NACCHO



DOMAININDICATOR GROUPINDICATORMEASURESSOURCEYear (or Group of Years)Smallest Planned Geographic Level of Analysis?Opportunity MeasuresIncome Income DistributionGini coefficient of income inequalityACS2006-2010HCC geo groupsSegregationHousing SegregationGini coefficient of minority-headed householdsACS2006-2010HCC geo groupsSocial, Economic, and Environ-mental FactorsSocial and Economic FactorsIncome% children in poverty ACS2006-2010HCC geo groupsEducationEducation distribution in adults older than 25ACS2006-2010HCC geo groupsSocial Connection & SupportSocial Capital BRFS2008-2010HCC geo groups*Community SafetyRate of violent crimes per personMSP2010 (+prior)HCC geo groupsAffordable HousingHouseholds who spend more than 30% of income on housingACS2008-2010HCC geo groupsQuality of Primary CareRate of Ambulatory-Care Sensitive Hospitalizations (Preventable)MDCH Vital Statistics2010 (+ prior)HCC geo groupsEnvironmental FactorsEnvironmental Quality% water wells w/evidence of significant nitrate contaminationLocal Health Depts.2011 (+prior)HCC geo groupsBuilt EnvironmentFood Desert StatusUSDA 2006/2010 ACSCensus tractBehaviors, Stress, and Physical ConditionHealth Behaviors and Physical ConditionObesityAdult Weight Distribution (BMI Categories) BRFS2008-2010HCC geo groups*Adolescent Weight Distribution (BMI Categories) MiPHY2010CountyTobacco UseCurrent Smoking in adults BRFS2008-2010HCC geo groups*Current Smoking in adolescents MiPHY2010CountyAlcohol UseBinge Drinking in adults BRFS2008-2010HCC geo groups*Binge Drinking in adolescents MiPHY2010CountyClinical CareAccess to CarePersons with a primary medical provider BRFS2008-2010HCC geo groups*Ratio of population to the number of primary care physiciansCounty Health Rankings2008CountyCommunicable Disease Prevention% children 19-35 months who receive recommended immunizationsMCIR2011HCC geo groups*StressMental HealthPoor mental health days in adultsBRFS2008-2010HCC geo groups*Adolescents with symptoms of depression in past yearMiPHY2010CountyHealth OutcomesIllness (Morbidity)Child HealthAsthma Hospitalization Rate in children 0-18MDCH Vital Records2010 (+ prior)HCC geo groupsQuality of LifePerceived health status (good vs. poor)BRFS2008-2010HCC geo groups*Adult HealthDiabetes-related Hospitalization Rate in adults 18+Local Hospital Data2011 (+prior)HCC geo groups*Deaths (Mortality)Premature Death% deaths before age 75MDCH Vital Records2009 (+ prior)HCC geo groupsMaternal & Child HealthInfant Mortality RateMDCH Vital Records2009 (+ prior)HCC geo groups Chronic DiseaseDeaths due to cardiovascular diseaseMDCH Vital Records2009 (+ prior)HCC geo groupsSafety Policies and PracticesDeaths due to accidental InjuryMDCH Vital Records2009 (+ prior)HCC geo groups2012 Indicators1409700-200025? HCC Geo Groups = 8 groups of census tracts, cities, and/or townships grouped by median home value and population density in Clinton, Eaton, and Ingham Counties. *subject to reportable data availability; some areas may have too few responses/incidents to report ACS = American Community Survey, conducted by the U.S. Census BureauBRFS = Behavioral Risk Factor Survey, conducted by local health departmentsMCIR = Michigan Care Improvement RegistryMDCH = Michigan Department of Community Health MiPHY = Michigan Profile for Healthy Youth SurveyMSP = Michigan State PoliceUSDA = United States Department of AgricultureCommunity Health Assessment and Improvement Planning ProjectIndicator Selection Where did we look for potential indicators?October 6 Healthy! Capital Counties Advisory Committee BrainstormingHealthy People 2020 Leading Health Indicators 2020/LHICounty Health Rankings Health Indicators Warehouse Community Health Status Indicators munityhealth.Capital Area Behavioral Risk Factor Survey (Clinton, Eaton, Ingham)Michigan Department of Community Health Statistics (Vital, Disease, Hosp.)?Ideal indicators should be… Our working model for how health happens:316420582550?Valid and AccurateStable, Reliable, Timely, and ConsistentRepresentative of the health of the entire communityGeo-code-able to the census tract levelMeaningfulRelevantEngaging to stakeholdersEasy to understandActionablePrompt discussion and debateFacilitate building coalitionsAct as a catalyst for actionResult in positive changeAnd finally…Contribute to a comprehensive picture of the health of the community.What is an ‘indicator’? A thing, especially a trend or fact, that indicates the state or level of something: "an indicator of affluence".Not all indicators included will meet all of the criteria, but the criteria may be used to help decide among indicators.It’s also important to note that the intention of this project is not to provide all of the data necessary to understand a specialized topic,but rather to provide a means to prioritize those areas which most contribute to ill health in the community.NOT INCLUDED AS INDICATORS: These indicators do not meet as many of the high quality indicator standards to be included in the main set but are still important and available.INDICATORSOURCENOTES__________________________________________________________________ (Social and Economic Determinants)__________________________________________________________________________________________________________________Students