The Neighborhood Deprivation Index and Provider Geocoding Identify Critical Catchment Areas for Diabetes Outreach

Abstract

Purpose In designing a Project ECHO™ Type 1 Diabetes (T1D) program in Florida and California, the Neighborhood Deprivation Index (NDI) was used in conjunction with geocoding of primary care providers (PCPs) and endocrinologists in each state to concurrently identify areas with low endocrinology provider density and high health risk/poverty areas. The NDI measures many aspects of poverty proven to be critical indicators of health outcomes. Methods The data from the 2013-2017 American Community Survey (ACS) 5-year estimates were used to create NDI maps for California and Florida. In addition, geocoding and 30-minute drive-time buffers were performed using publicly available provider directories for PCPs and endocrinologists in both states by Google Geocoding API and TravelTime Search Application Programming Interface (API). Results Based on these findings, we defined high need catchment areas as areas with: 1) more than a 30-minute drive to the nearest endocrinologist, but within a 30-minute drive to the nearest PCP; 2) an NDI in the highest quartile; and 3) a population above the median (5,199 for census tracts, and 1,394 for census block groups). Out of the 12,181 census tracts and 34,490 census block groups in California and Florida, we identified 57 tracts and 215 block groups meeting these criteria as high need catchment area. Conclusion Geospatial analysis provides an important initial methodologic step to effectively focus outreach efforts in diabetes program development. The integration of the NDI with geocoded provider directories enables more cost-effective and targeted interventions to reach the most vulnerable populations living with T1D.

Health Disparities in COVID-19: Addressing the Role of Social Determinants of Health in Immune System Dysfunction to Turn the Tide

“…In this perspective we have highlighted inflammation and immune cell changes as potential mediators of the relationships between exposure to adverse social conditions and COVID-19 severity and outcomes. It is known that existing inequities, may lead to the disproportionate burden of chronic diseases, such as asthma ( 116 – 118 ), Type 2 diabetes ( 119 , 120 ), obesity ( 121 – 126 ), and cardiovascular disease ( 127 – 129 ). In turn, these chronic diseases could mediate associations between social factors and worsening COVID-19 severity and outcomes ( 1 , 130 ).…”

Barriers to Technology Use and Endocrinology Care for Underserved Communities With Type 1 Diabetes

“…Research on type 1 diabetes tends to rely solely on recruitment efforts through major endocrinology centers ( 31 ) and subsequently underrepresents communities with type 1 diabetes most in need of strategic outreach. As part of a larger needs assessment for spearheading a Project Extension for Community Health Outcomes (ECHO) type 1 diabetes outreach program ( 32 , 33 ), focus groups were conducted with individuals living with type 1 diabetes with intentional recruitment efforts aimed at including the perspectives of low SES and racially diverse adults with type 1 diabetes.…”

Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D

“…To our knowledge, we were the first Project ECHO program to strategically recruit using a dual focus on FQHCs and using the NDI with provider geocoding. 26 By including targeted recruitment methods to identify spokes delivering care to medically underserved communities, the Project ECHO T1D pilot program reached PCPs in critical need of resources to help offset pronounced health disparities in the communities they serve. Feedback from the PCPs also indicates the participants found the program a worthy investment of their time both in terms of the quality of content presented in tele-ECHO clinics and through the provision of a Diabetes Support Coach for patient engagement.…”

“…On completion of the needs assessment, health centers (ie, 'spokes') providing care for medically underserved communities were strategically recruited for Project ECHO T1D by: (1) focusing on FQHCs and (2) the use of the Neighborhood Deprivation Index (NDI) and provider geocoding. 26 Covered under the Consolidated Health Center Program of the Social Security Act, FQHCs in the USA provide primary care services to underserved areas and must adhere to stringent guidelines including never turning patients away based on insurance status, and, providing care on a sliding scale based on ability to pay. 27 To identify high-need geographic catchment areas in FL and CA, the NDI was used in conjunction with geocoding of PCPs and endocrinologists in each state to concurrently identify areas with low endocrinology provider density and high health risk/poverty areas.…”