ithout data, we’re blind to the needs of the community and where to direct our resources,” says Nathan Johnson, senior director of community health investment at Providence Alaska.
Data is the natural byproduct of any interaction in the healthcare system. The admissions desk records payment information; an assistant measures patient weight, blood pressure, and heart rate; laboratories encode reams of results; and physicians note their diagnostic findings. This data is essential for creating positive outcomes, but safeguarding the privacy of patients and their data is just as important for Providence and other health systems. Once those individual data points have been made anonymous, compiled across the entire population, and spread over time, a general picture emerges of the health of the overall community.
According to CDC, “By collecting behavioral risk data at the state and local level, BRFSS has become a powerful tool for targeting and building health promotion activities.”
In addition to the federal health statistics, states collect and analyze their own. According to the National Institutes of Health, some states collect disease registries and some do not; some conduct health surveys and some do not.
In Alaska, the Division of Public Health within the Department of Health (which split from the Department of Health and Social Services in March 2022) maintains two collections of data. The section of Health Analytics and Vital Records tracks births, adoptions, marriages, divorces, and deaths. These data include the medical condition of each newborn and mother and, for each Alaskan who dies, the causes are catalogued to distinguish among illnesses or accidents, plotting the incidence over time.
“The ER is sort of the canary in the coal mine for the community,” says Johnson. A recent glaring example was the COVID-19 pandemic, during which health systems were at capacity, and the ER was the bellwether, he explains.
Johnson adds, “Coming back to this data helps us better understand the needs of the patients we serve and to get upstream and look in the prevention space, and that is inclusive of behavioral health. That data allows us to identify patterns so we can get ahead of them.”
Hospitals also rely on community health surveys to make informed decisions. “We collect secondary data through the Census and BRFSS, but in Alaska’s rural communities, the data samples are too small to get good information that way, so we field community health needs assessment surveys in the communities we serve,” says Johnson. “These help inform our annual grant making, which is driven by what we learn from those needs assessments. Right now we are in the middle of a community health needs assessment for Valdez. We’ll complete it by the end of the year, and for the first few months of next year we’ll create a community health improvement plan to address identified needs—work that includes community partners.”
Like other large healthcare systems, Providence Alaska also conducts key stakeholder interviews to fill in gaps in federal or state data. “When it comes to population-level data, it is very important to make sure that your data sample is representative of the community, and we understand that it’s very difficult to reach certain parts of the community,” says Johnson. “So we talk to the leaders of the organizations that have large service umbrellas in the community—like the Anchorage Community Health Center and Catholic Social Services, both of which serve some of the most vulnerable populations in Anchorage. Data never speaks for itself. You end up triangulating a lot of data points with the experience and depth of community and organizational leaders who have knowledge in particular areas of need.”
Construction on Providence Alaska House is now underway, and the project is expected to open in 2024. The facility will be for low-income people aged 55 and older who are experiencing homelessness and disabling health conditions, and it will include forty-five permanent supportive housing units and six recuperative care units. Supportive housing offers a permanent place to live for those experiencing homelessness. Recuperative housing is for those being discharged from the hospital and will give patients who are experiencing homelessness a period of time to convalesce and prepare for permanent housing placement.
“Supportive is the key word in permanent supportive housing. Individuals with these health challenges at this age often find it challenging to live independently, and we will be partnering with others to bring services to these individuals on-site,” says Johnson. “But we needed to look at the data to get a sense of the magnitude of the issue. In this instance, the whole idea of living outside in Alaska with any health condition would be challenging at best, but for those with these disabling conditions it’s profound.”
The Crisis Stabilization Center and behavioral health urgent care are designed to include three different programs to serve people experiencing a mental health crisis: a behavioral urgent care walk-in clinic; a 23-hour crisis stabilization for those experiencing a mental health or substance abuse crisis, meant to divert people from emergency rooms (ERs) and avoid unnecessarily high levels of care; and a 24-hour residential crisis stabilization for those who need to stay multiple days in order to stabilize. The 23- and 24-hour programs will begin accepting patients in mid-2024. The walk-in clinic is not yet under construction.
“The center plans were driven by myriad data, including needs assessment and hospital admission data from the ER,” says Johnson. Neither of these projects would be possible without the collection of data—both large and small—to aid in the planning.
“Our community surveys are entirely anonymous, so it’s all aggregate data and we’re not getting down into specifics,” says Johnson. “Where internal admissions data is concerned, we’re bound by HIPAA, and where data is shared with outside partners, it’s all de-identified and aggregated at a very high level.”
One large issue with health facilities collecting information is the siloing of data. Because many health systems are privatized and competitive, it becomes challenging from a community perspective and a government perspective to determine community needs and challenges in a marketplace where the providers are competing for resources.
“There are resources required to do data collection, and it’s very expensive right now to collect population-level data,” says Johnson. “A lot of people think that public health systems have this data, but we have to go out with community-level surveys, like BRFSS and the surveys Providence fields, and the polling is challenging. It’s very expensive because, to do statistically valid community polling, there is a lot of work involved. To drive meaningful interventions and community change, the community survey samples need to be representative of the community we are trying to serve.”
In the end, using the data becomes about resourcing a solution, whether it’s a housing project for the homeless, a mental health facility for those in crisis, or some unknown-as-of-yet future healthcare need.