245588 Mapping Quality in Health Care Systems A Novel Tool for Population Management

Tuesday, November 1, 2011: 12:50 PM

Clemens Hong, MD/MPH , General Medicine Division, Massachusetts General Hospital, Boston, MA
Steven Atlas, MD/MPH , Generl Medicine Division, Massachusetts General Hospital, Boston, MA
Lulu Liu , General Medicine Division, Massachusetts General Hospital, Boston, MA
Wei He , General Medicine Division, Massachusetts General Hospital, Boston, MA
Lawrence Stratton , General Medicine Division, Massachusetts General Hospital, Everett, MA
Lenny Lopez, MD, MDiv, MPA , Disparities Solutions Center, Institute for Health Policy, Massachusetts General Hospital, Boston, MA
Richard Grant, MD/MPH , General Medicine Division, Massachusetts General Hospital, Boston, MA
Background: As primary care networks, including community health centers, develop population-based systems of care, geographic information systems (GIS) may be a useful tool for identifying communities or neighborhoods with poor quality outcomes. We used GIS to examine breast cancer (BRC) screening rates among patients within a large academic primary care network by the communities in which they reside. Methods: We obtained GIS coordinates from the addresses of 142,690 primary care patients within our network cared for by 174 PCPs working in 13 primary care practices, including 4 community health centers. Using data from an electronic record repository, we identified all patients aged 42-69 years old eligible for BRC screening and calculated the proportion overdue for screening by town or city neighborhood and by census block group to identify geographic areas with low BRC screening rates. We then categorized census block groups by higher and lower BRC screening rates and compared differences in patient socio-demographic characteristics and median household income. These analyses were limited to census block groups with greater than 30 qualifying patients. Results: Overall, 9033 (21.3%) of eligible patients within our network were overdue for BRC screening; overdue BRC screening rates by census block group ranged from 0.0% to 53.3%. Maps generated from these data showed considerable geographic variation in the rate of overdue BRC screening among all network patients in Boston neighborhoods and surrounding towns. When we limited the analysis to patients receiving care at one network-affiliated community health center, maps identified several specific census block groups within the community with particularly high rates of overdue BRC screening. Across the Massachusetts area served by our network, census block groups with lower BRC screening rates had higher proportions of minorities (30.5% vs 17.9%, p<0.001), non-English speaking patients (17.3% vs 9.0%, p<0.001), and those not completing high school (13.4% vs 6.7%, p<0.001), and a lower median household income ($54594 vs $75739, p<0.001). Conclusion: Mapping quality indicators using GIS coordinates derived from administrative data may be a useful tool for geographically targeting resources and for tailoring interventions to the needs of specific communities. This detailed geographic approach may enable health systems to identify communities that are at high risk for lower quality outcomes and thereby reduce disparities in health and healthcare.

Learning Areas:
Provision of health care to the public
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe the potential use of geographic information system (GIS) data in identifying geographic areas with poor quality outcomes.

Keywords: Primary Care, Cancer Screening

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I am a junior faculty health services researcher that does research on health care delivery and quality improvement in primary care.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.