Articles Archives – PCCI

7 July 2021

PCCI CEO Statement – Dallas County Reaches Herd Immunity, More Work To Be Done




Statement from PCCI CEO Steve Miff:

“On July 4, Dallas County reached the 80 percent herd immunity threshold. This threshold is made up

by 46.6 percent of the total population being vaccinated and 48.7 percent of the population with natural immunity having recovered from being infected by COVID-19.

While this represents good progress, it is important that we understand the work is not over. We must continue to push for vaccinations so COVID and its variants can’t again take hold and diminish the progress we’ve made. Reaching the 80 percent herd immunity rate is not like flipping a switch, but a continuum in our journey.  It is an important accomplishment which is a credit to the residents and public health leaders who have committed themselves to crush COVID. While the whole community in average reached the 80 percent mark, there are only 49 ZIP codes above the 80 percent threshold with 45 ZIP codes still below the 80 percent mark. There are still significant pockets in the community that remain vulnerable.

How we got here

The calculations used to measure heard immunity track individual level data for both vaccinations administered and COVID test results since the beginning of the pandemic.  For those infected, yet not tested there are a 4x Adjusted Incidence Rate Ratio [AIRR] for the adult population and 5x for the pediatric group based on national and local seroprevalence data. The model also calculates an overlap 28 percent of vaccinated population of Dallas estimated to have had prior COVID-19 infection and recovered.

Delta Variant

Further, the current Delta variant is predicted to make up about 25 percent of COVID-19 cases locally, doubling approximately every two weeks. In one month, that could put the Delta variant in the range that has caused a new wave in infections in the UK, though their estimated immunity was below the herd immunity threshold for Delta.

The significantly higher viral loads and more infectious nature of the Delta variant could put the herd immunity target as high as 88 percent to suppress infection spikes when the Delta variant becomes the dominant variant in a few weeks’ time.

Vaccinations Lag

As a county, we’re still behind on vaccinations: Only 38 percent of the total population with completed vaccination series and 47 percent of the total population with at least one dose (61 percent of adults and 80 percent of those over the age of 65 years).  While previous infections and partial vaccinations do provide a level of protection, all evidence suggests that full vaccinations are the most effective way to stay safe against the delta variant.

Why is getting vaccinated still very important:

  • Infections remain very low for those vaccinated – local data from Parkland and the Dallas County Health & Human Services Department suggests an infection rate of only 0.04 percent for those vaccinated. Getting vaccinated doesn’t only protect you, but those around you, including the children who are not yet eligible for a vaccine.
  • Long COVID (prolonged COVID related symptoms such as fatigue, brain fog, muscle pain, shortness of breath, and loss of taste and smell) is prevalent in 10-30 percent of those infected and mortality for those unvaccinated is still a concern. Not getting vaccinated is rolling the dice on dying or dealing with long-term medical issues. 

The message is simple: don’t wait to get vaccinated. For those still hesitant, the safety and efficacy studies to date are overwhelmingly positive.  There are also two key upcoming milestones that should give further confidence to those who remain hesitant: Full FDA approvals for the mRNA vaccines expected in the upcoming weeks and approval for the under 12-year-old groups in the fall.”

-Steve Miff, PhD, President & CEO of Parkland Center for Clinical Innovation (PCCI) 

To monitor herd immunity and vaccination progress in Dallas County go to PCCI’s COVID-19 Vaccination and Herd Immunity Dashboard hosted on the Dallas County Health and Human Services’ website: https://www.dallascounty.org/covid-19/.

Background on PCCI’s herd immunity measurements

PCCI’s forecast for herd immunity is based on an innovative yet vetted statistical and immunological model and analysis of spread and management of diseases within communities. Further, PCCI’s 80 percent range for reaching herd immunity is in line with national estimates, such as that of Anthony S. Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases, who recently gave a range of 70 to 90 percent and the World Health Organization which gave a 60 to 70 percent range of infections and vaccines to reach herd immunity*.

PCCI’s forecast and estimates have been developed in coordination with community health leaders in Dallas County, including the DCHHS and Parkland Health & Hospital System.  Recently, PCCI has been collaborating with the leadership and expert teams at the Institute for Health Improvement on modeling.

*New York Times, Dec. 24, 2020: “How Much Herd Immunity Is Enough?”

https://www.nytimes.com/2020/12/24/health/herd-immunity-covid-coronavirus.html

 

6 July 2021

News Release: PCCI, Dallas County Release COVID-19 Vaccination and Herd Immunity Dashboard




Dallas, Texas – Parkland Center for Clinical Innovation (PCCI), which improves healthcare for vulnerable populations using advanced data science and clinical experts, has developed a COVID-19 Vaccination and Herd Immunity Dashboard to give residents of Dallas County up-to-date data about herd immunity levels, infections and vaccinations rates and corresponding demographic information.

