This document summarizes Donald Hayes' presentation on the use of geographic information systems (GIS) technology and community level data visualization to inform planning efforts in Hawaii. Some key points: - The Hawaii Department of Health uses a variety of health and socioeconomic datasets to identify needs, support grant applications, research, legislation and program evaluation. - Data is compiled into a Primary Care Data Book which provides indicators by community on health outcomes, risk factors and socioeconomics using data sources like the census and vital records. - The Data Book is used to assess primary care needs, highlight differences between communities, and facilitate data-driven decision making. It has supported funding and policy decisions and is utilized by various organizations.

1. Use of GIS
technology to
inform planning
efforts through
visualization of
community level
data in Hawaii
Presented by
Donald Hayes, MD MPH
CDC Assigned Epidemiologist
Hawaii Department of Health
Family Health Services Division
Oct 16, 2015

2. Acknowledgments
 Pat Heu and Linda Chock, FHSD Chief -- acting
 Annette Mente, FHSD Planner
 Catherine Sorensen, FHSD Office of Primary Care
and Rural Health
 Division of Reproductive Health, CDC
 Maternal and Child Health Bureau, HRSA

3. Use of Data
 Increase awareness about particular issue
 Grant applications
 Identify new research questions
 Identify Gaps in the data
 Prepare for legislation and policy work
 Program Evaluation
 Where should limited funds get distributed

4. Some datasets in Hawaii
Birth Certificate
Death Certificate
Behavioral Risk Factor Surveillance System
Pregnancy Risk Assessment Monitoring Survey
Youth Risk Behavior Surveillance
Youth Tobacco Survey
Birth Defects
Women, Infant, and Children
Newborn Metabolic Screening
Newborn Hearing Screening
Early Intervention Services
Hawaii Household Survey
JABSOM National children study
School Data
Emergency room data
EMS Transport Data
Injury Data
Cancer Registry
Fetal Deaths
Family Planning
Medicaid
Children with Special Health Needs
Breastfeeding survey
Perinatal Support Services
Child Death Review
Immunization
Emergency Preparedness
Primary Care Contracts
Health Insurance Claims Data
Medical Outpatient Records
Electronic Health Records

5. Some FHSD Data Products
 Primary Care Data Book
 PRAMS Trend and County Reports
 FHSD Profiles
 Health Status of Children in Hawaii
 Perinatal and Title V Fact Sheets
 Birth Defects Surveillance Reports
 Journal Articles– Child Obesity, Adverse Birth Outcomes, Postpartum Depression, Intimate
Partner Violence, Breastfeeding, Physician Screening, Chronic Disease and Birth Outcomes,
Adverse Childhood Events, Oral Health Services Utilization…..
Most reports are online at hawaii.gov website
All DOH and older FHSD: http://health.hawaii.gov/about/publications/
Starting 2015, but still on all DOH:
http://health.hawaii.gov/FHSD/publications/
Evaluation and Feedback
http://health.hawaii.gov/fhsd/evaluation-forms-2

6. Primary Care Needs Assessment
(PCNA) Data Book
 Health and socio-economic indicators by Community in
Hawaii
 Multiple Data Sources
 Census, ACS
 Vital Statistics
 BRFSS
 Hospital Discharge
 Tables/Maps highlight differences
 Need Community Involvement

7. Background
 1990-1994 Primary Care Access Plan
 Present Population Based Surveillance Data by
Community
 Improve awareness and discussion
 Facilitate data to action
 Initial MCH focus, starting in 2005 expansion to reflect
primary care
 Diverse Audience including
 Health Policy Makers
 Legislators
 Planners
 Public
 Distribution
 Hard Copy
 Online PDF

8. Summary
 Overview
 Summary Tables (all
indicators)
Chapter 1
 Introduction
Chapter 2
 Primary Care Office
 Designations
Chapters 3-8
 Indicators

9. Primary Care Areas Defined
• More detail on 3 largest areas (Ewa, E. Honolulu, W. Honolulu)
- 11 new areas
• 2010 Census Tract Changes

