Neighborhood-level hot spot maps to inform delivery of primary care and allocation of social resources

Abstract

Challenges to health care access in the US are forcing local policymakers and service delivery systems to find novel ways to address the shortage of primary care clinicians. The uninsured and underinsured face the greatest obstacles in accessing services. Geographic information systems mapping software was used to illustrate health disparities in Alachua County, FL; galvanize a community response; and direct reallocation of resources. The University of Florida Family Data Center created "hot spot" density maps of important health and social indicators to highlight the location of disparities at the neighborhood level. Maps were produced for Medicaid births, teen births, low birth weight, domestic violence incidents, child maltreatment reports, unexcused school absences, and juvenile justice referrals. Maps were widely shared with community partners, including local elected officials, law enforcement, educators, child welfare agencies, health care providers, and service organizations. This data sharing resulted in advocacy efforts to bring resources to the greatest-need neighborhoods in the county. Novel public-private partnerships were forged between the local library district, children and family service providers, and university administrators. Two major changes are detailed: a family resource center built in the neighborhood of greatest need and a mobile clinic staffed by physicians, nurses, physician assistants, health educators, and student and faculty volunteers. Density maps have several advantages. They require minimal explanation. Anyone familiar with local geographic features can quickly identify locations displaying health disparities. Personalizing health disparities by locating them geographically allows a community to translate data to action to improve health care access.

Figure 1

Medicaid birth density and count by census block group (2007–2009). Blue and purple colors indicate higher concentration of Medicaid-paid births in that geographic area. Numbers in the block groups outlined with solid black lines indicate births to women who qualified for Medicaid during the time period. Red numbers indicate zip codes. Stars indicate location of mobile clinic bus stops.

Figure 2

Density maps of child abuse and neglect (2005–2008) and domestic violence (2009). Left density map displays confirmed cases of child maltreatment, including abuse and neglect. Child abuse may involve physical, sexual, or emotional abuse. Right density map shows calls to law enforcement for domestic violence incidents in the Gainesville, FL, area in 2009. Domestic violence includes “domestic disturbance” and “domestic battery.” Battery can involve any dangerous weapon, including a hand or a fist.

Figure 3

Medical students staffing the Mobile Outreach Clinic. The Mobile Clinic visits neighborhood health-disparity hot spots weekly. More than 100,000 volunteer hours resulted in 4300 primary care services being delivered in Fiscal Year 2010–2011. Left to right: Lauren Cooper, Neil Wingkun, Vikram Narayan, Elizabeth Byrne, Zahid Iqbal, Blaine Farmer, Sara Rodriguez, Melanie Adamsky, and Jennifer Goetz