Hotspotting: Mapping our way to healthier neighborhoods Marina Del Rios, MD, MSc Illinois Heart...
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Transcript of Hotspotting: Mapping our way to healthier neighborhoods Marina Del Rios, MD, MSc Illinois Heart...
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Hotspotting:Mapping our way to healthier
neighborhoodsMarina Del Rios, MD, MSc
Illinois Heart Rescue Community Sphere LeaderAssistant Professor
Department of Emergency Medicine
Cardiac arrest
Cardiac arrest
http://illinoisheartrescue.com/
How to save a life
Geographic variation
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State wide quality improvement project
Purpose: to double neurologically intact out of hospital cardiac arrest (OHCA) survival
Vision: Every OHCA victim will receive life-saving, state-of-the-art care at the scene, en
route to, and in the hospital. Data driven activities
Data is your friend
Cardiac Arrest Registry to Enhance Survival (CARES)
Data to improve Bystander actions EMS and hospital
actions Allocation of
resources
Hospital
Disparity in post cardiac arrest care: Post Rosc protocols Therapeutic Hypothermia
IDPH support
CARES report cards
Pre-Hospital
Resuscitation Academy
Dispatch Assisted CPR training
New protocol development: Incident Command for Cardiac Arrest, field termination, and ROSC protocols
Targeted allocation of new ambulances
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Community
Three phase program approach
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Association of neighborhood characteristics with incidence of out-of-hospital cardiac arrest and bystander response in Chicago
Background
Neighborhood disparities in out-of-hospital cardiac arrest (OHCA) incidence and bystander CPR provision make it a major health equity challenge
The most recent study on OHCA in Chicago analyzed data obtained in the 1980s and found: The lowest rate of bystander-initiated CPR was in
predominantly black neighborhoods This association was independent of socioeconomic status.
It’s time for an update
First step:Needs assessment
To conduct a geospatial analysis of variations in OHCA incidence and bystander CPR provision to guide allocation of resources to neighborhoods in greatest need
As a secondary objective, we aimed to determine whether racial and socioeconomic disparities in bystander CPR persist in Chicago.
Methods
OHCAs were aggregated to census tracts
Incidence rates were calculated based on population density
Each incident was linked to census tract information, including demographic and economic factors.
Results
Results
Results
Conclusion
The incidence of cardiac arrest is disproportionately higher in minority and low-income census tracts in Chicago
Bystander CPR rates are overall low in Chicago
Bystander CPR is especially lower in high incidence neighborhoods and in minority and low-income neighborhoods
Disclaimer
Bystander CPR rates may have been underreported
This database only captures cardiac arrests where EMS was called – are there cases missed by the 911 call system?
Targeted mass CPR training
Targeted mass CPR training
Target Neighborhoods
School Based Initiatives:Garfield Park
71 high schools students347 family and friends4.88 per peer trainer
Faith-based initiatives:Englewood HANDDS
Community engagement
Targets “high risk” neighborhoods to increase bystander CPR
Performance report cards
Community ENGAGEMENT
Pay it forward model / peer coaching
Prevention?
Implications
"The sources of these disparities are complex, are rooted in historic and contemporary inequities, and involve many participants at several levels...” “Unequal Treatment” IOM 2003
In order to narrow and eventually eliminate disparities in survival it is important to recognize where in the continuum of treatment of OHCA these disparities exist
Implications
These disparities are of predominant concern and are major issues to be addressed when designing interventions to reduce the burden of OHCA
Coordinated efforts to improve bystander response complemented by approaches to prevent OHCA can lead to health equity in Chicago
Conclusions
Hotspotting paired with targeted community engagement efforts and follow-up can better address community needs and bring us closer to health equity
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