10. Hospital Locations

11. Community Health Centers

12. Health Professional Shortage
Areas

13. Methodology
 Census tract data aggregated into 35
communities in the State of Hawaii, County
and State level.
 For BRFSS data, Zip Codes converted to
areas based on Missouri Data Center Zip
code to census tract estimates
 Hospital discharge data, priority was census
tract information, but conversion used based
on zip code for those without
 SAS, SUDAAN software was used to create
an Excel document for use in ArcGIS

14. 2009 Version

15. 2012 Version

16. 2009 vs. 2012

17. Proportion of Population 65 years and over
 State: 14.0%
 [13.3% in 2000]
 7.7% in Mililani
 8.1% in Kapolei-Makakilo
 19.7% in Waikïkï-Pälolo
 20.1% in Hawai‘i Kai-
Kaimuki
Socio-economic Indicators (Chapter 3)

18. Proportion of Population Native Hawaiian
 State: 21.3%
 [19.8% in 2000]
 11.3% in Waikïkï-Pälolo
 11.3% in Airport-Moanalua
 57.4% Häna
 58.5% in Wai‘anae
 61.8% in Moloka‘i

19. Proportion of Adult Population Uninsured
 State: 7.1%
 3.5% in Hawai‘i Kai-Kaimuki
 3.8% in McCully-Makiki
 14.8% in Ka‘ū
 15.7% in South Kona
 19.4% in Häna

20. Proportion of Children in Households Receiving Assistance
 State: 17.2%
 4.2% in Hawai‘i Kai-Kaimuki
 4.7% in Lähainä
 43.0% in Puna
 49.2% in Wai‘anae

21. Infant Mortality Rate (per 1,000 live births)
 State: 6.0
 3.9 in Makawao
 4.2 in Wailuku
 4.2 in Köloa
 10.1 in Wai‘anae
 12.4 in North Kohala
Maternal and Infant Health (Chapter 4)

22. Proportion of Adults Who Are Obese
 State: 21.9%
 13.2% in Hawai‘i Kai-Kaimuki
 13.8% in Waialua
 37.6% in Moloka‘i
 43.5% in Wai‘anae
Morbidity-Risk Factors (Chapter 5)

23. Disease of the Heart Mortality Rate (per 100,000)
 State: 135.2
 72.3 in Mililani
 97.4 in Hawai‘i Kai-Kaimuki
 109.1 in Hänalei
 231.3 in Häna
 260.4 in Wai‘anae
Mortality (Chapter 6)

24. Proportion of Adults with No Teeth Cleaning Within Past Year
 State: 28.7%
 18.4% in Hawai‘i Kai-
Kaimuki
 22.4% in Wahiawä
 22.5% in McCully-Makiki
 43.8% in Puna
 47.6% in Wai‘anae
 49.3% in Ka‘ū
Adult Oral Health (Chapter 7)

25. Proportion of Admissions with a Substance Related Disorder
 State: 8.9%
 4.3% in Waipahu
 4.5% in Mililani
 5.0% in Hickam-Pearl City
 13.7% in South Kona
 13.8% in North Kona
 14.2% in Häna
 17.0% in Lähainä
Mental Health and Substance Related Admissions (Chapter 8)

26. Example 1: Grant Application
 ACA Grant For Home Visiting Announced
 Portion related to Needs Assessment (NA)
 NA a requirement for Title V agencies
 Portion of NA completed by use of data from PCNA
Data Book for identification of high risk communities
(poverty, low birth weight, infant mortality, no high
school diploma, unemployment, etc….)
 Data contributed to multi-million dollar grant award

27. Example 2: Data and Budget Cuts
Reduction in Primary Care Contracts in
response to executive memo
 FHSD Recommendation made to not eliminate or drastically
reduce the funding and develop contingency plans before any
drastic change in funding.
 Data used to justify higher risk in the areas served by the
contracts (poverty, per-capita income, unemployed, no high
school diploma,...)
No reduction

28. Example 3: Community Health Needs
Assessment
Individual Hospital CHNA
 Data used throughout several of the hospitals CHNA to comply
with federal requirements for nonprofit hospital organizations
related to ACA (to satisfy a requirement of a community health
needs assessment) . Various indicators used (in addition to
other data sources and outreach) including substance use and
mental health hospitalizations, behavioral risk factors, socio-
economic, and mortality data.

