Featured Blog Archives – PCCI

20 July 2021

PCCI Supporting Episcopal Health Foundation’s $8 million Texas Accountable Communities for Health Initiative




Episcopal Health Foundation selects six communities to participate in $8 million Texas Accountable Communities for Health Initiative

TACHI project aims to build sustainable community-based partnerships to address underlying, non-medical causes of poor health

Partners include organizations focused on housing, social services, employment training, health care, and more

HOUSTON – (July 20, 2021) – The Texas Accountable Communities for Health Initiative (TACHI), launched by Episcopal Health Foundation (EHF), has announced that six local communities from across the state have received funding as part of an $8 million project to go beyond the doctor’s office to improve the health and well-being of Texans.
Each community was awarded funding to establish an Accountable Community for Health (ACH) – a community-based partnership formed by local organizations from different sectors to address underlying, non-medical community health needs like safe housing, food security, safe places to exercise, and more. TACHI will grant funds to each ACH site, depending on specific needs, over a four-year period.

The TACHI sites selected are:

• Austin Rundberg
• Bastrop County
• Brazos Valley
• Greater Northside in Houston
• Gregg County
• Williamson County

• Learn more: www.txachi.org

“This is an important step forward to position these community-based organizations to advance community-led, financially-sustainable strategies to improve health, not just health care in their own neighborhoods,” says Shao-Chee Sim, EHF’s Vice President for Research, Innovation and Evaluation. “The goal is to improve health outcomes for under-served Texas communities by focusing on healthy living in communities, not sick care. That’s why the unique ACH partnerships are addressing community conditions outside of hospitals and doctors’ offices.”

ACHs include organizations focused on health care, housing, social services, public health, employment training, economic development, and more. Along with grant funding, TACHI offers the six community collaboratives technical assistance and peer-learning opportunities focused on topics related to health equity, community engagement, governance, data infrastructure, and financial sustainability.

“Essentially, ACHs serve as a local platform for bringing community organizations and residents together to address a shared community health goal, achieve greater health equity, and find ways to pay for the improvements over the long term,” Sim said.

EHF provides funding and leadership for the project. Two key partners are also working to ensure TACHI sites are making positive health impacts in their communities:

• Parkland Center for Clinical Innovation (PCCI) serves as the Project Management Office. PCCI, an independent affiliate of Parkland Health & Hospital System is a nonprofit, data science, and innovation organization known for their ground-breaking work in building connected communities of care.

• Georgia Health Policy Center (GHPC) serves as the external evaluator. GHPC, housed within Georgia State University’s nationally ranked Andrew Young School of Policy Studies, will conduct both formative and summative evaluation of TACHI to help PCCI and EHF understand how the initiative is making progress towards the stated goals.

To learn more, visit https://www.txachi.org/.

More information on TACHI Sites
Austin Rundberg » The Austin Rundberg site is a small, urban community located in the City of Austin bounded by I-35 and Mopac. Lone Star Circle of Care will serve as the backbone for this collaborative.
Bastrop County » Located east of Austin, Bastrop County Cares will serve as the backbone for this collaborative.
Brazos Valley » Located in Bryan/College Station, Texas A&M University will serve as the backbone for this collaborative.
Greater Northside – Houston » Based in Houston, Avenue CDC will serve as the backbone for this collaborative.
Gregg County » Located in Longview in East Texas, Community Healthcore will serve as the backbone for this collaborative.

Williamson County » North of Austin, the Williamson County Health Department will serve as the backbone for this collaborative.

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To schedule an interview, contact Brian Sasser at bsasser@episcopalhealth.org or 832-795-9404.
Related materials:

Texas Accountable Communities for Health Initiative: https://www.txachi.org/

Episcopal Health Foundation: www.episcopalhealth.org

By providing millions of dollars in grants, working with congregations and community partners, and providing important research, Episcopal Health Foundation is supporting solutions that address the underlying causes of poor health. EHF was established in 2013 and is based in Houston. With more than $1.2 billion in estimated assets, the Foundation operates as a supporting organization of the Episcopal Diocese of Texas and works across 57 Texas counties. #HealthNotJustHealthcare

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?”

