JAMIA Open Journal Examines PCCI’s Community Vulnerability Compass That Sets New Standard for Measuring Social Determinants of Health

The paper shows that overall, the CVC was comparable to or outperformed existing neighborhood indexes in measuring key SDOH at both the neighborhood and individual level. CVC showed a strong correlation with existing SDOH indexes (ADI, SVI, and EJI) across multiple social risk domains, demonstrating its ability to identify a cross-cutting range of social vulnerabilities and community equity markers. Additionally, CVC had very good recall rates for individual-level SDOH both when validated against Z-code documentation and against self-reported survey tools (>75%).

“This paper summarizes countless hours of research and development that culminated in creating an industry leading SDOH measurement tool that has the potential and momentum to become the gold standard,” said Steve Miff, PhD, President and CEO of PCCI. “The data and information presented in the paper offers a fully transparent look into how the CVC works and its ability to surface hyper-localized insights that is novel and unique. We are very proud of achieving this key milestone and expanding of how the CVC can support communities and population health in ways that have previously been out of reach.”

The JAMIA  article, co-authored by PCCI’s Yolande Pengetnze, MD, MS, Yusuf Tamer, PhD, Lance Rather, BS, and others, provided strong evidence of the benefit of gaining contextual understanding of social barriers to health in the individual’s micro-ecosystem.

The JAMIA article digs deep into our approach and the steps we took to test how addressing social determinants at the block group level helps address specific needs and health of vulnerable populations,” said Yolande Pengetnze, MD, MS, PCCI’s Senior Vice President of Clinical Leadership. “This article shows clear, thought-provoking results that can equip public health leaders with a trusted tool enabling new methods of addressing the needs of those most at-risk in our communities.”

PCCI’s CVC analyzes, at the ZIP Code, census tract, and block-group level, where a community’s most vulnerable residents live and the root cause factors limiting these residents’ ability to thrive. The CVC analyzes 26 clinical and socio-economic indicators that reveal the health, resiliency, and economic vibrancy of neighborhoods. CVC’s analyses provide true, holistic pictures of who needs the most assistance and where to find them, enabling proactive support of those in need.

PCCI’s CVC has been incorporated into a variety of use case solutions throughout Texas, including adoption across the Parkland Health system, by the Dallas County Department of Health & Human Services, the University Heath (San Antonio) Transplant Center, and serves as the backbone for the United Way of Metropolitan Dallas’ Data Capacity Building Initiative, which is helping hundreds of organizations in North Texas turn insights into impact.

“This paper offers proof of the viability and potency of the CVC,” said Lance Rather, PCCI’s Senior Director, Product & Strategic Partnerships. “The paper offers clear evidence of how the CVC can provide data previously unavailable at the neighborhood level. Organizations that have implemented the CVC have discovered how rapidly and intuitively it transforms complex social vulnerability data into actionable insights that substantially advance their core missions. The use of the CVC can be applied in so many ways by different organizations, and we are excited at the possibilities that lay ahead.”

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LISTEN: How PCCI’s CVC Offers Deep SDOH Community Insights:

In the News: Hundreds of Nonprofits Using Data to Pinpoint Needs in Dallas Communities

And as part of the United Way of Metropolitan’s six-year Data Capacity Building Initiative,  over 200 North Texas nonprofits are leveraging PCCI’s CVC data insights to better understand their service areas, target high-need and priority interventions to local residents, strengthen their capacity to measure program performance for better operations, and foster collaboration to achieve community-wide goals.

To read the full story on how PCCI is supporting the missions of nonprofits in Dallas, click here:

https://www.govtech.com/analytics/nonprofits-using-data-to-pinpoint-needs-in-dallas-communities

PCCI Elevates Albert Karam to Chief Information Officer

Parkland Center for Clinical Innovation (PCCI), an innovation leader that develops scalable solutions focusing on responsible applications of AI-in-Medical Care for vulnerable populations, announced that Albert Karam, MS, MBA, has been elevated to the position of Chief Information Officer (CIO) at PCCI. He was previously PCCI’s Vice President, Data Strategy Analytics​.

As CIO, Albert Karam is focused on development of data science platforms, infrastructure and innovative AI and analytics solutions. He is responsible for creating and implementing predictive algorithms for real-time decision support and population health to Parkland Health (Parkland) and other similar institutions across the country.

