Assessing the Public Health System in Delaware

Assessment Results

Essential Public Health Service #1:
Monitor Health Status to Identify Health Problems

On August 16, 2006, an Assessment Team including representatives from Nemours Health & Preventions Services, University Of Delaware, Delaware Health Care Commission, KIDS COUNT, and Division of Public Health (DPH) listened to public testimony from DPH, University of Delaware, and Health Commission. The Assessment Team then examined how the public health system in Delaware performs Essential Service #1: Monitor Health Status to Identify Health Problems . This service includes activities to:

1. collect and analyze health-related data;
2. report population-based trends in health status;
3. review the sufficiency and relevance of health data that is collected; and
4. use health-related data for planning and policy development.

The Assessment Team looked at four activity categories:

1. planning and implementation;
2. technical assistance and support;
3. evaluation and quality improvement; and
4. resources.

The Team identified a number of gaps in the public health system performance of this essential service in Delaware. A consensus agreed that the statewide public health system performance level is just above 50% based on the model standard for Essential Service #1.

The Assessment Team rated the Delaware public health system as having substantially met the model standard in the following indicator areas:

1. evaluation and quality improvement and
2. resources.

Under these two indicator areas, Delaware public health system partners are fairly strong in reviewing efforts to monitor health status, improving the use of data and data systems, using technology to monitor statewide health status, and gaining feedback from public health system partners.

The Team identified noticeable gaps in the indicator areas of:

1. planning and implementation, and
2. technical assistance and support.

Gaps included:

1. incomplete state health profile with poorly organized data;
2. no set of uniform health indicators;
3. minimal assistance in developing information systems;
4. no standard set of health-related data for partners.

Evaluation of the Assessment Process:

Members of the Assessment Team felt the public hearing information was very helpful and they appreciated the interaction and openness throughout the session. The process and the format of the assessment were well received, but the topics were quite broad and it was difficult to stay focused especially since some of the questions were difficult to understand and were open to interpretation.

Sharing of Final Thoughts

Assessment team members shared a wide range of thoughts about the assessment. The assessment was recognized as a rare opportunity to get together to learn from one another, and it emphasized the need for collaboration and working together to address gaps. Other comments focused on the issue of data sharing incompatibilities. If we had resources to envision a true IT architecture for the public health system, we would be able to identify the gaps and develop priorities to address them. One member was surprised to hear that Delaware is one of only 17 states that is going through the assessment process, and that Delaware is one of the first states to begin electronic data linking and access. One team member suggested that public health system partners need to do a better job of lobbying about successes. Another member was impressed with the expertise around the table, and felt the scores did not reflect that fact. A final comment spoke to the need for oversight for the entire public health system.

Priority List

Each member of the Assessment Team was asked to vote on a scale of 1 - 10 on the importance and priority of each of the four activity categories with 10 being the highest priority. Below are the indicator areas with the priority scores and a summary of strengths (in italic) and gaps (in bold ) that were identified during the public testimony. There was a lot of information that was shared and hopefully we captured the critical points.

1.1 Planning and Implementation (score – 9)

• Quick turnaround - surveys can be adjusted to fit current needs – i.e. during Flu vaccine period directly related questions can be added (flexibility);
• High-quality data
• Electronic system to facilitate use of vital records – one of only a handful of states
• Enhanced overall disease monitoring system in Delaware
• Health Insurance Portability & Accountability Act of 1996 (HIPAA) and firewalls offer increased security of data
• DPH Health Statistics Center (HSC) is mplementing the Electronic Vital Records System (EVRS)
• HSC maintains good storage methods
• Department of Education gather youth only data every other year
• Adult survey only - Delaware residents, non-institutionalized - low prevalence means aggregate data which often is not timely
• Cut funding - CDC has level funding or reduced funding for many programs 
• Lack of reproducing and sharing of data
• Cultural competency needs
• No longer have CAPS survey (Consumer Assessment of health care services) – need data about how DE interacts with health care system

1.2 Technical Assistance/Support (score – 7)

• Technical Support is available from Public Health & CDC
• Electronic reporting replaces paper reporting
• Expertise in investigation skills
• New Emergency Department Syndromic Surveillance System - syndromic reporting
• Facts sheets & database available to researchers
• Proactive – staff are available for assistance; flexible
• New electronic system lacks formal training programs
• Informal training provided only to selective individuals/groups
• Data limits - survey forms don't collect all pertinent demographic data
• HSC does not offer statistical or technical training in general; data not warehoused centrally
• Not a high degree of statistical analysis capability in house – tap into other resources
• Small population, low disease prevalence & lack of funding
• Lack of out-patient/emergency room data throughout DE hospitalization 

1.3 Evaluation /Quality Improvement (score – 7)

• Annual quality control reports
• Updated infant mortality data
• Strategy to institute new Hospital Discharge Review Board 
• Lack of surveys to collect data from detention centers such as substance abuse, crimes of violence
• Insufficient data - need to look at the entire picture 
• Barriers, utilization and disparities ossies around data
• Lack of feedback on reports and distribution 

1.4 Resources (score – 10)

• Youth data is available
• Annual demographic file is maintained
• Internet/fact sheets are available
• Surveys such as Pregnancy Risk Assessment Monitoring Systems (PRAMS) are conducted
• Collaboration does exist
• Nemours is a great resource to Delaware
• Delaware Children’s Health Chart Book (on-line version coming) is available
• Delaware Electronic Reporting Surveillance System
• Information and data shared; grants (made new positions possible – in response to Infant Mortality Initiative)
• Rural Health Initiative was formed
• High level statistical analysis – tap into other resources to compensate
• Demand for a qualified workforce is needed
• Decline in response rates to surveys
• Technology challenges
• Support for hardware & software lacking 
• Small state thus small sample size

Next Steps:

Once the discussion and reports from this meeting are shared with the group, several participants mentioned considering setting up town meetings with health organizations to bring the outcomes of the assessment to the communities. Several participants expressed the need to share contact information of all assessment team and the folks who provided testimonies. The Division of Public Health anticipates convening a meeting in the first quarter of 2007 with all of the participants in each of the essential service assessments. Participants will be asked to prioritize the services and gaps, develop an implementation plan, and draft action steps with assigned responsibilities.

• Go back to 2006 Assessment Meetings and Summaries

Last Updated: Wednesday July 11 2007