From Demonstration Projects to Documented Progress: Incorporating Hospitalization Data in Environmental Public Health Tracking

Data on inpatient hospitalizations and emergency department visits can be a valuable source of morbidity information for public health surveillance. Environmental public health tracking (EPHT) network developers have sought to incorporate hospitalization data because of their utility in evaluating the contribution of air pollutants such as ozone and particulate matter to adverse health outcomes such as asthma attacks and myocardial infarction (MI). Results of demonstration projects conducted in Wisconsin and elsewhere to explore how linking hospitalization and air quality data can advance public health surveillance led to the establishment of several hospitalization-based core measures among those upon which EPHT networks will be based. These include both summary measures (environmental public health indicators) and discrete data sets that provide nationally-consistent information about hospitalizations from EPHT grantees and other health agencies. In Wisconsin, outcomes from demonstration projects to (a) create an online report generation portal for accessing and analyzing asthma hospitalization data, and (b) conduct a multi-state analysis of hospitalization data for asthma and MI in tandem with air quality data were critical in evaluating approaches by which hospitalization data could be incorporated in EPHT networks. Ongoing challenges for state and national EPHT programs regarding hospitalization data include balancing desires for broadly-accessible platforms containing detailed data with confidentiality concerns, resolving spatial and temporal differences observed upon linkage with air quality data, and constructing clear and effective environmental public health messages based on hospitalization data from different jurisdictions.