Date of Defense:
Friday, February 21, 2020
Introduction: The Plain community is composed of Amish and Mennonites that settled around 16th century in US after fleeing religious persecution in Europe. The Eau Claire County settlement is one of the most numerous settlements in WI and includes approximately 2,000 individuals (2% of Eau Claire County population). Due to their religious and cultural beliefs that prohibit them from using social security, government services and health services, the Plain community, one of the most vulnerable communities in Eau Claire. This community has been experiencing significant access to care challenges affecting significantly child-bearing age women and children. The Eau Claire City-County Health Department (ECCCHD) is a key healthcare provider to the community through home-visiting program, which includes prenatal visits, newborn screening and emergency referrals. This evaluation was part of the quality improvement initiative and it is aimed to inform the health equity initiative and improve the quality of services through evidence-based decision-making process.
Experience: It was a needs assessment to evaluate direct client services from 2014 – 2018 and immunization services from 2008 – 2018 to all the clients in general with a focus on the Plain community. Data were extracted from Nightingale Notes and Wisconsin Immunization registry that are the 2 databases used to record client information. The analysis focused on client’s socio-demographics, the type of services provided and their trend overtime. Also, a data quality analysis was performed on the existing data collected in 2 databases that are Nightingale Notes and Wisconsin Immunization Registry. The data quality analysis was about completeness, accuracy, validity and duplicates.
Organization: In its mission to promote health and safety for all Eau Claire communities, the ECCCHD has established a long-term trusting relationship with the Plain community and has used this relationship to provide health services with respect for their cultural and religious beliefs and practices. In general, the services provided to the community are prenatal screening, post-partum follow-up, communicable diseases services and newborn blood screening as well as Children with Special Health Care needs screening.
The ECCCHD is a combined city and county health department that provides public health services to Eau Claire County that is home to 98,738 residents distributed in 13 towns, 2 villages and 3 cities. It provides diverse programs and services including maternal and child health, environmental health, community health promotion, communicable disease surveillance and investigations, and prevention policy and systems work. Some direct client services are immunizations, WIC, home visitation, and family planning services.
Results: In the data quality assessment, duplicates were found to represent 12% of the data. Age, gender and location were completed more 99.5% each. Conversely, variables such as marital status, race, ethnicities, employment and education had a completeness rate between 3% and 16%. In Eau Claire County, 36% of street addresses did not follow the standardized format. The race was the most confusing variable because of some confusion in the definition as well as the formatting in the database.
In the past 5 years, the ECCCHD has provided services to 7,098 distinct individuals whose age ranged from 1 day of life to 94 years, with 61% being children under 5 and young adults between 20-30 years. The clients were demographically representative of the county.
Were vaccinated,15,157 individuals between 2008 and 2018 in the ECCCHD. The vaccination rate was 1 – 34 vaccinations per person with 26.8% of the clients receiving one vaccination. Among all vaccines administered, 23.2% were Flu vaccine and 18% were Diphtheria, Tetanus, and Pertussis vaccine.
Among 7098 clients who received direct client services, 560 (7.9%) were Plain community with an annual average of 190±18 clients. Among them, 65% were females, mostly at reproductive age with an average of 30±0.5 years. Compared to male Plain community members who received services, females were older, with an average age of males of 18±1 years (p<0.001). Almost all (99.7%) services were prenatal care and newborn screening.
For immunization services, 1864 vaccinations were administered to 463 Plain community clients in 10 years. In the past 3 years, there were significant increases in number of clients who got vaccinated. It went from 72 clients in 2016 to 159 in 2017 and 320 in 2018. The number of vaccinations ranged from 1 to 24 vaccinations per client with a tie at 10% for 1, 3, 9, or 12 vaccinations per client. Most vaccines (73.8%) were administered in-home by PHN and Diphtheria, Tetanus, and Pertussis vaccine is the most administered in 33.4%. Over the past 10 years, more vaccinations have been administered to the community.
Lessons Learned: This project informed me about the evolution of the services in the health department. This project has strengthened my data cleaning and analysis skills as well as communication skills. Collaboration between different collaborators, managers and Public health Nurses to contextualize the analysis was an important piece in this project
Recommendations: Recommendations have been made to create a data quality standards document in the department for data quality improvement and consistency. It was suggested to organize regular data cleaning. Since the health department provides most of the prenatal visits and screening to the Plain community, it is recommended to redesign the data collection database to capture medical information on the clients in order to ensure a reliable women health outcomes and children’s health monitoring and evaluation of services as well as mothers and children’s health.
Conclusion: The field experience gave me real-word experiences in existing data analysis challenges. It has demonstrated the benefit of cultural competency through the respect of cultural values of communities. Clearly this collaboration has been improving health outcomes in the community. Evidence-based decision-making is necessary in improving care and in promoting health equity.