29. Example 4: Overlays
Department of Native Hawaiian Health, JABSOM. Assessment and Priorities for Health & Well-Being in Native Hawaiians & Other Pacific Peoples.
Accessed online at http://www2.jabsom.hawaii.edu/native/comm_ulu-reports.htm

30. Example 5: Other known uses
Journal Article references
Book Article references
Medical Practice Business Plan
Rural Health Nursing Resources

31. Evaluation
Feedback
 Paper
 Online

32. Evaluation Results
 Information from:
 Community non-profits
 Government agencies
 Education Institutions
 Use it for:
 Needs Assessment
 Planning
 Grant
 Resource/Facilities Planning

33. How use?
 Community Health Centers (CHC) need to update their
needs assessments (part of their federal grant application
process) every 3 years. The PCNA data book provides
valuable health information stratified by geographic regions
that match up with CHC service areas. As such, the PCNA
data book makes finding relevant health data so much easier
and convenient.
 Used specific topic information and shared as fact sheets
related to division and maternal and child health priorities.
This assisted in discussion with other partners and supported
further partnerships and use of this book by others in the
State.
 Indicators selected demonstrate significant community level
differences and highlight the importance of data visualization
by geography. Consolidates multiple data sources into one
document

34. How use?
 Use it to share information with stakeholders about community level
differences. Raises awareness and discussion of complex issues
 A lot of information that highlights the geographic disparities are
very useful. This resources provides comparative data across a
range of topics from birth to death. It includes risk factor and socio-
economic characteristics which are very useful in characterizing
communities for potential grant opportunities.
 Have used this in the request for information and request for
proposal process in serving specific geographical areas and as
reference materials for providers to use. Have incorporated in
presentations for grantors on areas being served through women's,
infant and maternal and child health contracts. Have referenced in
discussions with public health stakeholders and collaborative
planning activities. Have recommended to community stakeholders
for use in their planning and other activities to serve those in need.
 Ability to demonstrate service providers are located in appropriate
high risk communities

35. Other information?
 Early Childhood indicators. The ability to look at an online version that allows
you to get estimates from multiple indicators for a community. What about being
able to look at overlays and see if there are statistical differences/relationships
between communities.
 Hospitalization data, trends...Wouldn't it be great to see this on an interactive
map or if it could be dumped or used with UDS mapper?
 Homelessness
 Would like to see associations between the various indicators. For example,
how much of the heart disease deaths are due to poverty characteristics. Can
these maps be interactive so I can just select a community and get a download
of all the data for that particular community. I know the length of the book is a
concern, but think you should consider showing these same indicators by other
groups when possible (Race, education, language, insurance, employment,
etc...). Thanks for the great resource and look forward to its continued evolution
and usefulness. When is the next version coming out?
 Although aggregating the data based on population of each district, sometimes
for some of the work that we do and information that we need, stratifying it
further by ethnic background in each district will be very useful for us. Also,
having a group on Micronesian (or maybe just Pacific Islander without Native
Hawaiian) will also be useful as these groups are one of the special populations
that FQHCs serve and data on this group would be useful (although I am not
sure if their sample size would be sufficient to add them as another category). It
would also be useful to add new indicators that the federal government is
looking more into such as prediabetes.

36. Closing Comments
 Reports have helped raise awareness of data and issues
 Building capacity in health department
 Gradually increasing comfort and skills in GIS
 Opportunity to look at community level indicators based on
several data sources
 Geographic Disparities shown
- Some may be explained by race distribution
- Others may be explained by age distribution
- Others may be explained by poverty
- What about other factors?
 Additional analyses needed
 Superimposing two-three maps?
 Controlling for age, race/ethnicity and other factors
 Partners want more so it is not just a static PDF/document
 Next revision to PCNA currently in process

