Introduction to Health Data using Online Resources: AskCHIS Workshop Health DATA Program: Data. Advocacy. Training. Assistance. June 2012

I. Introduction II. Overview: Understanding Data and Developing & Answering Data Questions III. Modules 1-3: Accessing Data from the AskCHIS Online Data Query System IV. Practice with AskCHIS V. Evaluation & Conclusion Agenda

California Health Interview Survey  CHIS is the nation's largest state health survey  More than 50,000 Californians - including adults, teenagers and children - are surveyed every 2 years by CHIS  Conducted by the UCLA Center for Health Policy Research, located within the UCLA School of Public Health, in collaboration with the California Department of Public Health and the Department of Health Care Services  Center for Health Policy Research’s mission: improve and maintain the public’s health by advancing health policy research, public service, community partnership and education  Health DATA program exists to make data easy and understandable to a wide range of health advocates through trainings, workshops and technical assistance. Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

 Both California Governor Schwarzenegger's office and Democratic legislators used CHIS data to develop health care reform proposals. Governor Schwarzenegger also held a press conference at UCLA in which he cited a cornerstone CHIS publication - The State of Health Insurance in California - as important evidence of the need for health care reform.  More than a dozen First 5 county commissions - created by California voters to direct tobacco tax revenues to promote early childhood development - have used CHIS data to develop new public-private expansion programs for children ineligible for private insurance, Medi-Cal or Healthy Families. In most cases, CHIS has been the only data source available. Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion CHIS Case Studies

Goals and Objectives  To train and provide technical assistance to those who plan to use CHIS to increase their capacity to obtain and apply health and social data  Upon completion of this training, you will be able to:  Identify relevant and appropriate data sources to answer data questions  Increase knowledge and skills to use the AskCHIS data reporting system and computer tools to access, interpret and apply CHIS data Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

Overview  Distinguish between different data types  Identify the type of data CHIS provides  Review how to evaluate data sources  Review benefits and limitations of CHIS data  Develop and Answer Data Questions Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

Data Types  Quantitative data  Numerical- # of healthcare facilities in a city  Qualitative data  Textual/words, often descriptions- An individual’s account of her experience at a healthcare facility  Primary data  Collected and analyzed directly by individuals, communities and researchers  Secondary data  Collected and provided by a third party such as a non-profit, university or government agency Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

Evaluating Data Credibility Specificity GeneralizabilityReliability Timeliness Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

Benefits and Limitations CHIS CAN: CHIS CANNOT:  Provide data for California counties  Compare information between counties and the state  Compare information across ethnic groups  Compare data over time ( )  Provide data before 2001  Provide data on non- California households Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

 Citizenship and Immigration status:  U.S. born citizen Naturalized citizen Non-citizen  Years Lived in the US  Up to 1 year 2 to 4 years 5 to 9 years 10 to 11 years 12 to 14 years 15 or more years  Country of Birth  United States Mexico Central America Other Latin America Asia and Pacific Islands Europe Other  Informational available for respondent and respondent’s mother and father Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion Health and Migration - What can CHIS data provide?

 Identify a question that can be answered using data  Consider the population, location and pervasiveness of a specific community health issue when developing a data question  Identify appropriate data types and sources  Quantitative vs. Qualitative; Primary vs. Secondary  Identify stakeholders that can help answer the data question  Connect with stakeholders that work with community of interest  Present the Data  Present data in a simple and consistent manner- tables, charts and graphs are very helpful Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion Develop and Answer Data Questions

Brainstorm Activity Community Health Issue Data Question Data Types Needed Data Stakeholders Data Presentation Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion Select Your Own Question: How does health status differ amongst Californians with different types of immigration status. Example: What percentage of children ages 0-12 are covered by Medi-Cal?

