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2011 Model Practice Application (Public)
Application Name: 2011 Model Practice Application (Public) : Nassau County Department of Health : Real time advanced digital mapping to plan, identify and respond to vaccination penetration rates
Applicant Name: Dr. Maria Torroella Carney, MD, FACP
Real time advanced digital mapping to plan, identify and respond to vaccination penetration rates
Champaign-Urbana Public Health District
Real time advanced digital mapping to plan, identify and respond to vaccination penetration rates
Responsiveness and Innovation
Planning and responding to a pandemic is the core function of any health department in the country. The H1N1 pandemic was the single greatest threat to public health in the last many decades. It had the potential to kill millions and sicken many more. This came during the midst of the worst economic turmoil around the world. Although the Federal government and the WHO provide leadership and guidance on the response, each community is different. The response to a pandemic is truly local. The public health issue addressed through this practice includes assessment of the community demographics, resource availability and reaching the at-risk and vulnerable population through our vaccination efforts so as to curb the impact of the pandemic.
Agency Community Roles
CUPHD was the lead in implementation of the practice. In collaboration with the GISSA Lab at the Univerisity of Illinois, CUPHD lead the charge in providing funding, space and data for the practice. In addition CUPHD provided the administrative support for all practice related activities. Data collection, an integral component for real time mapping was done by the staff at CUPHD.
Costs and Expenditures
Target population/audience, if applicable: Champaign county population of 180,000 The number or percentage of the target population/audience reached, if applicable: 35% Public health issue that this practice addressed: The CUPHD worked collaboratively with the University of Illinois College of Veterinary Medicine Geographic Information System and Spatial Analysis (GISSA) lab to better plan, prepare for and respond to the H1N1 pandemic using real time advanced digital mapping. This response involved development of maps and protocols to facilitate creation of actionable maps and sharing of information for public health. For planning purposes we developed local, accurate maps of schools and day care centers, demographics and other local social and public health infrastructure. We evaluated our specific planning needs for vaccine delivery and potential acute disease outbreak starting in early 2009. Following CDC vaccine delivery recommendations, the vaccines were delivered first to target populations including children 9 years and under, and pregnant women. Goal: To plan and respond in real time to the needs of a potential acute disease outbreak through the creation and use of basic and advanced digital maps. Objective 1 - Develop and use a protocol for creation of maps of vaccinated individuals by place of residence integrated with census data, schools and other critical facilities using geographic information systems. Objective 2 – Develop and use mapping methods to provide timely information to decision-makers at CUPHD to ensure the inclusion of vulnerable populations during the delivery of H1N1 vaccines. Objective 3 – Develop effective communication of information from the technical outcomes to decision makers and the media and include feedback throughout the team working to improve vaccination rates. This practice was implemented during April-December 2009. Collaboration and Infrastructure was in place long before the pandemic arrived in our community. We have been planning and implementing the strategy for retrospective mapping of seasonal flu vaccinations for better decision making since 2006. It has been our intent to keep this practice low cost and replicable to other communities. The project has been implemented through the PHEP funding that comes through the State Health Department. There is minimal funding requirement once the infrastructure is in place. Outcomes of practice: The practice was successfully implemented and all of our objectives were met. What specific factors led to the success of this practice? (400 word limit) The communications, technical and data infrastructure to support the practice was in place before the pandemic. This was of critical importance for the success of the program. The leadership at the Health District has long been very supportive of implementing new technology for delivery of quality healthcare services to our community. The whole system is part of the daily working of the CUPHD and maps were created in GIS as necessary by the GIS analyst without special arrangements or complex contracts. The commitment to maintain a public health mapping system within which this process was developed, was already in place prior to implementation of the system and continues to this day. High quality and previously vetted data and protocols were available real time during the pandemic when resources were already thinned. This helped in informed decision making. Thus, this practice was implemented with modest resources and good community connections.
Although Geographic Information Systems (GIS) are very frequently used in public health planning,
many of the models developed for influenza do not use real time data for planning purposes. The real-time mapping tool was able to determine the population demographics and pockets of
vulnerable groups in the community. The accurate and up-to-date information on schools and day
care centers was especially helpful in development of efficient plans for vaccine distribution and
targeted outreach. Using GIS maps, we were able to look beyond individual level factors determining the vaccination and take neighborhood factors into consideration during the emergency flu response. Groups that had highest risk were targeted and vaccines and resources were redistributed to those areas. We believe that this method enabled proper allocation of resources We were able to assess the number of vaccinations given to the recommended population in real time and modify strategy based on evidence based public health practice.
