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Novel Approaches to Addressing Health Disparities & Social Determinants of Health
HEALTH EDUCATORS INSTITUTE CONFERENCE
AMY R. SHEON, PHD, MPHEXECUTIVE DIRECTORURBAN HEALTH INITIATIVE
Disclosure—Amy SheonPresident and CEO, Public Health Innovators, LLC: provides consultation to health systems, governments, philanthropic, corporate, non-profit and academic clients around digital health equity and innovation.
Funding Contracts Through Case Western Reserve University:◦ Public Insight Data: Health data visualization Subject Matter Expert◦NODE.Health/Uber Health (Evidence Base for Mobile Health)◦Ohio Department of Medicaid (Virtual Reality SDOH Simulation)◦Office of Cuyahoga County Executive, via Connected Insights, re digital
connectivity and health
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Learning Objectives
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Demonstrate novel data visualization techniques including mapping and storytelling to increase understanding of social determinants of health (SDOH)Describe potential value of digital medicine for public healthDescribe disparities in digital skills and connectivity, and frame them as a social justice issueDescribe use of public health data in a medical hackathonDemonstrate use of virtual reality to increase awareness of social determinants of health and increase empathy accuracy
Part 1: Health Disparity Data Visualization
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https://www.healthdatamatters.org
5https://www.healthdatamatters.org/October 17, 2019 AMY SHEON OHIO HEI CONFERENCE
Rationale
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Provide single place for accessing definitive data on health outcomes and social determinants of health
Bring focus on health disparities and health equity, esp place-based
Encourage open data movementSpawn innovation through real-time data access
October 17, 2019 AMY SHEON OHIO HEI CONFERENCE
Historic Lens: Redlining & Health
HOLC REDLINING, CIRCA 1930S
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http://guides.osu.edu/maps-geospatial-data/maps/redlining/
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Cuyahoga County: Health Status
LIFE EXPECTANCY, 2010-2015 % LIVING IN POVERTY
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Data source: Cuyahoga County Board of HealthOctober 17, 2019 AMY SHEON OHIO HEI CONFERENCE
Power of Data Visualizations
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% BLACK
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Historic Lens: Redlining & Health
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R² = 0.1602
60
65
70
75
80
85
90
Year
s
Not Redlined Redlined
Redlining and Life Expectancy
Data source: Cuyahoga County Board of HealthOctober 17, 2019 AMY SHEON OHIO HEI CONFERENCE
R² = 0.2138
0
50
100
150
200
250
300
350
400
450
500
Deat
hs/1
00,0
00
Not Redlined Redlined
Redlining and Cancer
Part 2: Digital Medicine Technology to improve population health
AKA: Connected Health, Mobile Health
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https://www.medinaction.com/technology-revolutionizing-healthcare-the-future-is-changing-now/
Participate in research; update health status
Caregiver proxy access
What can you do with Digital Health Tools?