Karam has been with PCCI since 2016 and has researched, developed, tested and deployed several predictive models for Parkland and the Parkland Community Health Plan (PCHP). Through his development of advanced predictive models for asthma interventions in North Texas, nearly 16,000 individuals have been enrolled in these programs, with tens of thousands more evaluated by the model for rising risk and potential engagement—enabling data-driven personalization, scalable impact, and improved disease management across vulnerable populations.  In addition to improving the lives of children across Dallas County, this work received.

Karam has also led elements of PCCI’s data analytics that supported the Dallas County Health and Human Services (DCHHS) efforts during the COVID-19 pandemic. His extensive experience offers a deep understanding of modeling workflows and implementation of AI models.

Karam obtained an MS in Mathematics from The University of Texas at Dallas (UTD) in 2015, and in 2020, he earned a dual degree MBA and MS in Data Analytics from UTD with a focus in Healthcare Administration. He has been a contributing author for several peer-reviewed papers, an inventor on PCCI patents, and is a regular speaker and presenter at industry conferences.

“Albert’s vision and energy fuels PCCI’s innovation engine. He and his team have been the behind-the-scenes leaders supporting public health in North Texas for years,” said Steve Miff, PhD, President and CEO of PCCI. “The impact of Albert’s work can be felt throughout our community, as his team’s will continue to pioneer AI innovations with even deeper and broader impact. He brings an exceptional set of standards to his work and is a champion for ethical and responsible applications of AI in healthcare.”

PCCI identifies more than 4.2 million Texas residents living in high or very high vulnerability neighborhoods in the five most populous counties

Researchers at Parkland Center for Clinical Innovation (PCCI) have completed a vulnerability assessment of Texas’s five most populous counties using PCCI’s Community Vulnerability Compass (CVC). The assessment found that in Harris, Dallas, Bexar, Tarrant, and Travis counties, a total of more than 4.2 million residents live in high or very high vulnerability block groups.

PCCI’s CVC analysis of these counties included a true, holistic analysis, at a block-group level, of 27 clinical and socio-economic indicators underpinning the health, resiliency, and economic vibrancy of their neighborhoods, down to the block group level. A block group is a statistical geographic subdivision of a census tract used by the U.S. Census Bureau for data tabulation and presentation, and it typically contains between 600 and 3,000 people.

Root causes that trigger a block group to be rated as high or very high vulnerability include socioeconomic challenges, access to healthcare, and several non-medical drivers of health (NMDOH), such as unsafe neighborhoods, chronic diseases, education attainment, and life expectancy. The “very high” designation indicates that these neighborhood block groups are in the top 20 percent of vulnerability when compared to the rest of the state. CVC vulnerability groupings are broken into quintiles and clustered into very low, low, moderate, high and very high areas. Groupings can be localized to specific catchment areas, with the ability to include or exclude individual block groups.

“Going well beyond typical ZIP Code analyses, this assessment offers a deeper look into Texas’ major metropolitan areas,” said Steve Miff, PhD, President and CEO of PCCI. “Our researchers use the CVC’s data insights to reveal the challenges and opportunities our community leaders can leverage to better understand the conditions their residents are experiencing and develop suitable approaches to address the needs of those populations. What we are seeing is that 33 percent (1 of 3) residents in our five largest counties are facing daily challenges that put their health and wellness at risk.”

In its statewide assessment, PCCI’s CVC found that nearly 43 percent of Bexar County’s block groups fall into the high or very high vulnerability rating, the highest percent of the five largest counties.

Following Bexar County was Harris County, with nearly 41 percent of its block groups falling into the high or very high vulnerability category. Dallas County followed with nearly 40 percent of its block groups in the high or very high level.

Rounding out the most populous five counties, nearly 31 percent of Tarrant County and nearly 12 percent of Travis County block groups were in the high or very high vulnerability category.

“As we train the next generation of physicians, they must understand the critical window into the drivers of their local community’s health the CVC powerfully highlights so we can continue to forge strategy to drive sustainable improvements.” – Stuart D. Flynn, MD, Founding Dean of the Anne Burnett Marion School of Medicine at Texas Christian University. 

• Harris County’s high or very high vulnerability block groups (1,154 of 2,830 total block groups) represent 1.7 million residents. Drilling down into vulnerability root causes, the CVC found the top three challenges in the most vulnerable block groups are neighborhood safety¹, followed by health insurance coverage² and mental health³.

• Dallas County’s high or very high vulnerability block groups (627 out of 1,570) represent 1.1 million residents. The CVC found that the top three issues in Dallas County’s most vulnerable block groups are clean air⁴, neighborhood safety, with health insurance coverage⁵ and education attainment⁶ tied for third.

