Day-to-Day Activities The Fellow will have opportunities to:

Transcription

1 Chronic Diseases Michigan Department of Health and Human Services, Chronic Disease Epidemiology Section, Lifecourse Epidemiology and Genomics Division Lansing, Michigan Assignment Description The Fellow will be working with mentors in the Chronic Disease Epidemiology Section (CDES) with an ability to focus on epidemiology across the lifespan and tailor an experience that matches the Fellow s interests and strengths; staff would be excited to host a fellow with a focus and interests in chronic disease epidemiology. The Fellow would have access to numerous data systems including but not limited to vital records; inpatient hospitalizations; cancer, stroke, and birth defects registries; Michigan Behavioral Risk Factor System (MiBRFSS), MiBRFS Asthma Call Back Survey, Pregnancy Risk Assessment Monitoring Survey (PRAMS), Youth Risk Behavior Survey (YRBS), and other surveys; newborn screening; Medicaid claims, enrollment, and pharmacy data; Michigan Stroke Registry; Hereditary Cancer Network Database; and Cardiac Arrest Registry to Enhance Survival (CARES). As a result, there are abundant opportunities for conducting evaluation of surveillance systems and intervention activities. Beyond these data sources, there is a critical need to identify and develop new data sources, evaluate and improve data quality, and improve the effective measurement of health outcomes. Equally important is the need to communicate findings in a participatory manner to chronic disease and partner organizations and Michigan residents. A coordinated data-to-action approach will provide the foundation for a continued system and outcomes evaluation, provide a data-based justification to educate policy makers, and support the goal of improving the health and wellness of real people across the life course. Moreover, CDES has a commitment to addressing health inequities and employs the same data-to-action construct by disseminating findings to program staff, other chronic disease epidemiologists, local agencies, and other partners. Electronic library capabilities are available from the State of Michigan librarian. The Department of Technology, Management and Budget provides hardware and software support and backup as well as secure network files and encryption for sensitive data. Day-to-Day Activities The Fellow will have opportunities to: Develop, maintain, and use data sets of varying size and complexity, link data files, edit data, maintain quality control, and manage projects; Participate in the design of studies, data collection, analysis, and interpretation of results and dissemination of key findings; Apply epidemiological methods and use analysis results to inform stakeholders and guide policy; Develop IRB applications and data use agreements in conjunction with Fellow mentors and MDHHS legal staff and keep both up-to-date; Review and edit reports and manuscripts for publication and prepare and deliver presentations;

2 Participate in site visits to the Quarantine Station in Detroit, MDHHS Office of Public Health Preparedness, the MDHHS State Lab, and others based on the Fellow s interests; Participate in other BEPH activities as time and interest permits, including communicable disease outbreaks and environmental field investigations; Plan and run meetings and communicate with mentors and key partners regarding project status; Develop professionally through seminars, professional meetings, webinars, and trainings at the Department or local universities and by assisting with mentoring student interns; Join the primary mentor on national, regional, state, and local workgroups; and Participate in strategic planning and other planning activities in the CDES. Potential Projects Activity Study of the trend in Stroke Comorbidities in the Michigan Inpatient Database The Michigan Department of Health and Human Services (MDHHS) has received three rounds of funding for the Michigan s Ongoing Stroke Registry to Accelerate Improvement of Care (MOSAIC) Program from CDC since The MOSAIC Program has continued to contribute to the expansion of the CDC Paul Coverdell National Acute Stroke Registry. Each consecutive grant has expanded the scope of the work of the Program, with the goal of developing a statewide comprehensive system of stroke care. MOSAIC works with 40+ hospitals and EMS providers throughout the state to improve the quality of stroke care, covering more than 60% of stroke hospitalizations in Michigan. More information about the MOSAIC Program can be found at: Stroke is accountable for 1 out of every 20 deaths in the United States. The decline of stroke mortality in the United States has slowed, and in some states has reversed in recent years. Although the quality of care has improved, as monitored by MOSAIC, the decreasing trend of stroke hospitalization and mortality rates in Michigan has slowed and in the past several years. Further investigation is needed to determine if there are changes in trends in patient demographics or associated comorbidities (i.e., secondary or tertiary causes of admission such as diabetes, hypertension, smoking). An analysis of the Michigan Inpatient Database would be necessary to identify changes in trends and disparities. A plan for the analysis would be developed with the MOSAIC Registry Consultant, Dr. Mathew Reeves, PhD, Professor of Epidemiology at Michigan State University, and the MOSAIC Program Manager and Epidemiologist, Adrienne Nickles, MPH.