16 June 2021

Blog: Is Your Connected Community of Care Making a Difference?




By Keith Kosel, Executive Advisor at Parkland Center for Clinical Innovation

We ask this type of question every day. For example, we may ask― “Is this product that I purchased making a difference?” or “Is this advanced training that I completed making a difference?” Implicit in this common question is the expectation that because we have made an investment in something to achieve a result, the result should be better or more improved than the pre-investment state. So too with a Connected Community of Care (CCC). As I have discussed in previous blogs, establishing a CCC requires a substantial investment in both time and money. Therefore, it is only natural to ask― “Is this CCC making a difference, and how would I know?” Unfortunately, most CCCs are established with very little forethought given to this exact question. While we expect the CCC will help community residents improve their health and well-being, how will we know conclusively that this has happened? How will we demonstrate its impact to a potential partner or― more importantly― a funder? This is where data, measurement, and evaluation come into play. For most people, these three words cause anxiety levels to immediately rise. But this doesn’t need to be the case; a little planning and forethought can go a long way to assuaging one’ anxiety when asked the question, “Is your CCC making a difference?”

Before we think about what data we will need to answer this question or how we will collect it, we first need to establish what we mean by “making a difference”. Understand, there is no one correct answer to this question. What may constitute a positive difference or impact for one organization may be much different for another, even similar organization. Many factors contribute to the final answer and each are usually organization-, ecosystem- and situation-specific.

In practice, there are many ways to define making a difference. First, we can look at quantitative or numeric information to make this determination. Are we providing more nutritious meals to indigent residents? Is the number of inappropriate Emergency Department visits declining or, conversely, is the number of residents having visits with a primary care provider increasing? All of these effects can be counted and judged against some predefined goal (more on this later). Second, we can assess making a difference by asking the people that are being touched by the CCC. Through surveys or brief interviews, community residents can tell you in their own words what impact, if any, the CCC has on their lives. While this qualitative (non-numeric) information can often be more informative than simple quantitative information because it represents the voice of the individual, to answer the question of whether your CCC is making a difference, you will also still likely need to establish numeric goals. A third way to assess whether your CCC is making a difference is indirectly via the financial and non-financial opportunities that arise as a result of having a CCC versus not having one. For example, having a CCC may make it much easier to perform contact tracing among vulnerable populations during a pandemic like COVID-19.

Having a CCC may also enable a healthcare system or a community-based organization (CBO) to apply for a grant that it otherwise might not be competitively positioned to do if it did not have an integrated system of healthcare and social service providers such as a CCC.

Regardless of the approach to define making a difference, the importance of planning for 1) what things will be measured to generate the necessary data, 2) how and when that measurement will take place, and 3) how the resulting data will be analyzed and evaluated, cannot be underestimated.

Similarly, these decisions cannot be put off until a later date as is often seen with start-ups, including CCCs. While it is natural to want to focus on the more immediate needs associated with launching a CCC, deferring the question of how we will know if the entity is making a difference can prove costly, both from an operational and financial perspective. At the Parkland Center for Clinical Innovation (PCCI) we encourage those planning a CCC to devote the necessary time early on to setting performance goals and objectives and determining how and when they will be measured and evaluated. While it is important to explicitly build this step into your CCC planning phase, the scope and scale of the work does not have to be extensive. In fact, at PCCI we strongly encourage CCCs to start small with a limited set of goals, objectives, and requisite measures and then scale up as the CCC grows and matures. This approach has the dual benefit of providing essential core information early on while also not overwhelming the CCC staff with data collection activities that may be a distraction from more pressing, day-to-day activities.

Based on this author’s work with literally hundreds of healthcare and social service provider organizations, experience suggests that most entities (both new and established organizations) do best if they initially establish 1) a limited number of goals― one or two at most, 2) a similar number of objectives to achieve each goal, and 3) no more than three to four performance measures to support each goal. While this may seem like an insufficient number of performance elements in today’s data-obsessed world, remember that you can always add additional goals, objectives, and measures as your expertise and comfort levels allow and as your CCC evolves.

