Collecting data on diverse communities: Challenges and successes from health plans, hospitals, and health departments

Abstract: Refugee Health Program, Minnesota Department of Health

Description of Program

The Minnesota Department of Health Refugee Health Program (RHP)’s goal is to control communicable disease among, and resulting from, the arrival of new refugees through a comprehensive health assessment, treatment for any conditions identified and referrals for follow up care within 90 days of their arrival. This health assessment introduces the newly arrived refugees to the U.S. healthcare system. The program is successful because of its comprehensive approach to the refugees and professionals, but also to the data collection involved in the domestic refugee health screening program.

Minnesota started resettling SE Asian (Vietnam, Laos and Cambodia) refugees in 1979 and this high influx of refugees from this region continued through the mid-1990s.  In the early 1990s, refugees from the former Yugoslavia and Soviet Union started arriving in Minnesota followed by sub-Saharan Africans in the latter half of that decade.  Since 2000, 69% of arrivals to Minnesota have come from Somalia, Liberia and Ethiopia with a one-time resettlement of Hmong refugees between 2004 and 2006. To date, over 88,600 refugees have made Minnesota their home, averaging 3,050 primary refugees yearly.

The RHP serves as the first point of notification of new primary refugee arrivals to our state. It receives a complete list of all the refugees and their demographic information including name, date of birth, gender, country of origin, city and county of residence, and most immediate health care needs.  Having access to these data a priori has been the program’s great advantage. After entering the demographic information in a web-based database, this and pertinent overseas medical records are forwarded to the local county public health (LPH).  LPH coordinates and ensures that refugees are linked to a clinic for their domestic refugee health assessment.  All health assessment results, interpreter needs and insurance statuses are collected on a standardized data collection form and are manually or electronically reported back to the RHP.  These data are analyzed, summarized and disseminated to interested internal and external stakeholders.  These colleagues use the data to plan, identify disparities, and develop studies and innovative community-level health education programs.

The RHP has 5 professional staff members with distinct roles: (1) Refugee Health Coordinator, (2) Nurse Consultant, (3) Epidemiologist, (4) Enhanced Surveillance Coordinator (5) Community Health/Outreach Specialist.  One support staff and multiple public health student workers assist with logistics.  Funding is a mix of federal and state dollars.

The RHP‘s Innovative Model and Measurable Outcomes  

We have created a model for successful refugee health screening, based on sound database development and partnerships with local public health and community organizations committed to providing culturally competent and appropriate care.

Data collection.  Data drives our RHP; we analyze disease prevalence and evaluate health disparities and resource needs in refugee populations or in professionals who serve them.  The RHP strives to ensure that all refugees complete their health assessment and works with all providers for a timely submission of the results. The program has improved its data quality protocol to assist internal and external partners to complete follow-up.  The protocol includes a mechanism to remind LPH clinics and private providers to submit completed forms.  The RHP also collects data on the reasons specific refugees are not screened (ex: Moved, missed appointment, refusals, etc…).  During the past 10 years, the screening rate among refugees has increased from 77% (1,462 out of 1,892) in 1998 to 98% (2,684 out of 2,740 eligible refugees) in 2007.

Partnerships with local public health. The Nurse consultant and the RHP rely heavily on the data summary reports to liaise and build strong relationships with partners including over 25 Minnesota counties that screen refugees, public and private clinics, and the resettlement agencies (VOLAGS) that facilitate the initial resettlement phase for all new arrivals. MDH’s role is to continually provide training and feedback, and offer trouble-shooting support as needed. The data are objective measures that identify health needs and service gaps for the various refugee populations. The training includes providing cultural competence knowledge about health beliefs systems especially as it relates to adherence to appointments, medical/treatment management, and access to care.

Among many examples, the data have been used to identify low screening rates in certain counties and interventions such as cultural competence training, revising screening and data collection protocol were implemented.

These mutual relationships, based on feedback and open communication, have contributed to our +95% screening rate each year.

Research studies and community health education.  The data also help us in developing research studies and targeted community health education. Over the past 5 years, the RHP has shared data with several partners, researchers and MPH students to study the refugee demographics, the prevalence of tuberculosis, intestinal parasites, lead poisoning, immunization completion and other health conditions.

Our Community Health/Outreach Coordinator also depends on the data to organize health classes at ESL centers, health articles in ethnic press, health interviews on ethnic radio, health forums, health shows for community TV and DVD production, and to highlight health care needs in various community-based organizations and task forces to improve service delivery.

Lessons learned and challenges overcome

Challenges:

·  Ensuring accurate and timely data reporting and recording – developing a good Data Quality protocol takes time and resources

·  Enhancing data systems in accordance with changes in national or state surveillance protocols and availability of database tools

·  Accommodating the changes many of our clinic partners face now with more of an emphasis on electronic medical records

·  Ensuring cultural competence and linguistically and culturally accessible health-related resources for refugees as they move to rural Minnesota communities

·  Maintaining quality health care and community resources for refugees as the number and countries of origin of our refugee arrivals experience great fluctuation over time and even from month to month.

·  Finding the resources and the time to partner with already stretched community organizations to undertake new initiatives, getting buy-in from the refugee groups, building trust, and sustaining education projects over time requires balance, prioritizing and creating thinking.

Lessons Learned:

1)     Key elements for successful data collection

a)     Data Quality Protocol to ensure accuracy, reliability and completeness

b)     Partnerships with Local Public Health and Volags through:

• Dialoguing between all partners in the health screening process- consult and seek feedback early when changes to protocol are anticipated
• Promoting leadership and “champions” at the county level
• Targeted training to meet clearly identified needs

2)     Use and Disseminate the Data! Data driven program leads to success!

a)     Monitor data to evaluate program objectives and assist partners as needed

b)     Study disease prevalence and trends in refugee populations

c)     Identify and cultivate research studies and projects

d)     Develop successful health education models targeting refugee communities by:

• Using data to prioritize health care access and unique health needs for various populations
• Identifying challenges and possible avenues to reach refugee groups
• Understanding how to develop and sustain partnerships on health initiatives over time