In Hamilton County Ohio—home to the city of Cincinnati—it’s not unusual to see kids from the same neighborhoods and complexes coming to the hospital for asthma attacks.
In fact, Andrew Beck, M.D., a pediatrician at Cincinnati Children's Hospital Medical Center, says that a few years back, he and other researchers began to see a loose correlation between certain neighborhoods and higher rates of asthma admission into the hospital. Meanwhile, he was seeing patients from well-to-do neighborhoods with significantly lower rates of admission.
The variation got him thinking about the possible link between air quality in a specific housing complex and rates of asthma admission. Dr. Beck and his fellow researchers decided to see if there was a correlation between the air quality in certain neighborhoods and the number of children from those neighborhoods that were admitted to the hospital for asthma. To do this, they had to compare housing and health data sets.
“We were looking at the correlation and relationship between census-track level housing code violation density and the rate in which children from those census tracks either came to the emergency department or were admitted for asthma,” Beck says.
The researchers studied 4,355 children between the ages of 1 and 16 who visited the emergency department or were hospitalized for asthma at Cincinnati Children’s between January 2009 and December 2012. They tracked those kids for 12 months to see if they returned to the ED or were readmitted for asthma.
Not only were the researchers able to capture a firm correlation between the two sets, they were able to advance the research to predict which kids were at high-risk to return to the ED or hospital based on where they live. Children who lived in areas with poor air quality were 84 percent more likely to return, according to Beck’s findings. Even with most of the population in predominantly poverty-stricken areas, the researchers were able to differentiate between high-risk and low-risk housing complexes.
“The reality was that most of the population we studied in this study were poor kids in the inner city. We were still able to see differences within that population,” Beck says. “That was surprising.”
Integration of Housing and Health Data
At a time healthcare still lives in silos, the integration of housing and health data sets is a novel concept. However, Beck says that in order for population health to work, leaders at accountable care organizations (ACOs), health systems, and other provider organizations headed down this path must consider it.
“This is quite relevant to the new era of accountable care and population health,” Beck says. “Figuring out ways in which we can [prevent hospitalizations and ED utilization] will take us away from standard medical management and place us into the realm of social and environmental services.”
Non-traditional medical data integration has begun to take place in some medical collaborative environments already. The New York-Presbyterian Regional Health Collaborative created a medical village, which “goes beyond the established patient-centered medical home mode.” It not only connects an academic medical center with a large ambulatory network, medical homes, and other providers with each other, but community resources such as school-based clinics and specialty-care centers (the ones that are a part of NYP’s network).
Integrating housing and census data as part of this push toward evidence-based medicine is conceivable, says Beck. Electronic identification of a patient’s location isn’t the tough part, he notes. The tough part is integration of this data into the electronic health record (EHR) in a way that prompts the clinician to intervene.
“Figuring out how to get the data in and use it to drive appropriate interventions is a challenge, but I think it’s certainly realistic,” says Beck.
Of course, getting to this point will take work. Beck sees help needed from both the policy side and from the IT side to achieve integrated housing and health data.
From the policy side, he says there needs to be “pay-for-performance” reimbursement for housing inspectors, community health workers, and others on the front line. Also, from a conceptual level he’d like to see at the point of housing data collection, thoughts on how it will be utilized at the bedside.
From the IT side, Beck points to innovation as the key ingredient towards an integrated future. IT leaders must figure out how to stay innovative when it comes to developing systems and learn from other industries. “It’s the concept of buying something on Amazon with two clicks and then it shows up at the door a day later. How can we bring that seamless connection from objective to outcome in healthcare?” he says.
