New York City's Population Health Surveillance System Revealed As Model For Others

New research finds NYC Macrosope on par with traditional gold-standard methods for estimating prevalence of obesity, hypertension, smoking, diabetes

New research published recently in AcademyHealth’s eGEMs journal reveals a new model for monitoring the health of communities that is more efficient than traditional methods while still providing reliable information about a population’s health.

“These findings validate an innovative method to monitor population health,” said one of the studies’ lead authors Katharine McVeigh, Ph.D, M.P.H., research director, Division of Family and Child Health at the New York City Department of Health and Mental Hygiene. “This series of papers provides an inside look at how the model was developed. Published in an open access journal, this blueprint is now freely available to other health departments looking to monitor population health more efficiently to improve the health of their communities.”

As New York City’s first electronic health record (EHR) surveillance system, NYC Macroscope complements traditional methods of monitoring the health of a population, such as statistically representative telephone and in-person surveys. While traditional methods are scientifically rigorous and have enduring important qualities, they are also labor intensive and can take a long time to yield results.

In contrast, EHRs are electronic versions of a patient’s medical records maintained by health care providers at patient visits. Data within these records can be more easily available and summarized in a timely manner.

“The challenge was that the NYC Macroscope draws data from a select group of medical providers who engage with the health department around clinical quality improvement and includes only 17% of all adult primary care patients, so our research team was concerned that it might not provide accurate estimates,” said co-author Remle Newton-Dame, M.P.H., director of healthcare analytics at NYC Health + Hospitals. “But we found that NYC Macroscope was able to produce high quality surveillance estimates for several indicators that were comparable to those from a gold standard survey.”

The authors compared 2013 results from NYC Macroscope to two different traditional surveys: the 2013-14 NYC Health and Nutrition Examination Survey (NYC HANES) and the 2013 Community Health Survey. They found that NYC Macroscope prevalence estimates for obesity, hypertension, smoking, and diabetes were comparable to the survey results. However, the treatment and control measures for diabetes, hypertension and high cholesterol were not.

“While indicator performance was variable, findings here confirm that a carefully constructed EHR-based surveillance system can generate prevalence estimates comparable to those from gold-standard examination surveys for certain conditions and risk factors,” said co-author Lorna Thorpe, Ph.D., professor and director of the Division of Epidemiology at the Department of Population Health at NYU School of Medicine.

For more information, visit www.academyhealth.org/NYCMacroscope.

NYC Macroscope and NYC HANES were initiatives designed and implemented by a team of researchers at the NYC Department of Health and Mental Hygiene, in partnership with researchers at the CUNY School of Public Health (who are now at the NYU School of Medicine). In addition to the authors quoted above, the team included Sharon E. Perlman, M.P.H., Pui Ying Chan, M.P.H., Claudia Chernov, M.P.H. and Katherine Bartley, Ph.D. of the NYC Department of Health and Mental Hygiene; Lauren Schreibstein, M.S., Laura Jacobson, M.S.P.H., Kathleen S. Tatem, M.P.H., Carolyn Greene, M.D., Elizabeth Lurie-Moroni, M.P.H., and Elisabeth Snell, M.P.H. all formerly of the NYC Department of Health and Mental Hygiene, and Jesica Rodriguez-Lopez, M.P.H. formerly of the CUNY School of Public Health.

This work has been made possible by the financial support of the de Beaumont Foundation, the Robert Wood Johnson Foundation including its National Coordinating Center for Public Health Services and Systems Research, the Robin Hood Foundation, the New York State Health Foundation, the Doris Duke Charitable Foundation, and the U.S. Centers for Disease Control and Prevention. The contents of this paper are solely the responsibility of the authors and do not represent the official views of the funders.

About eGEMs
eGEMs (Generating Evidence & Methods to improve patient outcomes) is a peer-reviewed, open access journal that seeks to accelerate research and quality improvement using electronic health data. The EDM Forum launched eGEMs in 2013, and the journal has since published more than 100 papers featuring cutting-edge projects from leaders in the field. eGEMs is led by an editorial board of experts from across the country and is a premier journal for approaches to redesigning the health system, including methods, interoperability, and governance. Visit the eGEMs website and follow us on Twitter to learn more about the journal, how to submit a manuscript, or to serve as a reviewer.

The EDM Forum is supported by the Agency for Healthcare Research and Quality (AHRQ), Grant 1U18HS022789-01.

About AcademyHealth
AcademyHealth is a leading national organization serving the fields of health services and policy research and the professionals who produce and use this important work. Together with our members, we offer programs and services that support the development and use of rigorous, relevant and timely evidence to increase the quality, accessibility, and value of health care, to reduce disparities, and to improve health. A trusted broker of information, AcademyHealth brings stakeholders together to address the current and future needs of an evolving health system, inform health policy, and translate evidence into action. For more information, visit www.academyhealth.org.