The Dallas County Health and Human Services Department (DCHHS) will host the COVID-19 Vaccination and Herd Immunity Dashboard, which will supplement its rich set of COVID-19 resources. The COVID-19 Vaccination and Herd Immunity Dashboard can be accessed here: https://www.dallascounty.org/covid-19/

The COVID-19 Vaccination and Herd Immunity Dashboard provides exclusive data for Dallas County, including herd immunity by percentage of the county’s population at the ZIP code level. This is helpful for monitoring the county’s efforts to drive vaccination efforts to reach the herd immunity threshold of 80 percent of the whole county’s population who either have recovered from COVID-19 or who have received vaccinations. The dashboard’s data also includes vaccinations by manufacturer, estimated active COVID cases and important information resources about the pandemic.

“The COVID-19 Vaccination and Herd Immunity Dashboard provides the relevant available information to help estimate how far along Dallas County is toward reaching the herd immunity goal as well as the rates of vaccinations across the whole community,” DCHHS Director Dr. Philip Huang said. “It is important that we understand that once the indicators suggest that we are at the estimated herd immunity threshold, the work is not over. We need to continue the push for vaccinations, which is the crucial element to reaching herd immunity. The data in this dashboard will allow us to monitor our fight against COVID in every corner of the county in order for us to take the necessary steps to maintain our positive momentum.”

For each ZIP code in Dallas County, the COVID-19 Vaccination and Herd Immunity Dashboard also includes insightful, localized vaccination demographic information, such as ethnicity, age, sex and race. This data is used to continue to ensure equity in all our efforts and to continue to reach the population in the most convenient and effective way.

“This is critical information that we need to guide and coordinate our efforts. Dallas County is unique in the country for having these analytics available at such localized levels for all of our residents,” said Dr. Steve Miff, PCCI’s President and CEO. “The way we crush COVID is by coming together as a community and the information from the dashboard empowers everyone with knowledge on what is happening where they live― what the herd immunity level is and what the vaccination level is so they may act accordingly to maintain their safety and that of their families.”

In February, PCCI forecast that Dallas County would reach the 80 percent herd immunity threshold in June. However, that forecast has been pushed back to July due to slowing vaccination rates.

“Our progress toward herd immunity in Dallas County is making a difference as we have seen with slowing rates of community transmission, and it is so important that we aggressively continue our community efforts to vaccinate,” said Dr. Huang. “With the knowledge we gain from the COVID-19 Vaccination and Herd Immunity Dashboard, we can empower all our citizens with the information to stay safe. Vaccines are the best line of defense against COVID-19 and its variants, so it is critical that as many county residents as possible receive a vaccine.”

PCCI’s forecast for herd immunity is based on an innovative yet vetted statistical and immunological model and analysis of spread and management of diseases within communities. Further, PCCI’s 80 percent range for reaching herd immunity is in line with national estimates, such as that of Anthony S. Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases, who recently gave a range of 70 to 90 percent and the World Health Organization which gave a 60 to 70 percent range of infections and vaccines to reach herd immunity*.

PCCI’s forecast and estimates have been developed in coordination with community health leaders in Dallas County, including the DCHHS and Parkland Health & Hospital System. Recently, PCCI has been collaborating with the leadership and expert teams at the Institute for Health Improvement on modeling.

The COVID-19 Vaccination and Herd Immunity Dashboard supports the Google Chrome, Microsoft Edge and Mozilla Firefox web browsers.

About Parkland Center for Clinical Innovation
Parkland Center for Clinical Innovation (PCCI) is an independent, not-for-profit, healthcare innovation organization affiliated with Parkland Health & Hospital System. PCCI leverages clinical expertise, data science and social determinants of health to address the needs of vulnerable populations.
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*New York Times, Dec. 24, 2020: “How Much Herd Immunity Is Enough?”

7 June 2021

PCCI’s 2020 Annual Impact Report




To give you a descriptive view into PCCI’s 2020, we have created an Annual Impact Report. This report provides highlights of our work during my fourth year at PCCI’s. Our accomplishments reflect not only our individual achievements, but our many collaborations and the community’s commitment to our mission. Specifically, this mission is powered by our people, innovative collaborators like Parkland Health & Hospital System (Parkland), Parkland Community Health Plan (PCHP), and many outstanding organizations that give us the support and purpose we need to champion each project we undertake. For this year, we have continued to produce impactful results for our stakeholders. As our mission expands, we will continue to seek like-minded organizations to work with us in pioneering new ways to health, especially for vulnerable and underserved populations.