3 Evaluation Sudden Cardiac Death in the Young Since 2004, Michigan has been analyzing data, convening stakeholders and developing interventions to reduce sudden cardiac death in the young. The case definition identifies deaths based on the primary ICD-10 cause of death. This project would examine the underlying causes of death to evaluate if the case definition needs to be changed. Drug-related deaths, drownings and other illdefined deaths could be included in the current case definition and shouldn t be. There is also a new data source, Cardiac Arrest Registry to Enhance Survival (CARES), that collects arrest information including CPR and AED use during the event, the patient s outcome from the ER or hospital and neurologic outcome at discharge. These data would elevate the knowledge and understanding of cardiac events among both those who survive an attack and those who do not. ArcGIS mapping trainings (if needed) will be offered for the fellow in order to analyze the spatial impact of these attacks and the proximity to medical facilities. Major Project Study of the Quality of Care and Outcomes Among Patients who Received Care in Rural Hospitals in the Michigan Stroke Registry (MOSAIC) There is very little data on stroke care and outcomes in rural hospitals in the national American Heart Association s Get-With-The-Guidelines database or elsewhere. To understand the quality of care and outcomes of stroke patient in rural hospitals (bed size <100), a summary of available data from those hospitals is needed to compare to non-rural hospitals during the same period. MOSAIC is unique in formally attempting to include smaller rural sites. Activity Hypertension screening at dental offices Annually, more adults visit a dental office than a medical office. This makes the dental setting a place to screen and identify earlier hypertension in adults. The Oral Health Program will be paying to have a question added to the 2020 Michigan Behavioral Risk Factor Survey (BRFS) to determine the prevalence of dental offices offering screenings to their patients. This project will provide survey design experience through the development of a question, pilot testing of the question on the 2019 Michigan BRFS, interview quality control, and analysis of survey data. Additional Project Identify low screening rates for cancer and identify populations at risk for latestage disease It is assumed that poor screening rates in certain racial, income, and geographical populations results in increased rates of late-stage cancer diagnoses. This assumption has not been studied in Michigan. This study will use Michigan Behavioral Risk Factor Survey (MiBRFS) data to identify populations with low screening rates and populations at risk for late-stage disease. Cancer Registry data (from Vital Records) will be used to perform spatial analyses to identify geographic areas that have an increased late-stage diagnosis rates to assess the assumption that populations with poor screening rates also have high rates of late stage cancer diagnoses.

4 Preparedness Role The Fellow will participate in trainings and exercises, through the BEPH and the MDHHS Bureau of EMS, Trauma and Preparedness. This may involve communicable disease, chemical, natural disaster, and radiological events. If a real emergency event takes place in communicable disease or environmental health, the Fellow will be assigned an epidemiology function within the Incident Command Structure. For example, one of the previous Fellows spent three weeks in a Command Center under EPA direction following a large oil spill in Michigan. The Fellow assisted with development of a survey instrument to determine perceived and real health effects from oil exposure, participated in the implementation of the survey at three affected communities and one unaffected community, and conducted analysis if the survey results. In addition, the Fellow will receive opportunities to participate in significant and urgent (non-emergency) communicable disease and chemical contamination events. All of MDHHS s EIS and CSTE Fellows and other CDC assignees participated in Michigan s first implementation of a Community Assessment for Public Health Emergency Response (CASPER) during September 2012, which involved door-to-door surveys using CASPER methodology. Additional Activities Educational opportunities BEPH is committed to providing the Fellow with the resources necessary to develop his/her epidemiologic skills as well as subject-matter expertise. The Fellow will be encouraged to participate in state meetings and annual conferences, including the Michigan Epidemiology Conference (March) and the Michigan Premier Public Health Conference (October). Work time and a state vehicle will be provided to attend off-site meetings and conferences. Traditionally, BEPH has a strong presence at the Annual CSTE conference and we expect that the Fellow and at least one of his/her mentors will attend. During the two-year Fellowship, he/she will be encouraged to make at least one poster or oral presentation at one or more of the state meetings. Educational opportunities are available to BEPH staff at the local universities (such as the University of Michigan Office of Public Health Practice online courses). Many are free or low cost; others, such as the Graduate Summer Session program at the University of Michigan will require funding from BEPH grants. The BEPH has a monthly Epidemiology seminar series, as does MSU, which also provides presentation opportunities. CDES staff have developed a monthly Epi Support group, an informal meeting to provide continuing education on topics related to epidemiology, statistics, mapping, and other topics that the group selects. Additionally, software training is available through a state contractor at reasonable cost. Additional Activities Promoting genetic testing for the relatives of individuals with known BRCA mutations (cascade testing) ICD 9 to 10 coding change Drive time mapping analysis of stroke centers Survey analysis on the BRFS Asthma Call Back Survey weights and macros Racial differences in hospitalization data such as length of stay or drug related ICD cause order Analysis of the BRFS Asthma Call-Back Survey,

5 Analyze Medicaid claims related to stroke episodes of care to look at health care and pharmacy utilization claims to assess follow up after stroke discharge, Analyze Medicaid claims to assess hypertension treatment prevalence by demographics, space, and time to aid in a needs assessment of hypertension care, Develop mapping materials to show surveillance data, including social determinants of health, to aid chronic disease partners in needs assessments and program targeting; this would include display of American Community Survey data, BRFS data, hospitalization data, Medicaid claims data, land use maps, and primary care and specialty care locations. Mentors Primary Secondary Robert Wahl DVM, MS Chronic Disease Epidemiologist and Manager Adrienne Nickles MPH Stroke Epidemiologist and Program Manager of Michigan s Stroke Registry