By BETSY TAYLOR
When Chicago residents and visitors tweet publicly about food poisoning, a web application called Foodborne Chicago sends a message to the person who sent the tweet, asking if he or she would like to file an online complaint. Then, the Chicago Department of Public Health investigates.
Health leaders in Chicago promote a shared bicycle riding program. They are, from left, Dr. Bechara Choucair, Sandra Bruce, Dr. David DiLoreto and Dr. Jay Bhatt. At the time of the photo, Choucair and Bhatt were executives with the Chicago Department of Public Health; both men have new roles, with Choucair serving as a Trinity Health senior vice president. Bruce is president and chief executive of Chicago-based Presence Health and DiLoreto is chief executive of Presence Health Partners, a health care provider network.
In the two years since the program began, the app classified more than 3,700 tweets related to food poisoning and generated messages to the person who posted about possible food poisoning, resulting in more than 700 food poisoning reports, more than 500 inspections and the identification of critical or serious violations at more than 100 food establishments, according to a May news release from the City of Chicago.
The innovative use of social media and data related to public health in Chicago was just one of the topics that Dr. Bechara Choucair discussed with a few dozen community benefit professionals during a meeting earlier this year of the CHA Community Benefit Committee at CHA's office in St. Louis. Choucair, Trinity Health's senior vice president for safety net transformation and community health, is the immediate past public health commissioner for Chicago, having served in that capacity from November 2009 through December 2014.
He talked about how the Chicago Department of Public Health collaborates with health care systems and other organizations and how public policy impacts community health. He encouraged the community benefit leaders to harness data from multiple sources to yield greater insight into health concerns and new approaches to creating healthy communities.
Choucair expects to draw on his experience in public health in Chicago in his new role at Trinity Health, which he started early this year.
He said Livonia, Mich.-based Trinity Health is working to be a "people-centered health system," built on episodic health care management for individuals, population health management and efforts to improve community health and well-being. The system is undertaking its community health improvement efforts through clinical services; community engagement, including programs with wraparound services for the vulnerable and poor; and by advancing community efforts to build environments that support improved health, that promote economic revitalization and safe housing and that positively impact other social determinants of health.
Choucair said traditionally in work to improve the health of a community, a lot of focus is on counseling and education efforts.
But it's "hard to reach 3 million people this way," he said, referring to Chicago's population. That's why in Chicago's public health initiatives, a lot of attention is focused on systematic change as well as using data to target resources for maximum impact. A key message from the work in Chicago has been: "It's not just about individual behavior. It's about how we behave as a city," Choucair said.
He pointed to policy changes in Chicago that helped drive smoking rates to "historic lows" for adults and teens by December 2014, when he stepped down as commissioner. In 2013, Chicago increased its city cigarette tax by 50 cents, which brought the city's combined federal, state and city taxes on a pack of cigarettes to $7.17. Chicago also banned the sale of flavored tobacco, including menthol cigarettes, near schools; increased regulation of electronic cigarettes; and mounted an advertising campaign to raise awareness about the dangers of smoking and support the creation of more smoke-free environments, including smoke-free parks, he said.
A number of initiatives are aimed at improving access to fresh and healthy foods in neighborhoods without them. One program worked with corner stores to encourage them to stock more healthy options. In some areas, businesses and hospitals eliminated unhealthy choices from their vending machines. The Chicago City Council approved an ordinance in 2012 that requires produce merchants to dispatch 50 percent of their carts to food deserts, or areas of the city that lack grocery stores and access to fresh fruits and vegetables.
Bike to work
Choucair said the city started its Divvy bike share program in 2013, funded with tax dollars and sponsorship money from BlueCross BlueShield of Illinois. It encourages residents to bicycle commute to work, or to step up their activity level by using the bikes. After paying an annual membership fee, the first 30 minutes on the bikes are free each time, and riders can pick bikes up and drop them off at locations throughout the city.
Will Snyder, system leader for community transformation with Chicago-based Presence Health, said his health care system provided 100 free annual memberships for employees to the bike program in 2014 on a first-come, first-served basis. It is offering twice as many free memberships in 2015. All Presence employees are eligible for a $10 reduction on an annual membership for the program, meaning they'll pay $65 a year to join the bike share program.
By the numbers
Another important way that Chicago works to advance public health is by releasing data and information in more user-friendly ways. Choucair said the public health department also asks hospitals to share health data.
And efforts to bring together different data sets in Chicago have resulted in new tools, like the Chicago Health Atlas website, chicagohealthatlas.org, where residents can get information on health outcomes in Chicago and browse their own neighborhood or zip code data to find resources about how to improve their own health. (See box.)
The Chicago Department of Public Health launched a Flu Clinic Finder app, created by web developer Tom Kompare, that pinpoints the most convenient location for the user to get a flu shot.
Choucair said pilot programs in predictive analytics also are interpreting data from disparate sources to try to predict public health needs and to determine how best to target resources to meet those needs. For example, the department of public health and the Eric & Wendy Schmidt Data Science for Social Good fellowship at the University of Chicago developed a model to use predictive analytics to figure out which homes likely pose the greatest lead poisoning risks for city children. The fellowship program allows data science students to gain skills and to work on data science projects with social impact.
In a 2014 Harvard Business Review article, Choucair and co-authors Jay Bhatt and Raed Mansour said the model is based on "home inspection records, assessor value, past history of blood lead level testing, census data and more." Children exposed to lead can experience neurological problems, slowed development and problems with their hearing and speech, they explained. When a community can use data to predict where it should focus its public health efforts, it can make better use of limited resources. For instance, predictive analytics may help the city prioritize home inspections in high lead poisoning risk areas, they said. Predictive models can be incorporated into electronic medical records, too, alerting health care providers of lead poisoning risk levels in their pregnant patients and pediatric patients, to encourage preventive approaches as well as reminders about ordering blood lead level tests, they said.
Chicago Health Atlas cuts big data into tidbits
As an example of how data is being used in Chicago, the Smart Chicago Collaborative is working with the Chicago Department of Public Health and five area hospitals through the Chicago Health Information Technology Regional Extension Center on the Chicago Health Atlas, a website for displaying aggregate health-related information on a map. It allows people to see the prevalence of health conditions in their area and to find out how they can improve their health. See chicagohealthatlas.org.
Diving into data
Will Snyder, Presence Health's system leader for community transformation, has worked with the Chicago Department of Public Health on some of its population health efforts. He offers suggestions for health care systems looking to improve their data related to population health.
- Start by analyzing community demographics, high utilizers, Food and Drug Administration adverse events and Medicare Part D data. Other data points can be added, such as affordable housing, transportation access, air quality, water quality, lead levels and more.
- Ask the public health department for the latest mortality data, obesity rates, birth weights and more.
- The Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services both have troves of publicly available data at data.gov/health.
- Look into academic resources, like the Dartmouth Atlas of Health Care, which documents variations in how medical resources are distributed and used in the United States. See dartmouthatlas.org.
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