To view the 2020 PCCI Annual Impact Report, please click the image below:

PCCI_AIR_FINAL_SINGLES

4 June 2021

PCCI COVID-19 Update: Vaccinations Help Dallas County’s COVID-19 Risk Drop 40 Percent in May




DALLAS – Due to vaccination levels and reduction in new COVID-19 cases in Dallas County, the Parkland Center for Clinical Innovation’s COVID-19 Vulnerability Index has recorded a 40 percent drop in average vulnerability from April to the end of May.

The Vulnerability Index decrease can be attributed to a moderate increase in vaccines, a 10 percent increase in vaccinated people (partial or complete) month over month, and a 37 percent decrease in active cases.

The ZIP code with the highest Vulnerability Index, 75243, has a 12.20 vulnerability rating, however that was a decreased by 61 percent from April. This decrease was driven by vaccinations.

Most vulnerable zip codes. The cases have continued to reduce substantially month-over-month. (See list below)

“Thanks to the vaccination programs implemented throughout Dallas County, we continue to see progress in our fight against COVID-19,” said Thomas Roderick, PhD, Executive in Residence at PCCI. “Our latest Vulnerability Index report is the most positive yet, with new cases slowing and modest, but important participation in the vaccination program continuing. This progress is a credit to the outstanding efforts of our public health leaders and residents devoted to crushing COVID.”

One of the hardest hit ZIP Codes during the past year, 75211, which includes the areas around Cockrell Hill and Oak Cliff, continues to be in the top 10 most vulnerable ZIP codes, however, its May rating of 9.63, is a massive improvement over its high of 196.9 in January.

Launched in June of 2020, PCCI’s Vulnerability Index identifies communities at risk by examining comorbidity rates, including chronic illnesses such as hypertension, cancer, diabetes and heart disease; areas with a high density of populations over the age of 65; and increased social deprivation such as lack of access to food, medicine, employment and transportation. These factors are combined with dynamic mobility rates and confirmed COVID-19 cases where a vulnerability index value is scaled relative to July 2020’s COVID-19 peak value. The PCCI COVID-19 Vulnerability Index can be found on its COVID-19 Hub for Dallas County at: https://covid-analytics-pccinnovation.hub.arcgis.com/.

Recently, PCCI revised its COVID-19 herd immunity forecast, 80 percent of residents either having recovered from COVID-19 or having received a vaccination, from mid-June to July, due to a slowing rate of immunizations. However, as of the end of May, Dallas County is closing in on the 80 percent goal, at 75.5 percent herd immunity.

“Without question, vaccinations are the key to Dallas County reaching herd immunity,” said George “Holt” Oliver, MD, Vice President of Clinical Informatics at PCCI. “Vaccinations have been the primary reason we’ve seen a reduction in risk and why we are in sight of reaching the herd immunity threshold. The vaccinations for adults and children over 12 years old, are effective, easily obtained and quickly administered. We should all do our part to get vaccinated and encourage others to do the same. That is the way we will crush COVID.”

Data Sources:
To build Vulnerability Index, PCCI relied on data from Parkland Health & Hospital System, Dallas County Health and Human Services Department, the Dallas-Fort Worth Hospital Council, U.S. Census, and SafeGraph.

About Parkland Center for Clinical Innovation
Parkland Center for Clinical Innovation (PCCI) is an independent, not-for-profit, healthcare intelligence organization affiliated with Parkland Health & Hospital System. PCCI leverages clinical expertise, data science and social determinants of health to address the needs of vulnerable populations. We believe that data, done right, has the power to galvanize communities, inform leaders, and empower people.

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20 May 2021

Herd Immunity Forecast For Dallas County Pushed Back to Late July




  • More natural immunity; decreasing vaccination rates   
  • Data from new UT Southwestern seroprevalence study raises PCCI’s county wide previously infected estimates to 48% of the total population;   
  • Herd immunity rate increases to 74 percent of the total population 
  • PCCI now forecasts Dallas County to surpass COVID herd immunity by late July 

Parkland Center for Clinical Innovation (PCCI) has updated its herd immunity forecast for COVID-19 in Dallas County. The new herd immunity analysis includes the up-to-date vaccination percentages for Dallas County as well as a change in the percentage of residents confirmed and presumed to have been infected. These factors indicate that the county’s herd immunity rate is now 74 percent of the total population. However, a continued decrease in vaccinations pushes reaching the herd immunity threshold of 80 percent of all residents either having been infected or being vaccinated towards late July. 