Even more important than the numbers, however, it is essential to get the selection of the goals, objectives, and performance measures correct. Each of these three performance elements plays an essential role in helping you answer the question “Is my CCC making a difference?” Your goals focus on the long-term― what do you ultimately want to happen, while your objectives are the short-term accomplishments that help you achieve your goals. In both cases, you must be sure that what you are expecting is both realistic and appropriate for your CCC’s stage of development. For example, assuming a newly established CCC will reduce ED utilization in its first year or two may not be reasonable and may lead to frustration and disillusionment if the goal is not achieved. If you select a BHAG (Big Harry Audacious Goal), you must allow sufficient time (and then some) for all the necessary pieces to come together. The rule of thumb for large-scale demonstration projects such as launching a CCC is that they 1) take (much) longer than expected, 2) cost more than budgeted, and 3) generally initially deliver less than expected. These facts should not dissuade you from your journey, but rather help you keep things in perspective as the project evolves to one that in the long-term is viewed as valuable in achieving your goals.

If getting the goals and objectives correct is important, then selecting the correct performance measures and designing a feasible measurement plan is paramount. Here again, quality is more important than quantity. A few well-chosen performance measures, implemented correctly, will generate far more in the way of actionable data than a plethora of randomly selected measures. To optimize your ability to assess if your CCC is making a difference, your performance measures should be collected at regular intervals following the launch of the CCC. While many established programs collect, analyze, and evaluate performance data on a quarterly basis, for fledgling CCCs, PCCI recommends this data be collected monthly for at least the first one to two years or until the CCC reaches a stable level of operations. While monthly data collection requires a little more work, the more frequent feedback allows you to make necessary program or operational modifications more quickly and with fewer disruptions than that afforded with quarterly feedback. If measurement and evaluation is an area where you don’t have a lot of experience, reach out to others that do, especially individuals and organizations such as PCCI that have experience assessing performance in large-scale, multi-sector collaborative projects.

While we all hope that the answer to the question “Is my CCC making a difference” is yes, the answer may be no early on in the life of a CCC. As disheartening as this news may be, it’s important to not give up, but to look critically at what is working and what is not and make adjustments where necessary. Usually, this examination does not necessitate a complete “reboot” of the CCC initiative, but rather requires making minor changes accompanied by paying closer attention to the CCC’s operations. Seek feedback from your staff and those you serve and be open to change, where change is warranted. As indicated, these types of projects take a lot longer to reach fruition than most people believe, but with a solid plan, patience, and flexibility, you will be able to answer, “Yes, my CCC is definitively making a difference in the lives of the community residents it serves.”

About the author
Dr. Keith Kosel is an Executive Advisor at Parkland Center for Clinical Innovation (PCCI) and is co-author of “Building Connected Communities of Care: The Playbook for Streamlining Effective Coordination Between Medical and Community-Based Organizations,” a guide that brings together communities to support our most vulnerable. At PCCI, Keith is leveraging his passion for – and extensive experience in – patient safety, quality, and population health by focusing on understanding social determinants of health and the impact of community-based interventions in improving the health of vulnerable and underserved populations.

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

12 May 2021

Dallas Morning News Op/Ed: PCCI CEO – Dallas Needs You In Race against COVID-19




In the Saturday, May 8 edition of the Dallas Morning News, PCCI’s CEO Steve Miff’s Op/Ed piece was published encouraging residents of Dallas County to receive their COVID vaccines in order for the county to reach herd immunity by June. To read the entire editorial, click on the image below:

https://www.dallasnews.com/opinion/commentary/2021/05/08/dallas-reaches-herd-immunity-at-80-immunity-we-are-at-35/?outputType=amp

 

12 May 2021

Updated PCCI Vulnerability Index Highlights Progress, but Ongoing At-Risk Communities




By Thomas Roderick, PCCI’s Executive in Resident
& George “Holt” Oliver, MD, PhD, Vice President, Clinical Informatics

Why this post

More than a year ago, the data scientists at Parkland Center for Clinical Innovation (PCCI) committed to take the fight to COVID-19 by assisting North Texas residents, community leaders and public health officials through delivering actionable pandemic intelligence.

