MCHB Divisions and Offices

Michael Kogan: Well, good morning. I’m Michael Kogan. I’m the Director of the Office of Data Information Management. Ironically, I was reading the paper too this morning, and I happened to look at my horoscope. Let me read it to you. “Whatever your marital status is, it’s influx. You will meet the love of your life today. We realize this is the third time this week we’ve told you that, but this time we’re not jerking your chain. If you are giving a speech today, don’t do it unless you can be assured that at least 10 percent of the audience wants to hear it.” So could we do a quick survey? Who would like to hear me speak? It doesn’t seem like 10 percent to me. Thanks very much. Hold on. My horoscope was right. My slides didn’t make it up here. Okay, while we’re waiting, what would you like to talk about? Would you like to talk about the baseball playoffs? Well, in the interest of time, why don’t I get started and we can just pick up along the way? I like to have more of an interactive presentation, so if you have questions during my presentation, you’re more than welcome to ask me at any point. If you can just follow along. We have four areas of focus in our office. The first is building and enhancing human resource capacity at Maternal Child Health Epidemiology. Second, is building and enhancing data systems at the national, state, and local levels. The third is enhancing the data capacity within the Maternal and Child Health Bureau, and the fourth is collecting and analyzing data related to the three MCHBs strategic plan goals and the MCHB program areas. Now you see your next slide, or your next handout, is titled “Survey of State and Territorial MCH Epidemiology Capacity.” That was a survey conducted last year, published last December by the Council of State and Territorial Epidemiologists. It’s a rather extensive study. They surveyed all 50 states. The response rate was 93 percent. They contacted MCH Directors, Children’s Special Healthcare Needs Directors, data people in the states, and let’s look at the next three bar charts, vital records. Let’s look at them all together: risk factors, survey data, screening and surveillance data. Okay, what do you notice about that? What jumps out at you when you look at these bar charts? Anybody, what jumps out at you?

Unidentified Speaker: (Inaudible).

Michael Kogan: Who said that? Can you all hear me? I mean (inaudible) slide I might as well do (inaudible). That’s right, nothings analyzed, or you have a big drop off. You see that (inaudible) data? It’s accessible to the MCH data staff, but there’s a big drop off. Why would you think that to be? (Inaudible). Why was there such a big drop off? Anybody?

Unidentified Speaker: (Inaudible).

Michael Kogan: I’m sorry, what? You could raise your hand so I could--

Unidentified Speaker: (Inaudible) of human resources according to (inaudible).