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Low Levels of MyChart Use at MetroHealth
020,00040,00060,00080,000
100,000120,000140,000160,000180,000200,000
Do Not Use PHR Use PHR
Num
ber o
f Pat
ient
s70.9%
29.1%
N=243,248
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Journal of the American Medical Informatics Association, Volume 24, Issue 5, September 2017, Pages 927–932, https://doi.org/10.1093/jamia/ocx020
Public Health Lens: Look at Disparities
34.1
23.4 23.8
05
10152025303540
White Black Hispanic
30.225.1
16.1
0
10
20
30
40
18-64 years 65-79 years 80+ years
Perzynski, et al 2017 17.4%
26.5%23.4%
39.3%
0%
10%
20%
30%
40%
UNINSURED MEDICAID MEDICARE COMMERCIAL
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Public Health Lens: SocioEcologicModel of HIT Barriers
SEM Model Source: U.S. Centers for Disease Control and Prevention
Fed/State/Local broadband policies
Access to internet, training, careProvider workflow, policiesTrust, support, content, development
Language, usability, privacy, cost
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Upstream Cause: MyChart Use by Broadband Access
17.5
22.5
29.8
36.334.8
0
5
10
15
20
25
30
35
40
0 - 20% 20 - 40% 40 - 60% 60 - 80% 80 - 100%
% U
sing
PHR
Census Tract Broadband Coverage % of total population
Perzynski, et al 2017
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Digital Divides As Social Justice Issue
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% With Broadband Internet
CLEVELAND SCENE MAGAZINE
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http://guides.osu.edu/maps-geospatial-data/maps/redlining/
% HH with no internet,2017 ACS 5 year estimate
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% Black
Digital Inclusion Framework
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% No Internet %HH Only Internet is Mobile
Digital Divides Risk Widening Health Disparities
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% Has Cell Data Plan Diabetes Prevalence, BRFSS 500 Cities Project 2015
Computers and Broadband in Home, 7 Cities
40.0
50.0
60.0
70.0
80.0
90.0
100.0
2015 2016 2017
% of Adults with BA
40.0
50.0
60.0
70.0
80.0
90.0
100.0
2015 2016 2017
% of Adults 65+ Years
40.0
50.0
60.0
70.0
80.0
90.0
100.0
2015 2016 2017
% of HS Grads
40.0
50.0
60.0
70.0
80.0
90.0
100.0
2015 2016 2017
% of <HS Grads
40.0
50.0
60.0
70.0
80.0
90.0
100.0
2015 2016 2017
% of Unemployed Adults
American Community Survey, 2015, 2016, 2017; analysis by Sheon. See: Health Data Matters LiveStories hdm.livestories.com
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Part 3: Digital Skills & Access as SDOH
Digital Natives?
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% of Youth <18 with Broadband
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Digital Inclusion as a Social Determinant of Health
Public Health Approach: Reframing
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“Digital Skills and Connectivity as Social Determinants of Health (SDOH)” panel
Solution: Population-based approach
Screening, Brief Intervention, Referral to Treatment (SBIRT)◦Screen all patients for digital skills and connectivity◦Refer to community organizations to address gaps in equipment, connectivity and basic digital skills◦Train patients to use health apps◦Train community health workers to screen, refer and train◦“Train the Trainer” model; partner with local CHW training programs
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Solution: Population-based approachScreening, Brief Intervention, Referral to Treatment (SBIRT)
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Cembali, NDIA 2018 Digital Inclusion Net Summit
Community Health Worker Model
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Addressing Disparities in Diabetes Management Through Novel Approaches to Encourage Technology Adoption and UseAmy R Sheon, Shari D Bolen, Bill Callahan, Sarah Shick, Adam T PerzynskiJMIR Diabetes 2017;2(2):6751
How can health systems leverage technology to engage patients? Sheon AR, Carroll L. 2019
Part 4: Bringing Public Health Perspective to Innovation
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Part 5: Bringing Innovation to Public Health: Neighborhood Immersion for Compassion & Empathy (NICE) VR Simulation for Medicaid Providers
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Thanks to:Health Data Matters and Neighborhood Immersion for Compassion & Empathy teams:
◦ Scott Frank◦ Matthew Kucmanic◦ Lauren Wooster◦ Alex Rothbaum◦ Bianca Wilson◦ Regime Willis
Live Stories (Adnan Mahmud)
Global Health Metrics (Adam Perzynski)
BioflightVR (Rik Shorten, Paul Suchy)
CWRU Medicaid Equity Simulation Team
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Dan Quigg, Public Insight Data
Digital Inclusion Partners:◦ Angela Siefer, National Digital
Inclusion Alliance (NDIA)◦ Bill Callahan, NDIA Policy Director
and Connect Your Community 2.0◦ Samantha Schartman, Connected
Insights◦ Adam Perzynski, MetroHealth
System◦ Wanda Davis, Ashbury Senior
Computer Community Center
Questions
[email protected]@amysheon
linkedin.com/in/amy-sheon-a1807212/
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![Visual storytelling [storytelling matters]](https://img.dokumen.tips/doc/110x75/54b865614a795970478b4802/visual-storytelling-storytelling-matters.jpg)