38. Data
Management
Data Analysis
and
Interpretation
Data
Collection
Data Presentation
and
Translation

39. Socio-economic Indicators (Chapter 3)
• Race (2010 Census)
- Alone
- Alone or in
combination
In addition to Native Hawaiian
and Filipino in 2009 data book,
added White, Japanese, and
Chinese in 2012 data book.
Primarily Multiple Race population in Hawaii
• Chinese (73% are in combination)
• Native Hawaiian (72%)
• Filipino (42%)
• Japanese (41%)
• White (40%)

40. Proportion of Population Filipino
 State: 25.1%
 [22.8% in 2000]
 7.0% in Hawai‘i Kai-Kaimuki
 45.6% Lïhu‘e
 54.4% Waipahu
 63.9% Läna‘i
Socio-economic Indicators (Chapter 3)

42. Primary Care Service Areas

43. Proportion of Adults with High Blood Pressure
 State: 28.4%
 11.7% in Häna
 22.3% in South Kohala
 22.5% in Köloa
 22.6% in Lähainä
 32.5% in Hilo
 32.6% in Wai‘anae
 35.4% in Waialua
 36.7% in Lïhu‘e
Morbidity-Risk Factors (Chapter 5)

44. Stroke Mortality Rate (per 100,000)
 State: 38.2
 22.1 in ‘Ewa-Kalaeloa
 22.8 in Mililani
 49.5 in Hilo
 56.4 in Waimea
 67.8 in Läna‘i
Mortality (Chapter 6)

45. Unintentional Injury Mortality Rate (per 100,000)
 State: 28.7
 10.0 in Mililani
 18.4 in Hickam-Pearl City
 19.3 in ‘Ewa-Kalaeloa
 48.7 in South Kona
 52.1 in Waialua
 58.6 in Wai‘anae
Mortality (Chapter 6)

46. Proportion Admissions w/ Delirium/Dementia Disorder
 State: 8.4%
 4.3% in Moloka‘i
 4.5% in Ka‘ū
 11.8% in Waikïkï-Pälolo
 11.9% in McCully-Makiki
 14.8% in Hawai‘i Kai-Kaimuki
Mental Health and Substance Related Admissions
(Chapter 8)

47. Proportion of Households with Linguistic Isolation
 State: 6.2%
 0.3% in Häna
 0.9% in Makawao
 14.4% in Ala Moana-
Nu‘uanu
 21.1% in Downtown-Kalihi

48. Proportion of Adults Who Smoke
 State: 16.1%
 9.9% in Hawai‘i Kai-Kaimuki
 11.0% in Hänalei
 25.3% in N Kohala
 25.9% in Ka‘ū
 26.0% in Wai‘anae

49. Cancer Mortality Rate (per 100,000)
 State: 134.7
 90.2 in Häna
 91.9 in Mililani
 95.2 in ‘Ewa-Kalaeloa
 173.1 in Waimea
 177.0 in Moloka‘i
 197.0 in Wai‘anae

50. Proportion of Admissions with a Mood Disorder
 State: 6.1%
 3.1% in Moloka‘i
 3.2% in Läna‘i
 3.4% in Häna
 8.0% in Hänalei
 9.1% in Hilo
 10.9% in Puna

51. Proportion of Civilian Labor Force Unemployed
 State: 4.6%
 2.3% in Hawai‘i Kai-Kaimuki
 2.3% in ‘Ewa-Kalaeloa
 9.7% in Ka‘ū
 13.5% in Moloka‘i

52. Example 2: Data and Budget Cuts
June 28-30, 2011: Reduction in Primary Care
Contracts in response to executive memo
 FHSD Recommendation made to not eliminate or drastically reduce the
funding and develop contingency plans before any drastic change in
funding. Data used to justify higher risk in the areas served by the
contracts. (Gordon Takaki and Pat Heu, 2011 FHSD Meeting)
July 7, 2011: No reduction

53. Example 2: PCNA
 June 2010: ACA Grant For Home Visiting Announced
 Portion related to Needs Assessment (NA)
 NA a requirement for Title V agencies
 Sept 2010: Deadline for Needs Assessment
 Portion of NA completed by use of data from PCNA
Data Book for identification of high risk
communities(Cindy Hirai led effort).
 Data contributed to multi-million dollar grant