PCCI made its initial herd immunity forecast for Dallas County in February, where it predicted the county would reach the herd immunity threshold by mid-June.  

 “The most critical factor in the fight to crush COVID remains vaccinations for the whole population, particularly with the county’s younger, working population and the recently approved high school and middle school students,” said Steve Miff, PhD., PCCI’s President and CEO. “Convenience, missed work or school from vaccine side-effects, and concerns about providing identifications for the transient and un-documented populations remain as key barriers to vaccinations and continue to be a key decision driver for the 20-30 percent of the unvaccinated population who are not opposed to receiving a vaccine, but have not yet rolled up their sleeves.” 

 An important new UT Southwestern virologic study indicates a ratio of 1:4 for confirmed positive (tested and confirmed) to presumed infected (positive antibodies, but never tested) population for Dallas County.  With this information, PCCI has updated the presumed infected adult population from a 1:3 ratio to the 1:4 ratio. This increase in the presumed infected results also in adjustment of the vaccinated population of Dallas estimated to have had prior COVID-19 infection and recovered from 21 percent to 28 percent.   

 For vaccinations, the weekly average is slowing below 15,000 first doses/week despite new age group approval for 12-15-year-old. To date, 1,018,696 people in Dallas County have been vaccinated, with 798,775 being fully vaccinated.  This indicates that approximately 40 percent of the whole county population, 52 percent of the over 18-year-old population, and 77 percent of the over 65-year-old have received at least one dose of the vaccine.   

The net results increase the current county wide herd immunity rate to 74 percent of the total population.  Twenty-six Dallas County ZIP codes are estimated as surpassing the 80 percent threshold to date.  

  

 Figure Above: COVID-19 Herd Immunity Current State, Dallas County, May 13, 2021; base population based on US Census ACS 2019 5 year; values capped at maximum of 0.8 to show relative progress; eastern zip codes in county tend to be sparser and cover a larger area; estimates may have variance across county estimates; using 4x AIRR based on UTSW seroprevalence data as best local estimate. Overlap estimate of 28% of vaccinated population of Dallas estimated to have had prior COVID-19 infection and recovered. 

 Significant plans are already underway to address convenience and access. PCCI has created an updated Vulnerability Index calculation and identified the top 100 neighborhoods with the most unvaccinated individuals (map below).  The map shows areas of low vaccination rates sprinkled across north and central Dallas County, but it indicates large sections of the southern half of the county have many unvaccinated. These areas in south Dallas often experience transportation gaps to access certain vaccination sites.  

Dallas County, City of Dallas and the Parkland Health and Hospital System are coordinating efforts to bring local community vaccination clinics to high risk, high opportunity locations.  There are 29 recent, active, and planned community locations to where individual can receive a COVID vaccine in their own neighborhood.   These are in addition to the local pharmacies, physician offices and other activities by many local health systems.   

  

Above Image: The dotted red areas indicate neighborhoods with highest numbers of unvaccinated individuals. 

“With this new analysis, we are able to pinpoint where the least vaccinated populations are in the county,” said Dr. Miff. “Our public health leaders are taking action and making progress toward reaching those areas, but each of us can take responsibility to quickly receive our vaccine and encourage our friends and neighbors to do the same, especially for those who live in neighborhoods with the low vaccination rates. Vaccines are the fastest and safest way we can get back to any sort of normal.” 

Why does it matter that we get to herd immunity through vaccinations instead of infection? 

Reaching herd immunity will significantly reduce the spread of the virus but reaching the 80 percent with equal numbers of vaccinated and natural immunity populations will not make the virus go away. For areas already at or above 80 percent, and for the rest of the county, until vaccination rates increase, there will likely continue to be low levels of constant infections, hospitalizations and periodic deaths.   

 “The virus will continue to linger in the background at relatively low and steady rates, with the periodic flareup. The best thing we can do is continue to vaccinate to reach and surpass the 80 percent vaccination mark and then drive both personal and community protection through the vaccines,” said Dr. George ‘Holt’ Oliver, Vice President of clinical Informatics at PCCI. 

 For more information about how PCCI has taken the fight to COVID-19, go to: https://pccinnovation.org/taking-the-fight-to-covid-19/. 

 About Parkland Center for Clinical Innovation  

Parkland Center for Clinical Innovation (PCCI) is an independent, not-for-profit, healthcare intelligence organization affiliated with Parkland Health & Hospital System. PCCI leverages clinical expertise, data science and social determinants of health to address the needs of vulnerable populations.   

