2000115-Strengthening-Communities-with-Neighborhood-Data

Using Data for City and Regional Strategies 239
were concerned about the rising costs of health care for uninsured people.
They agreed to share their patient billing data, including emergency
department visits and inpatient hospitalizations, with CamConnect and
the Camden Coalition of Health Care Providers. Negotiations to finalize
the data transfer took almost a year, and the organizations put extensive
protections in place to comply with HIPAA and the health systems’
institutional review boards (CamConnect 2010). The data contained the
address, diagnosis codes, demographic information, and financial information
about the hospital visit. The analysts faced many challenges in
merging data across the three hospital data systems, including developing
probabilistic algorithms to match individuals who visited multiple
hospitals. Their first groundbreaking analysis of 2003 data was published
in 2006 (CamConnect and Camden Coalition of Health Care Providers
2006). They discovered that half the population in the city used hospital
services in 2003. Their analysis helped them understand basic descriptive
information, such as the incidence and rates of chronic disease and
preventable incidents, the frequency of visits, and the distribution of
payment methods. Their maps of the rates of hospital visits due to diabetes,
falls, drug abuse, and assaults demonstrated the variation across
the city. The coalition recognized that all four of these causes of hospital
visits could be addressed by community intervention.
The next stage of the analysis expanded the coverage to six years. The
coalition identified more than 7,000 individuals with type 2 diabetes
who visited Camden emergency departments or hospitals 62,000 times
between 2002 and 2008 and accumulated charges of over $1.5 billion
(see figure 6.3). Just knowing the facts was not enough to improve the
situation for these patients. With support from the Merck Company’s
Foundation, the coalition launched the Citywide Diabetes Collaborative
to advance proactive, comprehensive care for people suffering from the
disease. 21 The maps showing the areas where diabetes was most prevalent
helped the collaborative to focus their outreach efforts for classes on how
to better manage the illness and reduce the need for hospital care.
The analysis also demonstrated that a small share of the patients generated
most of the costs and visits. From 2002 to 2007, 20 percent of the
patients accounted for 90 percent of the costs. 22 In 2007, Brenner worked
with social workers and emergency room doctors to identify the most
frequent visitors, termed the superutilizers. Health practitioners visited
these patients at home to learn more about how social and environmental
factors contributed to the health conditions and the patient’s ability
to follow up with medical recommendations. Patients were also given a