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What is the leading cause of death for your home county? Is the age-adjusted death rate for this condition significantly different from the statewide rate? How often are people from your county hospitalized for this disease?
If your county happens to be in Missouri, the answers to these questions are literally at your fingertips.
Public health officials there late last year began to roll out a Web page that allows residents to query a vast array of public health and facility data about the Show-Me state. In less time than it takes State Health Watch to describe the process, answering these questions is possible for virtually anyone with Internet access.
"What we’re really focusing on is getting data out to the communities so that they will have it available for community assessment," says Garland Land, director of the state’s Center for Health Information and Management.
The state’s data dissemination efforts focus on state and county profiles and on an interactive system called Missouri Information for Community Assessment (MICA). Mr. Land says expanded public access to health data stems from an effort by state governments and the state’s hospitals to encourage local health needs assessments.
In 1995, the Missouri Hospital Association contracted with Andersen Consulting to develop a planning tool kit dubbed Community Health Assistance Resource Team. The state Department of Health later required local health departments to perform health assessments and made available up to $10,000 per county for that purpose. While not all of Missouri’s 114 counties conducted the assessment the same way, the process did expand the grass-roots awareness of the process and particulars of health planning.
The Missouri Hospital Association currently is in the second year of a five-year program to fund intervention projects based on the results of the local assessments. The contract funds, approximately $250,000 in the first year and $400,000 for subsequent years, are administered by the state Department of Health.
Project areas among the 1999 proposals include substance abuse among adolescents, the use of resource mothers for pregnant teen-agers, and intensive housing and health education interventions for the elderly, says Doris Boeckman, a community interventions specialist with the state Department of Health. She credits a "very strong" relationship between the hospital association and state officials in executing what has become a national model in community health assessments.
"We wanted to make sure data was easily available to the communities so that the assessment process was as easy as possible," says Mr. Land. He says the state’s on-line initiative replaces a "pretty cumbersome" paper-based process for responding to residents’ requests for health data. "If you didn’t give the data to them exactly the way they wanted, they’d have to make a special data request and it might take a few weeks to get it to them."
The county-specific profiles provide information on morbidity and mortality, use of health services, the availability of health care resources, and several other public health measures. For data wonks, the page includes hot links to definitions of the causes of death and descriptions of the technicalities of age adjustment. The explanations are unobtrusive, though, and a background in epidemiology is not necessary to interpret the data.
MICA allows a user to create a specialized report on seven different categories of health data, including vital statistics and hospital discharges.
The information on hospital discharges is a subset of the patient-specific UB-92 data collected by the state as a condition of hospital licensure. Hospital data in the MICA system are oriented toward public health and do not include items such as payer, patient origin and destination, and charges.
State statutes limit the level of detail the Department of Health can release, either by special request or on the Web. For its members, the Missouri Hospital Association will continue to make available detailed hospital discharge information and specialized reports through a subsidiary, the Hospital Information Data Institute.
Two full-time analysts in the state Department of Health maintain the system, drawing on ad hoc assistance as needed. The project was jump-started by a grant from the Centers for Disease Control and Prevention.
Steve Wenger, director of market research and population health at Heartland Health System in St. Joseph, is a member of a committee that advises the state on how the data system should be developed. Mr. Wenger says the "exciting piece" of the project is putting the data in the hands of community health advocates with whom he works. "I’m trying to be an ambassador, and more and more people are using it," he says.
Contact Mr. Land at (573) 751-6272 and Ms. Boeckman at (573) 751-6412.