  

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18 May 2021

AMERICAN JOURNAL OF MANAGED CARE: Timely Preterm-Birth Prediction Among Pregnant Women in Medicaid Without Preterm-Birth History




The American Journal of Managed Care (AJMC), which delivers direct access and engagement of professional audiences by providing multichannel sources of trusted health care and scientific information, has published a peer review articled about a preterm birth prevention program pioneered by PCCI, Parkland and the Parkland Community Health Plan.

The article, titled “Timely Preterm-Birth Prediction Among Pregnant Women in Medicaid Without Preterm-Birth History,” examines how Parkland, PCCI and PCHP experts developed a novel prediction model that accurately predicts preterm birth in a timely manner among pregnant women in Medicaid without preterm-birth history.

To read the article in a PDF form, go to:

https://cdn.sanity.io/files/0vv8moc6/ajmc/ccfe23a271d8eb13e232bd68a5c4e0d9a69bdd0d.pdf

For the web article, go to:

https://www.ajmc.com/view/timely-preterm-birth-prediction-among-pregnant-women-in-medicaid-without-preterm-birth-history

3 May 2021

National Asthma & Allergy Awareness Month: PCCI’s Pediatric Asthma Efforts Making A Difference With Dallas Children




To support  May being National Asthma & Allergy Awareness Month, please review the exciting programs and innovation PCCI has spearheaded to help children manage asthma:

27 MARCH 2020

IN THE NEWS: HCPLIVE – TEXT MESSAGE PLATFORM IMPROVES ASTHMA OUTCOMES

Yolande Pengetnze, MD, MS, senior medical director at PCCI spoke to HCPLive about a texting program designed to improve outcomes for patients with asthma and pregnant women, and how the technology can be used at other health systems and for other chronic conditions. Click the image below to read the full interview:

15 JANUARY 2020

PCCI POSTER PRESENTATION: PRETERM BIRTH & ASTHMA POSTER FROM IHI SCIENTIFIC SYMPOSIUM

PCCI’s text messaging program on asthma and preterm birth prevention was featured as a poster presentation at December’s Institute for Healthcare Improvement (IHI) Scientific Symposium. The poster program titled “A Novel Evidence-Based Approach to Digital Outreach Improves Patient Engagement and Health Outcomes in Two Distinct Cohorts of Medicaid Patients,” was presented by by PCCI’s Senior Read More »

30 DECEMBER 2019

2019 YEAR IN REVIEW: PEDIATRIC ASTHMA

Among its accomplishments this year, PCCI reported how its predictive modeling helped reduce the harm caused by pediatric asthma. Please click on the image below to see how PCCI’s efforts were applied:

12 SEPTEMBER 2019

TEXAS MEDICINE MAGAZINE HIGHLIGHTS SUCCESS OF ONE CLINIC’S ALLERGY AND ASTHMA PILOT PROGRAM

The September issue of the Texas Medical Association’s magazine, Texas Medicine Magazine, featured the efforts of C. Turner Lewis, III, MD, Medical Director of Children’s Medical Clinics of East Texas, to mitigate the harmful effects of pediatric asthma and alergies. Dr. Lewis employed a pilot program that included elements of PCCI’s predictive modeling to help Read More »

29 JULY 2019

DEEP LEARNING MODEL TO PREDICT PEDIATRIC ASTHMA EMERGENCY DEPARTMENT VISITS

Pediatric asthma is the most prevalent chronic childhood illness, afflicting about 6.2 million children in the United States. However, asthma could be better managed by identifying and avoiding triggers, educating about medications and proper disease management strategies. Parkland Center for Clinical Innovation (PCCI) has been working with the Parkland Community Health Plan (PCHP) for the Read More »

17 JULY 2019

DALLAS MEDICAL JOURNAL: PEDIATRIC ASTHMA CONFRONT THE BARRIERS

PCCI’s mission is to support our community’s vulnerable populations, which includes helping children with chronic health issues, such as pediatric asthma. PCCI has been working for several years developing and testing predictive models to identify children at risk for asthma exacerbations. You can now see how this predictive modeling was used to help support pediatric asthma patients Read More »

20 April 2021

Expert Perspective: PCCI CIO testifies at Texas House Committee in favor of a making it easier to enroll MCO members into electronic communication




Vikas Chowdhry, PCCI’s CIO testified at the Texas State Capitol in front of the TX House Human Services Committee (chaired by Rep. James Frank) in support of House Bill 4343 sponsored by Representative Toni Rose (District 110). This bill will require HHSC to gather member contact preferences and gain their informed consent on the application, and then pass that consent to the Managed Care Organization (MCO), thus making it easier for MCOs to contact their members via their preferred electronic modes of communications such as texting.

