One of the things that will be fascinating to watch over the next several years is whether research demonstrates that the current efforts at multi-sector data sharing and an enhanced focus on social determinants of health pay off in improved health outcomes and lower costs. It seems logical that they would, but the focus is so new that it will require more research.
My colleague Heather Landi recently reported on a panel discussion of organization leaders working to use health IT to collect and integrate social and behavioral health data. She quoted Abigail Fallen, senior program manager, health information exchange and data security at the Camden Health Coalition in Camden, N.J., who said, "We have a large data shop and we take data from different sources that are not linked in order to link them together and to identify trends that are driving patients to multiple hospital stays. Our data tells narratives about our patient population.”
One particularly promising avenue is better data sharing between public safety and corrections organizations and health providers, and once again Camden is at the forefront. Last year I wrote about how the organization worked to share data between health providers and jails.
“There was useful information in the jail data,” said Stephen Singer, the Coalition’s senior manager of analytics and information architecture. “It helped us with linking the same individuals across systems, and the jail had something we had nowhere else — several aliases that clients went by.” That gave the clinicians a wider set of names and made it possible to link people across hospitals. “We didn’t have a full picture unless we knew when they were incarcerated,” he said. “It gave us a much richer picture of those clients."
Now the Coalition’s leaders have published a paper on lessons learned integrating healthcare and criminal justice data. With a grant from the Laura and John Arnold Foundation, researchers from the Camden Coalition analyzed cross-sector data and found that a small number of Camden residents have an enormous and disproportionate impact on the healthcare and criminal justice sectors, neither of which is designed to address the underlying problems they face, which the study identifies as: housing instability, inconsistent or insufficient income, trauma, inadequate nutrition, lack of supportive social networks, mental illness, and substance abuse disorders. These unaddressed social determinants of behavior appear to drive a cycle of repeated arrests and hospitalizations, the research finds.
Here are a few of the study’s key findings:
• There is a relationship between high use of hospital emergency departments (EDs) and frequent arrests, and a small subset of 226 individuals had extreme numbers of contacts with both hospital EDs and police.
• The study found that many of the factors that correlate with frequent hospital use also correlate with a high risk for crime and criminal justice involvement
• A majority of all Camden arrestees (67 percent) made a trip to the ED at least once during the study’s timeframe (2010 to 2014), with more than one-half (54 percent) of this group making five or more visits.
Integrating data across sectors using common identifiers offers a new view of an individual’s life and thus a more meaningful and complete understanding of the challenges he or she faces, the researchers find.
Among people in frequent contact with EDs and police, data reveal significant variety in their experiences and behaviors, suggesting that interventions will need to be tailored to meet their unique needs.
The report stresses that only by breaking down data silos among agencies that serve vulnerable populations can we begin to address the root causes of behavior and prevent individuals from cycling through multiple systems.
That raise the question of whether society will continue to treat the symptoms of conditions such as substance abuse, mental illness, and homelessness by cycling people through hospitals and jails or whether they will be met through deeper treatment of underlying diseases and problems. “In other words, have we chosen a seemingly quick fix, where we repeatedly funnel people who need treatment into our jails and hospitals, over solutions that foster the long-term safety and well-being of communities?”
In the next phase of their work, these researchers will turn their attention to designing and testing interventions to prevent people cycling through these institutions. I look forward to following up on these important efforts when they publish again.
