U.S. communities and federal agencies should more intentionally seek to create healthier communities during disaster preparation and recovery efforts — something that rarely happens now, says a new report from the Institute of Medicine. By adding a health “lens” to planning and recovery, a community can both mitigate the health damage caused by disasters and recover in ways that make the community healthier and more resilient than it was before.

“We have an opportunity to transform our response to devastating disasters into an effort to meaningfully enhance the healthiness of our communities,” said Reed Tuckson, chair of the study committee that wrote the report, and managing director of Tuckson Health Connections LLC, Sandy Springs, Ga. “Each year, millions, if not billions, of dollars are spent to restore communities after disasters. This report provides practical guidance for disaster and health professionals, government and elected officials, communities, and individuals that can not only enhance disaster recovery but also advance the realization of maximally health communities."

Healthy communities are conducive to healthy behaviors and free of environmental toxins and risks, and they include a robust human services infrastructure. They have roads that facilitate exercising such as running, biking and walking; houses that are safe; and ready access to fresh fruits and vegetables. They are also well-served by health and social services professionals who assist people in staying healthy and optimally managing diseases, noted the committee.

When roads, houses, and health infrastructures are lost in a disaster, communities should use all available federal, local and philanthropic dollars to rebuild in a manner that creates a community that is healthier than it was before the disaster. The report includes recommendations, case studies, and other supportive material to provide practical guidance for accomplishing this.

For example, local and elected public officials should incorporate a vision for a healthy community into community strategic planning. Healthy community planning should be the norm for all communities, and these plans should be connected to the pre-disaster planning that communities are also urged to conduct. Leadership by local officials is essential to bringing these two related activities together on behalf of their communities.

The report also provides specific guidance for federal agencies such as FEMA, the Department of Health and Human Services, the Department of Housing and Urban Development and other agencies involved in implementing the National Disaster Recovery Framework. For example, FEMA should update the National Disaster Recovery Framework to include health implications for the activities of all support functions involved in disaster recovery. In addition, federal agencies should use existing grant programs to enhance state and local ability to plan for and implement a healthy community perspective in disaster recovery.

How Twitter Can Help Predict Emergency Room Visits

Twitter users who post information about their personal health online might be considered by some to be "over-sharers," but new research led by the University of Arizona suggests that health-related tweets may have the potential to be helpful for hospitals.

Led by Sudha Ram, a UA professor of management information systems and computer science, and Yolande Pengetnze, M.D., a physician scientist at the Parkland Center for Clinical Innovation in Dallas, the researchers looked specifically at the chronic condition of asthma and how asthma-related tweets, analyzed alongside other data, can help predict asthma-related emergency room visits.

Ram and her collaborators — including Wenli Zhang, a UA doctoral student in management information systems, and researchers from the Parkland Center for Clinical Innovation — created a model that was able to successfully predict approximately how many asthma sufferers would visit the emergency room at a large hospital in Dallas on a given day, based on an analysis of data gleaned from electronic medical records, air quality sensors and Twitter.

Their findings, to be published in the forthcoming IEEE Journal of Biomedical and Health Informatics' special issue on big data, could help hospital emergency departments nationwide plan better with regard to staffing and resource management, said Ram, the paper's lead author.
"We realized that asthma is one of the biggest traffic generators in the emergency department," Ram said. "Often what happens is that there are not the right people in the ED to treat these patients, or not the right equipment, and that causes a lot of unforeseen problems."

Over a three-month period, Ram and her team collected air quality data from environmental sensors in the vicinity of the Dallas hospital. They also gathered and analyzed asthma-related tweets containing certain keywords such as "asthma," "inhaler" or "wheezing." After collecting millions of tweets from across the globe, they used text-mining techniques to zoom in on relevant tweets in the ZIP codes where most of the hospital's patients live, according to electronic medical records.

The researchers found that as certain air quality measures worsened, asthma visits to the emergency room went up. Asthma visits also increased as the number of asthma-related tweets went up. The researchers additionally looked at asthma-related Google searches in the area but found that they were not a good predictor for asthma emergency room visits.

By analyzing tweets and air quality information together, Ram and her collaborators were able to use machine learning algorithms to predict with 75 percent accuracy whether the emergency room could expect a low, medium or high number of asthma-related visits on a given day.
The research highlights the important role that big data, including streams from social media and environmental sensors, could play in addressing health challenges, Ram said.

She and her team hope that their findings will help them create similar predictive models for emergency room visits related to other chronic conditions, such as diabetes.

'Public Deliberation' Captures Informed Views on Complex Health Policy Issues

Public deliberation — a way to capture in-depth perspectives on controversial issues — effectively provides informed public views on complex health policy issues, such as the role of medical evidence in treatment decisions, according to a randomized controlled trial conducted by the nonprofit, nonpartisan American Institutes for Research and published in the May edition of the peer-reviewed journal Social Science & Medicine.

The U.S. health care system's complexity, coupled with the inherently emotional and personal nature of serious illness or injury, often makes it difficult for policymakers to obtain informed public views to help guide decisions on complicated health care issues. Unlike surveys and focus groups designed to measure the prevalence and range of opinions — or so-called top-of-mind opinions — public deliberation encourages people to become informed about a topic and consider alternative, often competing, perspectives. Public deliberation has three main components:

  • Educating participants about an issue, usually through neutral, objective written materials or conversations with experts
  • Ensuring balance by considering all sides of an issue
  • Encouraging participants to keep broader societal concerns in mind along with their individual points of view.