PCCI has observed health outcomes greatly improve for Parkland Health Plan’s members through our pediatric asthma and pre-term birth prevention text messaging programs and we fully support this bill that will allow MCOs to expand programs like this.

 

 

 

 

 

 

 

 

(Rep. Toni Rose (center) with Kay Ghahremani, CEO of Texas Association of Community Health Plans and Vikas Chowdhry, CIO at PCCI)

 

Full text of testimony is follows:

HOUSE BILL 4343 (ROSE)

TESTIMONY OF VIKAS CHOWDHRY

Mr. Chairman, members, good morning (afternoon), my name is Vikas Chowdhry.  I am the Chief Analytics and Information Officer for the Parkland Center for Clinical Innovation – PCCI – and I am testifying in support of House Bill 4343.

PCCI started as a department within Parkland Health and Hospital System and was spun out as an independent, not-for-profit organization in 2012 to not only serve the needs of Parkland, but to also pursue additional transformative initiatives that could have a broader impact. PCCI remains tightly connected to Parkland, the Parkland Foundation and the Parkland Community Health Plan. Our collaborative work focuses on the needs of vulnerable populations across North Texas and beyond. Our work focuses on cutting edge uses of AI, social determinants of health, and clinical expertise across clinical and community settings.

Representative Rose, thank you for filing this bill.  Simply put, when a health plan is able to text its members, health outcomes improve.  They can do this now, but (as you heard) MCOs are required to first call a member and ask for their consent.  The problem is not having to seek the consent, which is entirely appropriate, but having to get the consent via a telephone call, because of course most people do not answer calls from numbers they don’t recognize.  In Representative Rose’s committee substitute, HHSC is tasked with gathering member contact preferences and sending those preferences to the MCO.  This should make it more likely that an MCO can contact a member via text.

Why is this beneficial?  At PCCI, we have documented the positive impacts of programs involving the texting of members.  In our Asthma program, we studied Parkland Community Health Plan members under the age of 18 who were enrolled in our text messaging program.  Those in the study received 3-5 educational or reminder text messages per week, including 2-item Asthma symptoms surveys once or twice a week.  We saw a 22.5% increase in asthma outpatient visits, and a six-fold drop in asthma-related visits to the emergency department.  84% of the respondents to our satisfaction survey said that the program has taught them to take better care of their child’s asthma

We performed similar research in our Preterm Birth Prevention Program.  Pregnant women enrolled in the program received four to five messages per week.This study produced positive results as well, with a 24 percent increase in prenatal visit attendance, and a 27 percent drop in preterm birth rates. More than two-thirds of the respondents to our satisfaction survey said that as a result of this program, they feel better prepared to take care of themselves and their baby.

The analysis that we have shared above is based on pre-COVID data. Through COVID period, we observed an overall reduced impact on outcomes across all these groups but even within that period, members enrolled in text messaging program still had better outcomes compared to those not enrolled. So, just through something as simple as a few text messages, we saw better health outcomes and less expensive care.  Texting works.

Mr. Chairman, Representative Rose, members, thank you for the opportunity to visit with you today.  I’m happy to answer any questions.

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14 April 2021

PCCI’s Vulnerability Index Shows Lowest COVID-19 Infection Risk Level for Dallas County




DALLAS – Towards the end of March, Parkland Center for Clinical Innovation’s COVID-19 Vulnerability Index has recorded the lowest infection risk since the Vulnerability Index launched in June of last year.

“After the holidays, we had vulnerability index ratings at nearly 200, which meant the COVID-19 virus was running rampant through our community,” said George “Holt” Oliver, MD, Vice President of Clinical Informatics at PCCI. “It is a great relief to see that the highest vulnerability index rating now is only 16.91. This is a triumph for our county’s public health leaders, providers and residents who have made the sacrifices and efforts needed to bend the curve.”

One of the hardest hit ZIP Codes during the past year, 75211, which includes the areas around Cockrell Hill and Oak Cliff, saw its vulnerability risk hit the high of 196.9 in January. This was the highest level any ZIP code in Dallas County reached. By mid-March, its vulnerability rating was 8.74, a dramatic improvement for an area facing some of the most sever socioeconomic issues.

“This is very good news for the residents of the 75211 ZIP code; however, we advise caution going forward,” said Dr. Oliver. “I believe that our new normal will be continued vigilance. To keep COVID-19 from resurging, everyone who can be vaccinated should seek it, and adhere to local health official guidance that includes direction on social distancing and face covering.”