Many of us at PCCI and in the community have suffered the loss of family members, colleagues, coworkers, neighbors and friends. So with great relief we have witnessed tremendous scientific achievements in the development, approval and distribution of COVID-19 vaccines within a year. We have also seen the community evolve and adapt to life with COVID-19 and the actions expand from initial testing strategies to vaccine deployment, herd immunity projections and tracking, to now overcoming vaccination hesitancy and surveillance tracking of emerging variants, re-infections and individual/community immunity.

As our community and pandemic efforts evolve, so does the intelligence it needs. To meet that need, PCCI is evolving its technology and is pleased to announce the next phase of the Vulnerability Index.

What is the Vulnerability Index?

The Vulnerability Index is a measure of risk a community faces due to COVID-19. Higher risk means that people may be more likely to be infected with COVID-19, and if they do, they are more likely to experience symptoms and potentially face hospitalization and even death.

When the Vulnerability Index was first built, it covered factors correlated with COVID-19, including attributes in the community that don’t change quickly (like proportion of elderly population, people living with chronic conditions that are associated with COVID-19, and social determinants of health) as well as dynamic factors that increase immediate risk, like active COVID-19 cases and the mobility of the people living in the community.

How has the Vulnerability Index changed?

The North Texas community has evolved in two very important ways, and so the Vulnerability Index is changing as well.

    • First, as with the rest of the world it has adopted mask-wearing, social distancing, hand washing, and other hygiene and behavioral recommendations from public health authorities to limit the spread of COVID-19. Combined with the full opening of the economy, this means that a mobility factor has less relevance in identifying risk, because people change their behavior when they are out shopping at the grocery store, working, visiting parks, and otherwise engaging in the community. Without these behavior adjustments, mobility would continue to be important to monitor and understand, but not a critical factor in predicting neighborhood vulnerability.
    • Second, the introduction and uptake of the vaccine has started the process of lifting communities to herd immunity (HI), which is where the virus has a hard time finding people to infect because enough people have antibodies. As more people get vaccinated, there are fewer people in the community to become infected, and the community is less vulnerable.

An important caveat is that COVID-19 variants can continue to arise. PCCI is conducting ongoing surveillance on reinfections across Dallas County to assess the emergence of new variants, transmission and potential drop off of previously developed immunity. If this happens it means the mediating effect of the vaccination against COVID-19 risk may be decreased – so more people face infection risk. This is also captured in the updated Vulnerability Index.

How is the Vulnerability Index used?

The Vulnerability Index is used to inform how the communities and municipalities across Dallas County coordinate efforts to improve access to testing, vaccinations and create a path towards herd immunity. Below is a balloon plot, which shows cases on the horizontal axis and vaccinations on the vertical axis. It highlights HI progress in early April for ZIP codes across Dallas County. Each circle represents the current progress; each tail shows the improvement over two weeks. Upward “balloon” trajectory is favorable as it indicates that improvement was a result of vaccinations, not infections.

Source: The Parkland Center for Clinical Innovation

One thing that immediately jumps out is that ZIP codes with higher static vulnerability (or long-term risks in a community that do not change quickly such as age, medical comorbidities and social/economic factors) were slower at vaccine uptake. A potential reason for this is social determinants of health (SDOH) – people who live in these zip codes may be in jobs that are not conducive to have the ability to take time off from work and to travel to vaccine sites to be vaccinated. This information is used by community organizers, public health officials, and health care providers to coordinate efforts and target each community in a way that removes barriers to vaccinations and target information and education via convenient and trusted sources.

Excelsior!

Ongoing vigilance against the virus remains key, and this includes getting vaccinated at your first available opportunity. As we enter the second summer in the pandemic, we at PCCI are committed to monitoring for COVID-19’s continued impact on the community, whether through improving the view into impacted communities, the impact of variants, reinfection risk, and more.

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

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