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Targeted Interventions, Targeted Interventions, Mapping & Health Mapping & Health

AnalysesAnalyses

for Western Tidewater Health Districtfor Western Tidewater Health District

Nancy M. Welch, MD, MHA, MBA, Acting DirectorNancy M. Welch, MD, MHA, MBA, Acting DirectorWestern Tidewater Health DistrictWestern Tidewater Health District

October 21, 2010October 21, 2010

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Why Evaluate?Why Evaluate?

• Responsible Program ManagementResponsible Program Management– Program PlanningProgram Planning– Program ImplementationProgram Implementation– Program EffectivenessProgram Effectiveness– Program EfficiencyProgram Efficiency– Cost EffectivenessCost Effectiveness

• Program AccountabilityProgram Accountability– Required by funding agenciesRequired by funding agencies– Justify use of dollarsJustify use of dollars

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Research vs. EvaluationResearch vs. Evaluation

““Research seeks to Research seeks to proveprove; ;

evaluation seeks to evaluation seeks to improveimprove…”…”

--M. Q. Patton--M. Q. Patton

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Gather Credible EvidenceGather Credible Evidence

• Start with evaluation purpose and over-Start with evaluation purpose and over-arching questionsarching questions

• Develop indicators--specific, measurableDevelop indicators--specific, measurable

• From whom do you want to collect From whom do you want to collect information?information?

• Determine the best way to measure the Determine the best way to measure the indicatorsindicators

– Data that already existsData that already exists

– New dataNew data

How to Start --How to Start --

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Trends…Trends…

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Rates = Mathematical Conversion of Rates = Mathematical Conversion of Absolute NumbersAbsolute Numbers

(as if all represent same population size)(as if all represent same population size)

• Use rates--not absolute numbersUse rates--not absolute numbers

– Benefits:Benefits:

• Honest trend no matter change in Honest trend no matter change in populationpopulation

• Enables comparisonsEnables comparisons

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Rates -- Examples:Rates -- Examples:

• Disease or Entity Rate per 100,000 Disease or Entity Rate per 100,000 population or 1,000 personspopulation or 1,000 persons

• Risk in different age groupsRisk in different age groups

• Remember “Percent” is also a rateRemember “Percent” is also a rate

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Su

ffol

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een

Pre

gnan

cy R

ates

Su

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k T

een

Pre

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ates

(per

1,0

00 f

emal

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ge 1

0 –

19)

(per

1,0

00 f

emal

es a

ge 1

0 –

19)

Source: Virginia Department of HealthCompiled by the Suffolk Department of Budget & Strategic Planning August, 2010

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WT

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irth

Tre

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Bir

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Teenage Live Birth Rates per 1,000 FemalesWestern Tidewater Health District

0

5

10

15

20

25

30

35

40

45

50

2004 2005 2006 2007 2008

Isle of Wight County

Suffolk City

Southampton County

Franklin City

Virginia

Linear (Franklin City )

Linear (SouthamptonCounty )Linear (Suffolk City )

Linear (Isle of WightCounty )

Source: VDH Health Statistics

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Low Birth Weight Trends Below 5.5 lbs. (percent of total births)

Source: Virginia Department of HealthCompiled by the Suffolk Department of Budget & Strategic Planning August, 2010

11Sex

uall

y T

rans

mit

ted

Dis

ease

sS

exua

lly

Tra

nsm

itte

d D

isea

ses

STD RATES - Chesapeake

2.482.73 2.71

3.10 3.11 3.05

3.93

4.564.91

1.76 1.76 1.79 1.821.51

1.18 1.06 1.16

2.16

0

1

2

3

4

5

6

7

8

2000 2001 2002 2003 2004 2005 2006 2007 2008 adj

Year

Rat

e (p

er 1

000

popu

latio

n) Chlamydia

Gonorrhea

Other

Syphilis

Grand Total

Source: VDH Health Statistics

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Targeted Intervention…Targeted Intervention…

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Targeted by Targeted by Neighborhood Neighborhood Statistical Areas Statistical Areas (NSAs), Middle & (NSAs), Middle & High Schools High Schools notednoted

Chesapeake Live Births to Teenage Mothers, 2001-05

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Chesapeake Infant Death Analysis, Chesapeake Infant Death Analysis, 1999-20041999-2004

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WTHDWTHDTeen Teen PregnancyPregnancy

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WTHD WTHD Infant Infant MortalityMortality

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Socio-economic Breakdown by Census Tract, Chesapeake-2006

Definitions:Lower income census tract -- both % on Food Stamps & % Receiving TANF are >= the City-wide percentageMedium income census tract -- either % on Food Stamps OR % Receiving TANF is >= the City-wide percentageHighest income census tract -- both % on Food Stamps & % Receiving TANF are < the City-wide percentage

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Cost Benefit Analysis…Cost Benefit Analysis…

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Evaluation of CGH E.R. Visits by Evaluation of CGH E.R. Visits by Adult Clinic PatientsAdult Clinic Patients

Total ER VisitsTotal ER Visits # Patients Seen# Patients Seen Average Visits/ptAverage Visits/pt Society Cost of ER VisitsSociety Cost of ER Visits

FY’00FY’00 1818 1212 1.51.5 $ 73,735.20$ 73,735.20

FY’01FY’01 5151 3939 1.311.31 $ 64,702.05$ 64,702.05

FY’02FY’02 4545 5252 0.870.87 $ 51,014.22$ 51,014.22

FY’03FY’03 4848 5656 0.860.86 $ 49,823.93$ 49,823.93

FY’04FY’04 3535 5151 0.690.69 $ 52,088.65$ 52,088.65

Before Adult ClinicBefore Adult Clinic 7171 5656 1.261.26 $ 73,440.26 $ 73,440.26 (average)(average)