Conducted as part of the Deliberative Methods Demonstration funded by the Agency for Healthcare Research and Quality, the AIR study is among the first large-scale randomized controlled trials of alternative methods of public deliberation and included 1,338 people assigned to take part in one of four deliberative methods or to a reading-materials-only control group.

The participants all considered the same health policy issue: “Should individual patients and/or their doctors be able to make any health decisions no matter what the evidence of medical effectiveness shows, or should society ever specify some boundaries for these decisions?”

Between August and November 2012, AIR convened 76 public deliberation groups in four communities: Chicago; Sacramento, Calif.; Silver Spring, Md.; and Durham, N.C. The communities were selected to ensure a diverse sample in terms of racial, ethnic and socio-demographic background, with special attention to including members of three AHRQ priority populations:  Hispanics, African-American women and elderly people.

Compared with the control group, public deliberation increased participants' knowledge of medical evidence and comparative effectiveness research and shifted their attitudes about the importance of medical evidence in treatment decisions, according to the study.

“There is growing awareness that informing and engaging the public — both as patients and as citizens — is critical to achieving better care and better health,” said AIR Vice President Kristin L. Carman, lead author of the study and executive director of AIR's Center for Patient & Consumer Engagement. “The study findings indicate that public deliberation is an effective way for policymakers to both engage citizens in complicated health care issues and potentially to 'see around the corners' to better understand and anticipate how public attitudes might change as people learn more about specific issues and discuss them.”

The results of a related AIR analysis published in the February Journal of Health Care for the Poor and Underserved underscore the value of public deliberation as an effective way to gather diverse public input, including views of people from differing racial and ethnic backgrounds and education levels. The study found that regardless of race, ethnicity or educational attainment, participants showed similar increases in knowledge following deliberation.

Report Offers Blueprint to Improve Professional Care, Education of Children

Given that children's health, development and early learning provide a critical foundation for lifelong progress, the workforce that provides care and education for children from birth through age 8 needs consistent, high-quality training to produce better outcomes for children, says a report from the Institute of Medicine and National Research Council. To build a workforce unified by a common knowledge base and necessary skills, the report offers a blueprint with specific actions for local, state and national leaders in areas of higher education, professional learning during ongoing practice, policies for qualification requirements, and other standards for professional practice.

Children begin learning at birth, and they develop at a rapid, cumulative pace in their early years. Young children thrive when they have secure, positive relationships with adults who are knowledgeable about how to support their development and are responsive to their individual progress.  However, young children's need for consistency and continuity is not being met because the systems that provide their care and education from infancy through the early elementary years are fragmented, concluded the study committee that wrote the report. 

Qualification requirements for care and education professionals currently vary widely based on their role, the ages of the children with whom they work, and which agency or institution has authority to set qualification criteria.  The science of child development and early learning shows that the work of all lead educators for young children requires the same high level of sophisticated knowledge and skills, regardless of the child's age.

Therefore, the committee recommended a collaborative effort to develop and implement phased timelines at the individual, institutional, and policy levels for transitioning to a minimum bachelor's degree requirement for all lead educators -- those individuals who bear primary responsibility for instructional and other activities for children in formal care and education environments as well as oversee assistant teachers and paraprofessionals. 

“Despite their shared goal of nurturing and securing the future success of children, care and education professionals for this age group currently work in disparate systems where the expectations and policies have not kept pace with what the science of child development and early learning indicates children need,” said committee chair LaRue Allen, Raymond and Rosalee Weiss Professor of Applied Psychology and chair of the department of applied psychology in the Steinhardt School of Culture, Education, and Human Development at New York University.  “Although it will take considerable time and effort, establishing a cohesive workforce for young children will help connect what we know about how to support children to what we do in the settings where they develop and learn.”

The committee concluded that higher education institutions should develop high-quality training programs for specific professional roles as well as interdisciplinary programs that foster a shared fundamental knowledge base and skills that support child development for professionals in all sectors working with young children — care and education, social services, and health/allied health professions — using required core coursework, learning activities, and field-based experiences.

The report also recommends creation of a new model for evaluating and assessing early childhood professionals, which should align with findings on the science of how young children develop and learn, reflect day-to-day practice, be tied to access to professional learning, and account for setting- and community-level factors such as overcrowded classrooms, lack of resources, and varied home environments.

To improve continuity of children's care and education, practitioners, leaders, and policymakers at the state and local levels should develop strategies and mechanisms for strengthening collaboration and communication across professional roles and practice settings.  For example, specific professional roles, such as navigators or case managers, could be supported to facilitate connections for children and families so that the entire burden of collaboration does not fall on practitioners.

The study was sponsored by the U.S. Department of Health and Human Services' Administration for Children and Families and Health Resources and Services Administration; U.S. Department of Education; W.K. Kellogg Foundation; Robert R. McCormick Foundation; David and Lucile Packard Foundation; and the Bill and Melinda Gates Foundation.  The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.