• Bexar County’s high or very high vulnerability block groups (486 out of 1,139) represent 657,131 residents. For Bexar County, the CVC found that the top three challenges in Bexar County’s most vulnerable block groups were neighborhood safety, followed by chronic diabetes⁷ and households without vehicles⁸.

• Tarrant County’s high or very high vulnerability block groups (382 out of 1,246) represent 618,942 residents. Additionally, the CVC found that the top three challenges for Tarrant County’s most vulnerable block groups are clean air, chronic obesity⁹, and neighborhood safety.

• Travis County’s high or very high vulnerability block groups (89 out of 766) represent 140,760 residents. The CVC analysis found that the top three challenges for Travis County’s most vulnerable block groups are chronic alcohol abuse¹⁰, neighborhood safety, and green space access¹¹.

“Each of these counties have unique and distinct challenges so there is no one solution to address issues across all of Texas,” Dr. Miff said. “The power of the CVC is that it gives us the ability to surface insights not only at the county level, but for each neighborhood making up these regions. This refined geographic precision allows us to learn the true nature and shared characteristics of neighborhood vulnerabilities so that our health and community leaders can create sustainable, customized solutions to address those vulnerabilities.”

About PCCI

The Parkland Center for Clinical Innovation (PCCI) is a not-for-profit, mission-driven organization with industry-leading expertise in the responsible application of artificial intelligence, machine learning and NMDOH data modeling to address the needs of vulnerable populations. PCCI started as a department within Parkland Health and was spun out as an independent organization in 2012. PCCI strives to leapfrog the status quo by harnessing the transformative potential of data. Our unique capabilities allow us to provide innovative, actionable solutions that more effectively identify needs, prioritize services, empower providers, and engage patients. 

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¹Neighborhood Safety: Crime and violent crime rates per 1,000 residents in the past year

²Health Insurance Coverage: Percentage of uninsured

³Mental Health: Percentage of adults ages 18+ who stated that their mental health was not good for 14 or more of the past 30 days

⁴Clean Air: An indication of the level of air pollution

⁵Health Insurance Coverage: Percentage of uninsured

⁶Education Attainment: Percentage of population without high school degree

⁷Chronic Diabetes: Prevalence of diagnosed diabetes among adults ages 18+

⁸Households without Vehicles: Percentage of households without a vehicle

⁹Chronic Obesity: A BMI of 30 or greater indicates obesity, according to the CDC.

¹⁰Alcohol Abuse: Prevalence of binge drinking among adults ages 18+

¹¹Green Space: Number of parks within ZIP Code boundaries

PCCI Publishing: Oxford Academic – The Association of Social Determinants of Health and Penicillin Allergy Labels

Published in Oxford Academic, Oxford University Press’s academic research platform, a new paper co-authored by PCCI’s Yolande M Pengetnze, MD, MS, Senior Vice President Clinical Leadership, looks at how social determinants of health are related to penicillin allergy labels that are associated with numerous adverse outcomes including poor infectious outcomes and antimicrobial resistance.

The primary independent variable was social vulnerability  defined by PCCI’s Community Vulnerability Compass including 27 indicators of social vulnerability.

Go here to view the abstract: https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciaf153/8099189?redirectedFrom=fulltext#google_vignette

NEJM Catalyst – Pediatric Asthma Surveillance System (PASS): Community-Facing Disease Monitoring for Health Equity

In 2024, the highly respected medical journals, The New England Journal of Medicine Catalyst, published a peer-reviewed paper authored by experts from PCCI, Parkland Health and the Dallas County Health & Human Services department about the innovative Pediatric Asthma Surveillance System (PASS) that allow Dallas County residents suffering from asthma understand their risks.

The PASS dashboard, hosted on the DCHHS website, has served the county for two years leveraging innovative data management that gives asthma risks down to the block level.

See the abstract below:

PCCI Publishing: Virtual Health Care Encounters for Lung Cancer Screening in a Safety-Net Population

Recently published in the Journal of Clinical Oncology, is a publication co-authored by George “Holt” Oliver, PhD, MBA, VP Clinical Informatics at PCCI, that examines how lung cancer screening was conducted during the COVID-19 pandemic to help determine the difference between virtual and in-person encounters in an urban, safety-net health care system.

https://ascopubs.org/doi/pdfdirect/10.1200/CCI.24.00086