Launched in June 2020, PCCI’s Vulnerability Index identifies communities at risk by examining comorbidity rates, including chronic illnesses such as hypertension, cancer, diabetes and heart disease; areas with a high density of populations over the age of 65; and increased social deprivation such as lack of access to food, medicine, employment and transportation. These factors are combined with dynamic mobility rates and confirmed COVID-19 cases where a vulnerability index value is scaled relative to July 2020’s COVID-19 peak value. The PCCI COVID-19 Vulnerability Index can be found on its COVID-19 Hub for Dallas County at: https://covid-analytics-pccinnovation.hub.arcgis.com/.

Currently, the 75150 ZIP code, at the intersection of Interstate Highway 30 and 635 has the highest COVID-19 risk at 16.91, down from a high of 107.30 in January. The ZIP code 75204, in east downtown Dallas, has the second highest vulnerability level at 15.81, down from a high of 126.5 in January.

PCCI’s forecast of Dallas County reaching COVID-19 herd immunity is still on-track but reaching that threshold is highly dependent residents receiving their vaccinations.

“With vaccinations available to all adults, we need to get in line and get immunized,” said Dr. Steve Miff, PCCI President and CEO. “We don’t want another year to go by where grandparents can’t hug their grandchildren. We have seen how safe and effective the current vaccines are, so it is the responsible thing to do for our friends, families and co-workers to get immunized.”

While always concerning when adverse reactions emerge, the action by the FDA to pause the J&J vaccine is out of “abundance of caution” and it’s a strong signal of how responsive they are to any potential safety concerns. Cerebral venous sinus thrombosis (CVST) with J&J vaccine has been reported in 6 young women (ages 18-48) among 6.8 million doses in the US. To date, Dallas County has administered 61% Pfizer, 35% Moderna, and 4% J&J. The syndrome has been dubbed vaccine-induced immune thrombotic thrombocytopenia.(VITT), based on a similar syndrome after the commonly-used medication heparin abbreviated HITT. The reported rates are much lower than IV Heparin which is used frequently in the hospital. While the risk benefit ratio of continuing to use J& J vaccine in the US COVID-19 vaccination plan may still make sense given the observed case fatality rate of 1.8% of COVID-19, prudence to understand the situation given the FDA emergency use authorization for use is warranted..

The FDA pause for the J&J vaccine will not significantly impact the PCCI initial estimate for Dallas County’s path to herd immunity by June. We were progressing towards herd immunity at a rate of approximately 3% per week, which was ahead of initial predictions. While the allocations for J&J were scheduled to increase and the latest developments will pause those vaccinations likely for days, up to several weeks, we forecast that Dallas county will continue to make progress at 2-2.5% per  week, which maintains the pace for mid-June.

A year in retrospective
With the COVID-19 pandemic ongoing for over a year, PCCI identified the zip codes with the highest average vulnerability from July 2020 through March 2021. These represent areas which have faced the highest risk during the COVID-19 pandemic to date.

Data Sources:
To build Vulnerability Index, PCCI relied on data from Parkland Health & Hospital System, Dallas County Health and Human Services Department, the Dallas-Fort Worth Hospital Council, U.S. Census, and SafeGraph.

About Parkland Center for Clinical Innovation
Parkland Center for Clinical Innovation (PCCI) is an independent, not-for-profit, healthcare intelligence organization affiliated with Parkland Health & Hospital System. PCCI leverages clinical expertise, data science and social determinants of health to address the needs of vulnerable populations. We believe that data, done right, has the power to galvanize communities, inform leaders, and empower people.

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Authors

Steve Miff, PhD., President & CEO of PCCI, George “Holt” Oliver, MD, Vice President of Clinical Informatics at PCCI and  Thomas Roderick, PhD, Senior Director of Data and Applied Sciences at PCCI.

7 April 2021

“BUILDING CONNECTED COMMUNITIES OF CARE” BOOK EXCERPT Case Study – Engaging Patients—Location and Relationships Matter




Following is an excerpt from PCCI’s book, “Building Connected Communities of Care: The Playbook For Streamlining Effective Coordination Between Medical And Community-Based Organizations.” This is a practical how-to guide for clinical, community, and government, population health leaders interested in building connected clinical-community (CCC) services.

This section is from Chapter 6, “Clinical Providers Track.” The purpose of the Clinical Providers Track is to set out the stakeholders and processes required to integrate clinical entities, insights, programs, interventions, strategies, and measurement for the CCC.

PCCI and its partner Healthbox, offers readiness assessments as a service. If you and your organization are interested, go here for more information: https://pccinnovation.org/connected-communities-of-care/.