Michael Kogan: That’s right, a lack of community resources. And by the way, I should point out that the expected federal budget deficit this year is somewhere between $400 and $500 billion, and while they promised (inaudible). I’m sure it will be. Let’s keep that in mind (inaudible). It’s in your best interest to answer questions in that you might get candy. Any other reasons why might (inaudible) drop off? Lack of community resources, what else? Anyone else? Well, we also found that one of the major issues is lack of training in this area, and so going into the next area, going into the first focus of what we talk about. We’ve worked on a number of programs to try to enhance the capacity in Maternal and Child Health Epidemiology. The first program I’ll talk about is cosponsored by the Centers for Disease Control and our Division of Research Training Evaluation, and Ann Drum--Ann, could you raise your hand--is the Director of that Division, and it’s purpose is to enhance data analysis capacity at the state and local level. We target it at midlevel, people with midlevel skills and people who have responsibilities for collecting, processing, analyzing, and reporting MCH data. We have a distance-learning component beforehand, and the heart of the course is a five-day hands on course. We try to integrate both didactic lectures and integrative exercise so people can integrate what they’ve learned in the course. Further, people are supposed to come to the course with a problem they’re working on so they can come out of the course with some solutions to some problem they’ve been dealing with that has to do with MCH Epidemiology, not the relationships. Further, in the course, we offer a year of technical consultation, up to a year of technical consultation with the faculty after course. During the first course we held for this, there was a hurricane. During the second course, there was a record heat; it was 113 degrees. Now I encourage you to apply for the third course because statistically not much can go wrong beyond that. Now you see on the next piece of paper in front of you is--we realize that there are different issues with the Basin territories. They have different kinds of data systems; they have different resources; they have different staffing patterns. So this year we’re planning to hold an MCH training course for the *Basin territories, and this is cosponsored with the Division of State and Community Health, with Cassie Lauvers division. Going on to the next piece of paper. One of the things we were running across, and you might have some thoughts on this too, is a lot of times when programs are designed in Maternal and Child Health, they’re also, maybe generally at the state and local level, you might write a report and it might go into a file somewhere. Another state might want to address a similar kind of problem and never have heard about your report. And we’ve heard from different scientific journals, “We don’t get papers, or many papers, from people at the state and local level.” So we tried to design a program to increase the visibility and get the results of programs into the scientific literature. That way, if the state is designing a program, they can go to scientific literature and say, “Oh, this state did this kind of program on,” let’s say, “enhanced prenatal care, and they seem to have success,” or alternatively, “They designed this kind of program and it didn’t work. Maybe we shouldn’t go ahead with the same kind of program in our state.” So I encourage you that if you have something you want to write up, to take advantage of this program. The way it works is if you have data and you have a two page abstract, you can send it to us and we have medical writers who’ll write up the paper for you and work with you, you’d be first author, and would help you try to get into scientific literature, and I’ll give you my phone number at the end. And again, this is cosponsored by the CDC. We have a number of other programs in MCH Epidemiology. There’s an annual series of four to six web-based sessions that we call Data Speak. This program has been going on for about 10 years. It draws on a wide variety of topics such as youth obesity and youth violence, multiple births, just a wide variety of topics, and I’m going to go through these rather quickly. We also have a program where we support nine Schools of Public Health and their doctoral students in Maternal and Child Health Epidemiology, particularly those students who use state or local data for their dissertation. What we’re trying to do is strengthen links between academia and state MCH departments. There’s also a program that’s been going on now for 15 years, it is sponsored by CDC and HRSA, on state based Maternal and Child Health epidemiologists. Some are funded through a Title V block grant. Anywhere from 10 to 15 states are taking advantage of this at this point. We also have a project with David Heppel’s division on supporting data capacity building for state and community child health review teams looking at child death reviews. We also sponsor a program for Master’s level internships called the Graduate Student Intern Program. This places Master’s level students in state either Epi departments, MCH departments, or both, for a 12-week summer internships. We sponsor about 20 students each summer to do this. We also work Emory University. They offer an 18-month certificate program with the CDC for training in Maternal and Child Health Epidemiology. Every year, there’s a conference on Maternal and Child Health Epidemiology. For the last three years, we’ve offered two days of hands on training before the conference. The first year, we offered “How to Analyze Medicaid Data.” Last year, we offered training on how to use *Sudan because that was a statistical software program that’s often useful for analyzing complex survey data, and with the release of our Children’s Special Healthcare Needs Survey, we thought it was important to offer training in that. This year, we’re offering training on how to link data, different methods for doing that. So again, this is through AMCHP. Both HRSA and CDC contribute to this. If you are interested in sending someone from your state, please contact AMCHP, or if you don’t know anyone at *AMCHIP, contact me and I’ll put you in touch to the right people. Now the second focus is building and enhancing data systems at the national, state, and local levels. Now the first thing I want to talk about is the National Survey of Child Health. This is a