Modules 1. Introduction to AskCHIS Developing a Data Query 2. Executing Queries and Retrieving Data 3. Additional Features Interpreting and Presenting AskCHIS Data Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

AskCHIS  Online data query system that allows you to access specific health information from CHIS  CHIS information can also be accessed via:  Data Access Center located at the UCLA Center for Health Policy Research   Public Use Files available on the AskCHIS website Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

AskCHIS: 1. Log-in to AskCHIS (or register)2. Select a Geographic Area3. Select a Main Topic4. Select a Compare By Group5. Select a Population for your Results Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

Developing the Query: Topics  AskCHIS topic fact sheet  Online at:  Data Dictionary  Online at:  Questionnaires  Online at:  AskCHIS Keyword Search  Online at: (click on AskCHIS, then Main Topic) Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

Worksheet 1 (Appendix, B-19 )  Step 1: What question are you trying to answer?  What is the percentage of children (ages 0-12) in Los Angeles County covered by Medi-Cal?  Step 2: Review the Topic Sources  Main topic: Health Insurance; Search by “Medi-Cal”  Step 3: Identify the health topic you are interested in and corresponding CHIS Variable  “Covered by Medi-Cal”- Data available for children, adolescents and adults through 2009  Step 4: Identify a Population to be included in your results  Specify age range: 0-12 Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

1 Topic: One-way table  Table provides answer to a data query that focuses on only ONE health topic or characteristic, aka Univariate table  Univariate tables provide percentages, populations estimates and confidence intervals  Interpretation: In 2009, 41.2% of children (ages 0-12) in Los Angeles County were covered by Medi-cal. Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

Additional Features  Compare to State  In 2009, 41.2% of children in Los Angeles County were covered by Medi-Cal, as compared to 31.9% of children in California.  Change time period  Compare 2 years  Show Trend Line: Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

AskCHIS: 1. Log-in to AskCHIS (or register)2. Select a Geographic Area3. Select a Main Topic 4. Select a Compare By Group (if applicable) 5. Select a Population for your Results Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

2 Topics: 2-way table (Worksheet 2: Appendix, B-21 )  Table provides answer to a data query that focuses on the distribution of one variable across the levels of a second variable, aka Bivariate table  The distribution of children covered by Medi-Cal across poverty levels  Interpretation: In 2009 in Los Angeles County, 86% of children (ages 0-12) whose household income was 0-99% FPL were covered by Medi-cal, as compared to 46.3% of children whose household income was % FPL. Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

Bivariate Tables  Trend Line: Covered by Medi-Cal by Poverty level Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

Unstable Estimates  Given the small size of many California Counties, data pulled for certain health indicators can yield “statistically unstable” results  These are marked by a red asterisk (*) in the generated tables Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

Interpreting and Presenting Data  Switch main variable and compare by variable:  “Transpose topic”  Interpretation: In 2009, 63.4% of children covered by Medi-Cal had household incomes of 0-99% FPL.  Export Data in Excel  Export in other formats: Excel Export  Show in bar graph, pie graph Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

Unstable Estimates: Worksheet 3 (Appendix, B-23)  Increase/change the geographic area  Use statewide totals or larger counties  Remove Comparative categories  Try not limiting by race/ethnicity, gender or age  Use data from a larger time frame  Combine information from a series of years  Use different indicators  Look at “Currently Insured” vs. “Type of Health Insurance Coverage” Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion

Practice with AskCHIS Example: Migration and Health Possible Topics: All children have health coverage. Examples of research questions:  What is the percentage of children (ages 0-12) in Los Angeles County covered by Medi-Cal? How does that percentage compare to the percentage of children covered by Medi-Cal in the state of California?  Of children (ages 0-12) in California that are not currently insured, what percentage have been uninsured for the last 12 months? What has been the trend from 2001 to 2009? Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion Health Insurance: Current Coverage, Coverage Offered, Managed Care Features, Medication/Vision/Dental, Past Coverage, Eligibility Health Conditions: ADD/ADHD, Asthma, Child Development, Cholesterol, Diabetes, Heart Disease, High Blood Pressure, Seizure Disorder/Epilepsy Health Behaviors: Physical Activity/Exercise, Height and Weight, Diet, Vitamin and Supplement Use, Flu and Pneumonia Vaccines, Teen Health Education Demographics: Age and Gender, Language, Race/Ethnicity, Family and Marital Status, Education, Employment, Income and Poverty, Residency in the US Place of Residence: Urban/Rural, Regions, Housing/neighborhood Child Care/Parental Involvement: Child Care, Parenting/Parental Involvement

Evaluation and Conclusion  Please complete the workshop evaluation before you leave today:   Review the appendices in the workbook and resources at:   Contact information:  Ashley V. Parks Research Associate, UCLA Center for Health Policy Research Introduction - Overview - Modules - Practice with AskCHIS - Evaluation and Conclusion