This practice was implemented during April-December 2009. Collaboration and Infrastructure was in
place long before the pandemic arrived in our community. We have been planning and implementing the strategy for retrospective mapping of seasonal flu vaccinations for better decision making since 2006
This project was made possible with dedicated partners from the community. The main partner for this practice was the GISSA lab at University of Illinois. This lab provided the technical skills required to process spatial data and create the maps and analysis desired by the Health Department. In addition, the regional planning commission partnered with the Health Department to provide local up-to date property parcel and street base maps that were required for this practice. And finally, the
healthcare and first responder community supported this initiative by providing timely data for
analysis. Timely communication with sharing of information is the key to fostering strong collaboration among community partners and stakeholders. The Health Department involves stakeholders during the planning and implementation phase of the practice as it fosters commitment and ownership among partnering entities and builds a strong foundation for success
of the practice.
This practice required only minimal start-up cost as most of the work was already being done as a university-local health department partnership. In-kind costs include personnel time at the Health Department and facilities and administrative support. The project has been implemented through the PHEP funding that comes through the State Health Department. There is minimal funding requirement once the infrastructure is in place. Minimal personnel time is dedicated each week to keep the datasets updated so that they could be utilized during an emergency. These datasets are also utilized for other Public Health program planning, evaluation and implementation on a daily basis.
Outcome Process Evaluation
Objective 1: Develop and use a protocol for creation of maps of vaccinated individuals by place of residence integrated with census data, schools and other critical facilities using geographic information systems. Performance on this objective was measured by monitoring project development milestones, including identification of required data (population demographics and place lcoations) and their sources, development of a protocol for mapping health data, creation of maps, and production of complete protocol and procedures for meaningful mapping of public health data. The key metrics for this protocol were completeness, flexibility, and meaningful representation of data. The performance data (project plan milestones and the final report) were collected and reviewed by the project lead, epidemiologist Awais Vaid. Project team meetings were held monthly during the spring of 2009 and the final protocol and report were submitted in June,2009. The data incorporated into the model included locations of all childcare facilities, all schools, and certain census data (by block group) such as income, and average number of children per household. Mr. Vaid determined that the protocol had succeeded on all metrics. The protocol ranks high in flexibility because any kind of data can be visualized as a layer in the map, enabling the comparison of that data to any of the built-in data (locations of schools and population demographic information). Extending the flexibility is the option to import and map any data reported in the U.S. Census reports and other local data. The representation of data was determined to be highly meaningful as it is possible to layer the geo-referenced health data (e.g., number of immunizations per census block group) on top of any sort of geo-referenced information (e.g., census data or locations of facilities). By using such data and systems in the past during periods without the immediate threat of pandemic, the experience in interpretation and communications needed for effective use were well established. This information enables the local health department to pinpoint locations of extreme (low or high) adoption, incidence, or risk. Regular meetings as this project developed enabled a cycle of feedback among the partners developing the protocol, tools, and maps. Objective 2: Develop and use mapping methods to provide timely information to decision-makers at CUPHD to ensure the inclusion of vulnerable populations during the delivery of H1N1 vaccines. Performance on this objective was measured in terms of frequency of updated maps, and length of time from the receipt of new raw data to the production of mappable data to meaningful maps in the hands of decision-makers. Mr. Vaid was responsible for coordinating the production of updated maps of vaccination rates. Prof. Marilyn Ruiz, director of the GISSA lab provided oversight and advice to the GIS technician. Without such a system in place, data would have been presented to decision-makers as a spreadsheet or table. Visualization of data would have been limited to the community level, and pinpointing areas of high need, or low compliance would have been impossible. In the past, decision-makers were limited to using their best-guesses to commit resources and later analysis often revealed gaps that might have been closed if the decision-makers had access to better information. Because a protocol and tools were already in place, the time from new data to meaningful maps in the hands of decision-makers was less than a day. Thus, the evidence of the success of this practice is simply that decision-makers had maps of immunization data as they were making decisions on where and how to commit resources. Objective 3: Develop effective communication of information from the technical outcomes to decision makers and the media and include feedback throughout the team working to improve vaccination rates. Performance on this objective was measured in terms of vaccination