who graduate high school with a CEPI – by School Districtschool districts can’t be mapped to census tracts or county (very well)regular diploma 4 years after starting 9th grade LHI% children eligible for free/reduced lunchCounty Health Rankings /CEPIused poverty of all children instead of poverty + near poverty in school aged children% illiterateCounty Health Rankings / ACSused educational attainment instead of this measureUnemploymentCounty Health Rankings / BLSchose to measure income inequality instead given volatility in this statisticChildren in single parents householdsCounty Health Rankings/ACSnot clearly actionable(Environmental Factors)____________________________________________________________________________________________________________________________Access to physical activity opportunitiesCounty Health RankingsRate of Recreational Facilities per 100,000 – problem comparing rural/urban Access to healthy foodsCounty Health Rankings% zip codes with grocery store/produce stand – measures rural-ness.% of labor force that drives alone to workCounty Health Rankings / ACSnot clear what element rural-ness plays in this measureLiquor store densityCounty Health Rankings measures rural-ness more than exposure to liquor(Health Care)_____________________________________________________________________________________________________________________________________Persons with medical insurance LHIBRFSwe chose to measure utilization rather than access to payment sourceDiabetic ScreeningCounty Health Rankingsonly of Medicare population; doesn’t measure quality of care across population Mammography ScreeningCounty Health Rankingsonly of Medicare population; doesn’t measure quality of care across populationMedicaid enrollees with a dental visit in past yearMedicaid Data difficult to obtain geo-code-able (Health Outcomes / Morbidity)______________________________________________________________________________________________________________________Low-birthweight birthsMDCH Vital Statisticschose to swap for measure of child morbidity (asthma) instead, since infant mortalityHypertension rate in adultsBRFSoverlap with cardio. disease deaths; significant disparity for African Americans notedDiabetes rate in adultsBRFSoverlap with cardiovascular disease deathsSTD /Chlamydia infection rate MDCH Vital StatisticsSTD infection rates not reliable, more a measure of access to testingPreterm birthsMDCH Vital Statisticsnot as outcome-oriented as infant mortalityPercent of births to teenage mothersMDCHcan be considered a social determinant, behavior, and outcome measure at same timeHIV Prevalence RateCounty Health Rankings / MDCHnumbers low at small geographic levelsAlcohol-related Traffic Crash InjuriesMSP/OHSPchose to swap to make room for diabetes indicator(Health Outcomes/Mortality)_______________________________________________________________________________________________________________________Homicide rateMDCH Vital Statisticstoo few events to compare at small geographic levelsSuicide rateMDCH Vital Statisticstoo few events to compare at small geographic levelsDATA GAPS: These indicators are relevant but do not have adequate data available to include.CATEGORYINDICATORNOTES(Social & Economic Factors)________________________________________________________________________________________________________________________TransportationAccess to transportationNo clearly defined indicator – need more conversation to develop this(Environmental Factors)____________________________________________________________________________________________________________________________Air QualityAir Quality Index LHICould not identify air quality indicator specific to the municipality/census tract level.Children 3-11 exposed to secondhand smoke LHIData not available with current BRFS methodology.(Health Behaviors/Health Care)_____________________________________________________________________________________________________________________Specialty Care AccessAccess to specialty care servicesData not availableNutritionTotal vegetable intake for persons over age 2 LHINot collected in BRFS separate from fruitPhysical ActivityPersons who get adequate physical activity LHIProblem with the consistency of definition of adequate physical activityReproductive/Sexual HealthSexually active females 15-44 who received reproductive health services LHIData not available at the population level.Persons living with HIV who know their serostatus LHIData not available at the population level.Clinical Preventive ServicesPercent of adults with colorectal cancer screening according to guidelines LHI Data not available at the population level.Adults with hypertension whose blood pressure is under controlLHIData not available at the population level.Adult diabetic population whose diabetes is not controlled LHI Data not available at the population level.Oral HealthPersons over age 2 who visited the dentist in past year LHIData not available at the population level.Alcohol UseAdolescents who used alcohol or any illicit drugs recently LHIData not readily available; possibly can get county level from MiPHYLHI = Leading Health Indicators from Healthy People 2020 ................
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