ensure the Medical Home/PCP are informed of outcomes

Outcomes: Happy, Healthy Families Comprehensive Community Based Culturally

Competent Seamless Knowledgeable

Providers Parent to Parent

Support

Contact Information:[email protected]@state.co.us

Colorado Department of Public Health and Environment, PSD-

HCP A4,Cherry Creek Drive South,Denver CO, 80246