DR. ROBERT VANDERSLICE DR. PETER SIMON NANCY SUTTON RHODE ISLAND DEPARTMENT OF HEALTH Health...

DR. ROBERT VANDERSLICEDR. PETER SIMONNANCY SUTTONRHODE ISLAND DEPARTMENT OF HEALTH

Health Partnerships for Healthy Housing

Healthy Housing

• Two biggest issues: Lead and Asthma• Preventable +-• Older and poorly maintained housing• Concentrated in urban core, but not just an

urban problem• Lead as proxy for other issues• Two kinds of data: Case-Making and

Operational

Higher Lead Exposure = More Chronic Absence

Higher Lead Exposure = More Grade Repetition

Higher Lead Exposure = Lower Achievement

Policy Implications

School performance improvement without a comprehensive, coordinated investment in social and environmental determinants of health will continue to produce unimpressive results. This is work that Public Schools cannot do alone.•Changes in early intervention system: need more attention for 5-20 mcg/dl (more research!)

– Not just Part C, more broad

•Changes in prevention system: targeted, proactive enforcement

Operational Data: Healthy Housing Mapper

NANCY SUTTONRHODE ISLAND DEPARTMENT OF HEALTH

Asthma Insurance Claims Project

Asthma

• Traditionally tracked 15 datasets, sizable

portion of Asthma Program budget

• These are necessary but not sufficient

• Much more precise data needed for case-

making, operations

• Enter… Insurance Data

RI Insurance Claims Data Project• RI Health Plan Data

– NHPRI

– BCBSRI

– UHC of New England

• Purpose:

– Map clustering of children w/asthma

– Identify high risk homes, neighborhoods, communities

– Document geographic clustering of asthma cases,

hospitalizations, and ED visits

RI Insurance Claims Data Project

• Providence Plan - RI Data Hub• Explore relationships between asthma and: – academic performance– school absenteeism– age of housing–poverty–public v. private insurance

Claims Data

• Address, Name, DOB

• # of Asthma Cases

•# of Asthma ED Visits

•# of Asthma inpatient admissions

•One Data Request = 3 insurers, 5 different

datasets!

First Run: Basic maps

Address data allow much more accurate mapping than ED/Discharge data from hospitals

Name and DOB will allow HUB linkage

Next Steps for Asthma

• Combine with lead hotspots for HH Mapper

– ID least healthy housing in city

• DataHUB Link to students, schools

– Confirm link to attendance, performance

– ID disproportionate asthma in schools

Imagine this analysis for Asthma

Policy Implications

• TARGETING LIMITED RESOURCES (e.g., Asthma Control Program)

– Identify schools, health centers, communities with greatest need for intervention

– Strengthens integration efforts

• HEALTH CENTERS/PRIMARY CARE PROVIDERS– integrate asthma into QI/Patient-Centered Medical Home models

• COMMUNITY PLANNING & DEVELOPMENT– provides evidence of association between poor housing/communities

& health– sidewalks, bike routes/paths, public transit, traffic routes, open space

Policy Implications

• SCHOOLS & PUBLIC/SUBSIDIZED HOUSING– Proximity to highways, Diesel– IPM/pest management– Cleaning supplies/practices– mold/moisture– smoke-free

• HOUSING– smoke free private housing rentals– code enforcement