After Adult ClinicAfter Adult Clinic 4040 5656 0.710.71 $ 41,341.45 $ 41,341.45 (average)(average)

Ave Cost Saved per yr by decreasing ER VisitsAve Cost Saved per yr by decreasing ER Visits $32,098.81$32,098.81

** Cost of ER Visits = (total #pts) x (56%) x (Ave visits/pt) x (Ave ER Cost), Average ER Cost= $209

(http://content.nejm.org/cgi/content/short/334/10/642)(http://content.nejm.org/cgi/content/short/334/10/642)

• Group selected if admitted to adult clinic in FY’02-03, and randomly selected Group selected if admitted to adult clinic in FY’02-03, and randomly selected 100 patients 100 patients

• Looked at all visits for this group (56% had been to the ER at least once)Looked at all visits for this group (56% had been to the ER at least once)

• We calculated average # ER visits before/after starting adult clinic. Hypothesis: We calculated average # ER visits before/after starting adult clinic. Hypothesis: there would be a decrease in Average ER visits (increased access to care)there would be a decrease in Average ER visits (increased access to care)

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Evaluation of CGH hospitalization Evaluation of CGH hospitalization by Adult Clinic Patientsby Adult Clinic Patients

• Group selected if admitted to adult clinic in FY’02-03, and randomly selected Group selected if admitted to adult clinic in FY’02-03, and randomly selected 100 patients 100 patients

• Looked at all visits for this group (25% had been hospitalized at least once)Looked at all visits for this group (25% had been hospitalized at least once)

• We calculated average LOS before/after starting adult clinic. Hypothesis: We calculated average LOS before/after starting adult clinic. Hypothesis: there would be a decrease in hospitalization (increased access to care)there would be a decrease in hospitalization (increased access to care)

Hospital Days Hospital Days per yearper year

Average Length Average Length of Stay per of Stay per

hospital stayhospital stayAve Hosp Days Ave Hosp Days per AC Patientper AC Patient

Society Cost of Society Cost of hospitalizationhospitalization

Before Adult ClinicBefore Adult Clinic 104.7104.7 4.194.19 1.051.05 $ 1,294,800$ 1,294,800

After Adult ClinicAfter Adult Clinic 77.277.2 3.093.09 0.770.77 $ 949,520$ 949,520

Ave Cost Saved per yr by decreasing hospitalizationAve Cost Saved per yr by decreasing hospitalization $345,280$345,280

• CONCLUSION: Adult Clinic Care decreases hospitalization and CONCLUSION: Adult Clinic Care decreases hospitalization and subsequent costssubsequent costs

**Society Cost calculated = (Ave Hosp days/Pt) x (Total # pts is 645) x (Ave Cost per Hospital Day is $1911.85 per day)

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Est. Cost Savings if Baby Care were Est. Cost Savings if Baby Care were Chesapeake City-wideChesapeake City-wide

Total Total BirthsBirths

Infant Infant deathsdeaths

Surviving Surviving infantsinfants

Avg Avg Perinatal Perinatal Cost per Cost per

infant ($)infant ($)1,21,2

Baby Baby Care % Care % ChangeChange

# Babies # Babies ImpactedImpacted

Total Cost Total Cost (millions $)(millions $)

Extreme Extreme PrematurityPrematurity ((<<28 wks)28 wks)

201201 9191 110110 $ 239,749$ 239,749 -39.3%-39.3% -43-43 - $ 10.36- $ 10.36

Premature Premature (29-36 weeks)(29-36 weeks)

17121712 2525 16871687 $ 16,647$ 16,647 -20.5%-20.5% -346-346 - $ 5.77- $ 5.77

Full Term Full Term ((>>37 wks)37 wks)

15,13315,133 3030 15,10315,103 $ 4,788$ 4,788 +2.6%+2.6% +389+389 + $ 1.87+ $ 1.87

Potential Hospital Cost Saved over 2000-05Potential Hospital Cost Saved over 2000-05 - $ 14.26$ 14.26

Ave Cost saved per yearAve Cost saved per year - $ 2.38 $ 2.38

Est. City-Wide Cost of Baby CareEst. City-Wide Cost of Baby Care + $ 1.04**+ $ 1.04**

Return on InvestmentReturn on Investment 129%129%**If Baby Care were city-wide for all high-risk citizens (teens, pycho-social problems, substance abusers, etc) Ave Cost of maternity portion of BC per year = $573,182/3 = $191,061 Ave spent per BC client = $3266 x 319 Preemies/yr =$1.04 million

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Infant Mortality Analysis for ChesapeakeInfant Mortality Analysis for Chesapeake

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ConclusionConclusion• Baby Care improves birth outcomes.Baby Care improves birth outcomes.

– Infant Mortality is Infant Mortality is 65%65% lower lower– Rate of Low Birth Weight is 14% lowerRate of Low Birth Weight is 14% lower– Rate of Extreme LBW is Rate of Extreme LBW is 35%35% lower lower– Rate of Prematurity is 21% lowerRate of Prematurity is 21% lower– Rate of Extreme Prematurity is Rate of Extreme Prematurity is 39%39% lower lower– In Teens the post-pregnancy Rate is In Teens the post-pregnancy Rate is 89%89% lower lower

• Baby Care if projected to all high risk maternity Baby Care if projected to all high risk maternity patients in the City of Chesapeake could patients in the City of Chesapeake could produce a perinatal hospital cost savings of produce a perinatal hospital cost savings of $1.34 million per year (ROI = 129%) by reducing $1.34 million per year (ROI = 129%) by reducing premature births.premature births.

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Questions?Questions?