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Case Study: Engaging Patients—Location and Relationships Matter

As part of our CCC history, PCCI has developed and tested a number of approaches to identifying individuals within the population of vulnerable and under-served Parkland patients who could benefit from screening for health related social determinants, engaging them in the completion of a brief risk assessment and subsequent linkage to available community resources. As with many of the elements of the CCC, this proved to be a learning experience in which initial, more conventional approaches gave way to new and more innovative approaches of engaging this population to optimize goal
attainment.

RECRUITMENT
Much of the initial work began with screening in the outpatient setting. Parkland has 12 Community-Oriented Primary Care (COPC) clinics located throughout Dallas County to serve local residents. Because the COPCs see a large number of patients on a daily basis, many of whom are considered vulnerable and underserved, these COPCs were determined to be a great
location to conduct the social determinant risk assessments. When a patient checked in for a visit, the office staff would provide the patient with a paper-based screening tool to self-administer. Trained community health workers were available in the waiting area to help, if required. Initially we felt like this approach made sense since the large number of COPC patients translated into large numbers of completed screening surveys. However, while there were a large number of initial screenings, the number was very low of patients that agreed to engage with a PCCI community health worker to connect with local community services. Many stated they were not interested or needed to leave the facility for another commitment. Other patients completed the needs assessment but left the COPC before staff members were able to connect with them. Of these, very few responded to follow-up phone outreach and the ones that did were hesitant about referral to community-based services. The team attributed this gap to the lack of personal engagement at the point of initial screening.

As a result of this initial experience, the team made some changes to the screening protocols. Three concurrent workflows focusing on different points of patient encounters were designed and tested. The three new points included: (1) engagement while the individual was in the ED, (2) engagement of individuals that had already left the ED, and (3) engagement of hospitalized patients on the medical/surgical floors of the hospital.

For the direct engagement while the individual was in the ED, licensed social workers conducted initial face-to-face screenings with patients awaiting care. The social workers were provided a list of eligible patients (those with multiple ED visits in the past year) and went room to room to conduct the screenings and determine if the patients were interested in connecting with community resources. Because many of these patient interactions took place while the individual was in the middle of an ED care visit, the PCCI team member was mindful of this and stepped aside, as needed, to ensure they didn’t interrupt the patient’s care. For those individuals that left the ED before screening, the PCCI team placed these individuals’ names and contact numbers on a sheet and later reached out to them by phone to explain the program and ask if they were interested in receiving information on community resources.

Finally, for those individuals undergoing an inpatient stay in the hospital, PCCI personnel obtained census data reports with information about eligible patients and then staff visited these patients in their rooms to conduct one-on-one conversations to implement the screening tool and to determine if the patients were interested in receiving more information about navigation services to community resources.


As shown in Table 6.1, a key learning from this undertaking was that the site matters in conducting the screenings and successfully connecting people to local programs for support. We learned that engaging patients during their inpatient stay was the optimal care setting in which to conduct screenings and then connect those patients to the appropriate community resources.

Establishing trust with patients early in the process was essential, both for completing the initial screening tool and for facilitating connection to community services. During our initial approach, we relied on self-administered screenings that provided little in the way of opportunity to establish a relationship with patients. Our modified workflow allowed our social workers and community health workers to verbally administer the screening tool and provide additional explanations as part of that exchange. This process also made the transition to navigation services virtually seamless and much more
effective. Feedback from patients has also been positive; most indicated that the information received was useful and many said they would share this information with other family members and close friends.

THE SCREENING PROCESS
The PCCI community engagement team consisted of six community health workers and two master’s-level, licensed social workers. Initially, the team consisted entirely of social workers, but our experience taught us that a blended staff model was more cost-effective. PCCI physician leaders coached all team members on how to be flexible and professional when working in the ED, where care moves at a rapid pace. The team needed to take cues from medical staff on where and when to step in to conduct the screenings. Similar trainings were delivered to those staff visiting patients in the hospital.

Over the course of the 6-month pilot, we were also able to identify a number of key elements that increased both the effectiveness and efficiency of the screening process. For example, we learned that it took on average 15 minutes to complete the assessment tool when it was facilitated by a team member but only 10 minutes when self-administered. While the self-administered survey took less time to complete, we found a much higher percentage of incomplete and inaccurate responses, making many of the screens useless. As would be expected, we also found that older patients—those 65 or older—took on average 20 minutes to complete the facilitated screening survey while younger individuals completed it in half the time. The difference was attributable to the amount of questions asked and attendant conversations, which were much more prevalent with older patients. Finally, once we began to work more closely with the patients and they developed a better sense of the purpose of the work, we encountered very few issues with obtaining consent from the patients to share their information with others.

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