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Hotspotting:Mapping our way to healthier

neighborhoodsMarina Del Rios, MD, MSc

Illinois Heart Rescue Community Sphere LeaderAssistant Professor

Department of Emergency Medicine

Cardiac arrest

Cardiac arrest

http://illinoisheartrescue.com/

How to save a life

Geographic variation

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State wide quality improvement project

Purpose: to double neurologically intact out of hospital cardiac arrest (OHCA) survival

Vision: Every OHCA victim will receive life-saving, state-of-the-art care at the scene, en

route to, and in the hospital. Data driven activities

Data is your friend

Cardiac Arrest Registry to Enhance Survival (CARES)

Data to improve Bystander actions EMS and hospital

actions Allocation of

resources

Hospital

Disparity in post cardiac arrest care: Post Rosc protocols Therapeutic Hypothermia

IDPH support

CARES report cards

Pre-Hospital

Resuscitation Academy

Dispatch Assisted CPR training

New protocol development: Incident Command for Cardiac Arrest, field termination, and ROSC protocols

Targeted allocation of new ambulances

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Community

Three phase program approach

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Association of neighborhood characteristics with incidence of out-of-hospital cardiac arrest and bystander response in Chicago

Background

Neighborhood disparities in out-of-hospital cardiac arrest (OHCA) incidence and bystander CPR provision make it a major health equity challenge

The most recent study on OHCA in Chicago analyzed data obtained in the 1980s and found: The lowest rate of bystander-initiated CPR was in

predominantly black neighborhoods This association was independent of socioeconomic status.

It’s time for an update

First step:Needs assessment

To conduct a geospatial analysis of variations in OHCA incidence and bystander CPR provision to guide allocation of resources to neighborhoods in greatest need

As a secondary objective, we aimed to determine whether racial and socioeconomic disparities in bystander CPR persist in Chicago.

Methods

OHCAs were aggregated to census tracts

Incidence rates were calculated based on population density

Each incident was linked to census tract information, including demographic and economic factors.

Results

Results

Results

Conclusion

The incidence of cardiac arrest is disproportionately higher in minority and low-income census tracts in Chicago

Bystander CPR rates are overall low in Chicago

Bystander CPR is especially lower in high incidence neighborhoods and in minority and low-income neighborhoods

Disclaimer

Bystander CPR rates may have been underreported

This database only captures cardiac arrests where EMS was called – are there cases missed by the 911 call system?

Targeted mass CPR training

Targeted mass CPR training

Target Neighborhoods

School Based Initiatives:Garfield Park

71 high schools students347 family and friends4.88 per peer trainer

Faith-based initiatives:Englewood HANDDS

Community engagement

Targets “high risk” neighborhoods to increase bystander CPR

Performance report cards

Community ENGAGEMENT

Pay it forward model / peer coaching

Prevention?

Implications

"The sources of these disparities are complex, are rooted in historic and contemporary inequities, and involve many participants at several levels...” “Unequal Treatment” IOM 2003

In order to narrow and eventually eliminate disparities in survival it is important to recognize where in the continuum of treatment of OHCA these disparities exist

Implications

These disparities are of predominant concern and are major issues to be addressed when designing interventions to reduce the burden of OHCA

Coordinated efforts to improve bystander response complemented by approaches to prevent OHCA can lead to health equity in Chicago

Conclusions

Hotspotting paired with targeted community engagement efforts and follow-up can better address community needs and bring us closer to health equity

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