partnership. The data is being collected through the National Center for Health Statistics, and using what’s called the state and local area integrated telephone system survey mechanism. It’s a random digit dialing that is used for the National Immunization Survey. We then tie into that. What this is, first, there hasn’t been a national survey on child health in the United States in the last 15 years. Amazing, huh? And there has never been a survey on child health where you can get state level estimates. This will be the first ever survey that will be able to do that. Two thousand kids per state: it gathers information on the physical, mental, and emotional health of children on such topics as health and functional status, health insurance coverage, healthcare access and utilization, usual source of family care and medical home, family and neighborhood functioning, and “A” specific issues. This survey began in January of this year. We expect it to be in the field till, I would guess, early spring of 2004, and hopefully, the data will be available by the end of 2004. We also do another survey at MCHB specifically in our office. Every four years a survey is done on U.S. children in the sixth through 10^th grades. The information is compared to 30 other countries conducting the same survey. It’s cosponsor with the National Institute of Child Health and Human Development and David Heppel’s group. The next survey is scheduled to begin for the next academic year in 2004, and one of the things that I wanted to point out is David talked about the bullying campaign. Now the impetus for the bullying campaign came from a paper that was published in JAMA that we did with the National Institute of Child Health and Human Development, and I think it’s a really nice marriage of using data that we’ve collected and turning that, hopefully, into an effective program. Okay. I was told I have four minutes left. If you want candy, you have four minutes left. I don’t give them out afterwards, okay? So, any questions do it quickly. Next project we have is integrating state health information systems in newborn screening. We had sponsor programs for a number of years to try to help states integrate their information systems. You can get information that you can get from integrated systems that you can’t get from a single system. I use an example that if you link the Medicaid system, data system, to birth certificates, you can find out the percent of kids on Medicaid who have low birth weight or preterm birth. Information you couldn’t get from each system individually. But we wanted to go beyond that. Does integrating health information systems lead to more effective programs? In this program, we’re contributing half the funding and the Division of Children with Special Healthcare Needs is contributing half the funding too. Does integrated health information systems lead to improved newborn screening programs? Next, using multilevel modeling to design programs to address disparities. Oftentimes when you see information, you’ll probably get it from vital statistics, you might get it from a survey, but you have similar data systems and they’ll give you similar information. What we wanted to do again was go beyond that. We wanted to look at what’s a statistical technique called multilevel modeling that you link information that you can get from individual records, let’s say on birth records, and link them to another level, let’s say the group level that you can get from the latest census data. It can tell you what neighborhoods have the most preterm birth. Are there certain pockets? Does that relate to crime? Does it relate to housing? Does it relate to a number of factors we usually don’t look at? If you’re designing programs at the state level, you may want to get out of--as David used the terms--silo and not just look at public health, but look at other factors that can improve maternal and child health outcomes, and we’re working with four state and local health departments in this area. Two minutes left. Okay. I’ve got to tell you, it’s boiled celery for lunch; candy sounds better to me. Okay, let’s go right to data analysis activities. We do a yearly publication called “Child Health U.S.A.” Some of you may be familiar with that. It’s an annual chart book that summarizes the latest available information on children’s health in the U.S.A. It’s collected from the most recent information on child health from all the federal data sources. I see some people shaking their heads that you’re familiar with this. It’s supposed to serve as a concise reference for policy makers and program managers. Building on “Child Health U.S.A.,” in the last two years we’ve done a similar book for women’s health U.S.A. It’s a joint project with our Office of Women’s Health and our Division of Perinatal Systems in Women’s Health. Again, it’s summarizing all of the latest information, usually from federal data sources on women’s health in the country. For our chart book on adolescent health, we derive the data from the latest Health Behaviors of School Aged Children Survey, and it compares how U.S. teenagers are doing to teenagers in 30 other countries. We have information that kids in the U.S. often complain of health symptoms, much like headaches, much more frequently than kids in other countries. In terms of exercise, they’re right in the middle, but in terms of obesity, as you well know, they’re at the top. It gives policy makers and you and the states a chance to look at how we compare to other countries and where might we target interventions. We’re working on a chart book with Children of Special Healthcare Needs and hope to release that soon from our National Survey of Children’s Special Healthcare Needs. We’re also starting work on a chart book on border health, meaning the border with Mexico, not Canada. We also do technical assistance, so if people have data questions, and they sometimes do about surveys or whatever, please feel free to contact our office and you see my contact information on the last page. Thank you very much. Oh, wait, hold the applause, question.

Unidentified Speaker: Which are the four states or locals you’re working with in terms of health disparities?

Michael Kogan: Okay. It’s the city of Philadelphia, the state of Maryland, the state of Michigan, and the state of North Carolina. Yes?

Unidentified Speaker: You know on your survey on child health, children is being defined as (inaudible).

Michael Kogan: (Inaudible). Any other questions? Okay, thank you.