Building a citywide, all-payer, hospital claims database to improve health care delivery in a low-income, urban community.

Developing data-driven local solutions to address rising health care costs requires valid and reliable local data. Traditionally, local public health agencies have relied on birth, death, and specific disease registry data to guide health care planning, but these data sets provide neither health information across the lifespan nor information on local health care utilization patterns and costs. Insurance claims data collected by local hospitals for administrative purposes can be used to create valuable population health data sets. The Camden Coalition of Healthcare Providers partnered with the 3 health systems providing emergency and inpatient care within Camden, New Jersey, to create a local population all-payer hospital claims data set. The combined claims data provide unique insights into the health status, health care utilization patterns, and hospital costs on the population level. The cross-systems data set allows for a better understanding of the impact of high utilizers on a community-level health care system. This article presents an introduction to the methods used to develop Camden's hospital claims data set, as well as results showing the population health insights obtained from this unique data set.

Generating hypotheses about care needs of high utilizers: lessons from patient interviews.

Informed by a largely secondary and quantitative literature, efforts to improve care and outcomes for complex patients with high levels of emergency and hospital-based health care utilization have offered mixed results. This qualitative study identifies psychosocial factors and life experiences described by these patients that may be important to their care needs. Semi-structured interviews were conducted with 19 patients of the Camden Coalition of Healthcare Providers' Care Management Team. Investigators coded transcripts using a priori and inductively-derived codes, then identified 3 key themes: (1) Early-life instability and traumas, including parental loss, unstable or violent relationships, and transiency, informed many participants' health and health care experiences; (2) Many "high utilizers" described a history of difficult interactions with health care providers during adulthood; (3) Over half of the participants described the importance to their well-being of positive and "caring" relationships with primary health care providers and the outreach team. Additionally, the transient and vulnerable nature of this complex population posed challenges to follow-up, both for research and care delivery. These themes illuminate potentially important hypotheses to be explored in more generalizable samples using robust and longitudinal methods. Future work should explore the prevalence and impact of adverse childhood experiences among "high utilizers," and the different types of relationships they have with providers. Investigators should test new modes of care delivery that attend to patients' trauma histories. This qualitative study was well suited to provide insight into the life stories of these complex, vulnerable patients, informing research questions for further investigation.

Pre-teen literacy and subsequent teenage childbearing in a US population.

BACKGROUND: While literacy is a key factor in health across the life course, the association of literacy and teenage childbearing has not been assessed in the US. STUDY DESIGN: Prospective cohort study using standardized reading data from 12,339 girls in the seventh grade in the 1996-97 or 1997-98 academic years of the Philadelphia Public School System linked to birth records from the city of Philadelphia (1996-2002). RESULTS: Less than average reading skill was independently associated with two and a half times the risk of teen childbearing than average reading skill (aHR 2.51, 95% CI: 1.67-3.77). Above average reading skill was associated with less risk (aHR 0.27, 95% CI 0.17-0.44). A significant interaction (p<.05) between reading skill and race/ethnicity indicated that Hispanic and African American girls had greater risk of teen-childbearing by literacy. CONCLUSIONS: Literacy strongly predicts risk of teenage childbearing independent of confounders. The effects of literacy were stronger among girls with Hispanic or African American race/ethnicity.

Use of city-archival data to inform dimensional structure of neighborhoods.

A growing body of research has explored the impact of neighborhood residence on child and adolescent health and well-being. Most previous research has used the US Census variables as the measures of neighborhood ecology, although informative census data are not designed to represent the sociological and structural features that characterize neighborhoods. Alternatively, this study explored the use of large-city administrative data and geographical information systems to develop more uniquely informative empirical dimensions of neighborhood context. Exploratory and confirmatory structural analyses of geographically referenced administrative data aggregated to the census-block group identified three latent dimensions: social stress, structural decline, and neighborhood crime. Resultant dimensions were compared through canonical regression to those derived from US Census data. The relative explanatory capacity of the city-archival and census dimensions was assessed through multilevel linear modeling to predict standardized reading and mathematics achievement of 31,742 fifth- and 28,922 eight-grade children. Results indicated that the city-archival dimensions uniquely augmented predictions, and the combination of city and census dimensions explained significantly more neighborhood effects on achievement than did either source of neighborhood information independently.