Bridget Booske, Julie Willems Van Dijk, Brenda H
Henry, David Kindig, and Patrick Remington
D id Ki di
dP t i kR i t
AcademyHealth Annual Research Meeting
June 28, 2010
,
The MATCH Project
and the County Health Rankings
• The Wisconsin MATCH Team
– Including Pat Remington, Jessica Athens, Julie g
g ,
,
Willems Van Dijk, Dave Kindig
• Robert Wood Johnson Foundation
Robert Wood Johnson Foundation
– Including Brenda Henry, Michelle Larkin, Jim Marks, Joe Marx, Pamela Russo
Marks, Joe Marx, Pamela Russo
• Our Partners
– Including CDC, NCHS, ASTHO, NACCHO, NNPHI, I l di CDC NCHS ASTHO NACCHO NNPHI
Dartmouth Institute, 11‐member Metrics Advisory Group Burness Communications
Advisory Group, Burness
Background Methods Results Discussion & Conclusions
Goals
• Give communities reliable, comprehensive l bl
h
information about their health in form of nation’s first‐ever County Health Rankings
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• Engage policymakers and community leaders from wide range of sectors in partnerships to p
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improve population health
• Identify incentive models that can be used in communities throughout the nation to
communities throughout the nation to improve population health
Background Methods Results Discussion & Conclusions
Countyy Health Rankings
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• Built upon state‐level model developed by America’s Health Rankings (1990) and county‐
level model developed in Wisconsin (2003)
• Provide a measure of the overall health of nearly every county in the United States
nearly every county in the United States
• Each county:
– gets a snapshot of their overall health and the factors t
h t f th i
ll h lth d th f t
that influence their health
– is able to see how its health compares to that of other is able to see how its health compares to that of other
counties so they can see where they are doing well and y
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where they could improve
Background Methods Results Discussion & Conclusions
Methods
1. Identify model (Kindig and Stoddard, 2003)
Programs
and
Policies
Health
H
lth
Factors
Health
Outcomes
2 Collect data: 2.
C ll t d t available, valid and reliable, timely, l bl
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l
consistently collected, and reflect important—and modifiable—aspects of population health
3. Create summary measures
•
•
•
Standardize individual measures (using z‐scores)
Assign weights (based on lit review, expert opinion +)
Calculate summary measures
4. Rank summary measures & communicate results
Background
Methods
Results
Discussion & Conclusions
Health Outcomes
Mortality (length of life)
(50%)
Morbidity (quality of life)
(50%)
Tobacco use (10%)
Health behaviors
(30%)
Diet & exercise (10%)
Alcohol use (5%)
U
Unsafe
f sex (5%)
Clinical care
(20%)
Access to care (10%)
Quality of care (10%)
Education (10%)
Health Factors
Employment (10%)
Social & economic factors
(40%)
Income (10%)
Family & social support (5%)
Community safety (5%)
Programs and
Policies
Physical environment
(10%)
Environmental quality (5%)
Built environment (5%)
Data Sources
Data
Sources
Behavioral Risk Factor Surveillance System
Census County and Zip Code Business Patterns
Census County and Zip Code Business Patterns
CDC‐Environmental Protection Agency Collaboration
Dartmouth Atlas Project Medicare Claims Data
Dartmouth Atlas Project, Medicare Claims Data
Decennial Census and American Community Survey, CPS
FBI Uniform Crime Reporting
FBI, Uniform Crime Reporting
HRSA, Area Resource File
National Center for Education Statistics
National Center for Education Statistics
National Center for Hepatitis, HIV, STD, and TB, CDC
Vital Statistics National Center for Health Statistics CDC
Vital Statistics, National Center for Health Statistics, CDC
Small Area Income and Poverty Estimates
US B
US Bureau of Labor Statistics
f L b St ti ti
Background
Methods
Results
Discussion & Conclusions
Results: www.countyhealthrankings.org
Results: www countyhealthrankings org
Background
Methods
Results
Discussion & Conclusions
Urban versus Rural
50 healthiest vs. least healthy counties
60%
56%
Healthiest
50%
Least Healthy
46%
40%
28%
30%
20%
16%
10%
2%
6%
10%
2%
4%
20%
6% 4%
0%
Urban
Background
Methods
Rural
Results
Discussion & Conclusions
Health Outcome Disparities
Health Outcome Disparities
Median values for 50 healthiest vs. least healthy counties
Least
Healthy
Premature death
rate
Self-reported health
(fair or poor)
Background
Methods
Healthiest
Ratio
12 368
12,368
4 904
4,904
25
2.5
20%
9 5%
9.5%
21
2.1
Results
Discussion & Conclusions
Health Factor Disparities
Health Factor Disparities
Median values for 50 healthiest vs. least healthy counties
Least
Healthy
Adult smoking
Preventable
hospital stays
Children in
poverty
Access to healthy
foods
Background
Methods
Healthiest
Ratio
26%
16%
1.6
95
61
1.6
30%
9%
3.5
33%
47%
0.7
Results
Discussion & Conclusions
Why Rank?
• One of greatest disparities in the US is that some places are healthy, but others are not
some places are healthy, but others are not • There is relatively little discussion about these disparities by the public or policy makers
Rankings reduce data to a form that everyone
• Rankings reduce data to a form that everyone can easily understand and use • Rankings allow comparisons
Rankings allow comparisons
• Rankings draw attention and can be used to
• help target interventions and funding
• help select and reward high-performers
• help identify and motivate low-performers
Background
Methods
Results
Discussion & Conclusions
What Lessons Did We Learn?
What Lessons Did We Learn?
• Advance preparation for public health leaders was very important
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• Media attention was successful in terms of quantity and quality
quantity and quality
• National media wanted national rankings but our focus was on state and local audiences
• Lots of hits on web site but users focused on Lots of hits on web site but users focused on
data and often didn’t find other information
Some Challenges of Rankings
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• Differences in ranks may not be statistically significant
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• County issues:
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• Could not rank all counties
• No county gov’t structure in some states
N
t
’t t t
i
t t
• Counties vary greatly in area, population size and demographics
• Ranks only one factor to consider
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• “Action” needed may be complex and expensive
Background
Methods
Results
Discussion & Conclusions
Conclusions
• The County Health Rankings are
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beginning to g
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focus discussion on the multiple determinants of population health
of population health
• Hopefully
Hopefully they are they are
also drawing in multiple partners
multiple partners
• And …
Background
Methods
Results
Discussion & Conclusions
For more information, go to
www.countyhealthrankings.org
Or send email to O
d
il t
match info@match wisc edu
match‐info@match.wisc.edu