Closing Gaps on Health Outcomes
By Albert B. Kelly
Over the course of 2 terms as a mayor for the City of
Bridgeton, one issue that has presented a constant challenge to me and my
colleagues both in the public and nonprofit sectors, is improving the health
and well-being of residents. Our primary reference to check progress is the
County Health Rankings & Roadmap from the Robert Wood Johnson Foundation. By
that measure, we haven’t moved the needle very much. Cumberland and Salem
counties are consistently ranked at or near the bottom statewide.
The purpose of the rankings is to help counties understand
what it is that influences resident health. They look at the obvious such as rates
of smoking, obesity, teen births, and access to healthy foods. They also consider
other impacts from such things as predatory lending, discriminatory prison
sentencing, and school funding. Together these all play a role in the health
and well-being of people and communities.
In thinking about our area, I also began to wonder if we weren’t
missing other things or if there were new ways to think about issues and outcomes.
With that in mind, I stumbled onto the Dartmouth Atlas of Health website which
basically measures variations in how medical resources are distributed or used across
the country and in states down to the county level.
In much the same spirit as the Rutgers University study from
a couple of years ago that concluded that the poorest municipalities in South
Jersey receive 33% less total state funding compared to similar communities in
the rest of the state; I wanted to see if some patterns were obvious in terms
of healthcare and maybe get some additional insights if possible. I don’t know
that I did.
The Dartmouth project is a couple of decades old and uses
Medicare data (those 65 years or older) from the Centers for Medicare and
Medicaid Services (CMS) among others, to provide information and analysis about
healthcare nationally and in states. My focus was on different rates statewide.
The project explains rates as “the number of events or amount of resources
divided by the number in the population so if an area with 100,000 Medicare
enrollees has 810 hip fracture repairs, then the rate of hip fracture repair is
8.1 per 1,000 Medicare enrollees”.
In looking at 2015, the latest year I could find, Cumberland
and Salem Counties had the highest rate of discharge related to Congestive
Heart Failure (CHF) at 21.50 and 22.81, while Hunterdon County was lowest at
9.09 followed by Somerset at 11.22.
For Chronic Obstructive Pulmonary Disease (COPD), Salem and
Cumberland counties were highest at 16.67 and 14.55 while Somerset and Morris
Counties were lowest at 5.07 and 5.30 respectively. For kidney/urinary
infections, Cumberland County led the way at 8.99 followed by Salem at 8.98
while Sussex County was at 4.89 and Union County at 5.03.
These numbers reflect the RWJ Foundation rankings. When it
comes to certain other measures, healthcare feels like a revolving door or
“catch as catch can”. Cumberland County had among the highest percentage of
patients visiting an ER within 30 days of both a medical discharge (22.84%) and
surgical discharges (20.54%). Hunterdon County was lowest at 17.53% (medical)
and 13.16% (surgical). Cumberland was highest for hospital readmissions within
30 days of discharge whether for medical (16.33%) or surgical (14.24%).
Statewide, total Medicare reimbursements per enrollee were
highest in Salem ($11,670) and Cumberland ($11,196) hospital and skilled nursing
facility reimbursements were also highest in the state per enrollee at $5,603
(Salem) and $5,365 (Cumberland). So there is certainly enough quality medical
care being delivered, yet it doesn’t seem to be reflected in the health
outcomes. The data didn’t suggest how to move the needle in a positive
direction, but it did suggest some questions.
Is the higher number of ER visits and readmissions indicative
of a lack of access to transportation for follow-up office or therapy visits or
a need for more evening hours? If so, is it possible to improve things with
mobile or pop-up clinics? Are the rates for CHF, COPD, and pneumonia reflective
of people delaying treatment for various reasons so conditions worsen? Is it simply
a cost issue? Is more bilingual education needed?
I’m not sure, but somewhere in the data is the gap between healthcare
delivery and health outcomes. Whatever else the data may say, it suggests to me
that we’ll have to do more outside-the-box thinking in trying to close it.