Child Opportunity Index helps hospitals target community programs

The index, which provides details for 72,000 neighborhoods nationwide, is proving to be a useful tool in identifying factors that impact children’s health. 

Hospitals can play an important role in improving the health status of communities if they can use data to pinpoint areas of need and then launch appropriate programs.  But designing programs to help children can be particularly challenging, given the difficulty of compiling and analyzing all the necessary data. 

However, many children’s hospitals across the country are turning to the Child Opportunity Index, a valuable resource that identifies neighborhood features that help children develop in a healthy way, giving each neighborhood a score based on 29 factors.  Some hospitals are using the index to help build better community health needs assessments, as required under the Affordable Care Act. Others are using the tool to help devise neighborhood outreach efforts, such as those designed to reduce the prevalence of asthma. 

The Index “helps us with our decision making on where the hospital is going to be making investments.”

“Healthcare institutions that are interested in understanding drivers of population-based inequities would be well-suited to use tools like the Child Opportunity Index to begin to get a sense of how neighborhood conditions drive outcomes,” says Andy Beck, MD, an attending pediatrician at Cincinnati Children’s Hospital Medical Center. The hospital used the index to help understand factors, such as pollution and housing conditions, which were contributing to high levels of asthma among children in two low-income neighborhoods, says Beck, who’s an associate professor at the University of Cincinnati College of Medicine. 

The institution then devised risk mitigation measures, such as working with the city to improve conditions at a housing complex that fell into disrepair and educating school nurses on how to better recognize asthma symptoms early on.  A five-year outreach effort in the two neighborhoods led to a 20 percent decline in hospitalizations of children for all causes, but primarily asthma, Beck explains. 

How the index works 

The Child Opportunity Index, which was updated with version 2.0 in 2020, will be updated again in about one year and then annually, says its developer, Dolores Acevedo-Garcia, a professor and director of the Institute for Child, Youth and Family Policy at Brandeis University. The index measures 29 factors to rank 72,000 census tracts nationwide on a scale of 1 to 100, based on their percentile in the “national opportunity distribution,” she explains.  “Opportunity” refers to the neighborhood conditions and resources that contribute to childhood development, Acevedo-Garcia says. Factors are grouped in three domains – socio-economic, educational, and health and environment. The index illustrates that Black and Latino children are highly concentrated in neighborhoods with the lowest opportunity ratings, the professor says. 

In the health and environment domain, factors include insurance coverage, air quality measures, presence of healthy food outlets, availability of green space, housing vacancy rates, illegal drug use, and more.  The index gathers data from many primary sources, including the Centers for Disease Control and Prevention as well as state and local agencies, and then analyzes the data to come up with opportunity scores. “It’s a holistic measure of factors that really matter for children,” Acevedo-Garcia says. 

A tutorial on how to use the index will soon be available at the website that describes the tool. 

Conducting a needs assessment 

Hospitals and other provider organizations can use the index “to focus on areas they serve that need more investment,” says Chaya Merrill, director of the child health data lab within the child health advocacy institute at Children’s National Hospital in Washington.  The hospital, which has used the index to help identify neighborhoods that face health challenges, will soon finish its latest needs assessment and then work on a community health improvement plan to respond to identified needs, Merrill says. It will work with community leaders to develop an intervention plan, which will be published in November. 

Interventions might range from programs to address short-term problems, such as food insecurity, to policy changes, such as local governments taking action to improve meal programs at schools, she points out. 

Community outreach 

In Chicago, Ann & Robert H. Lurie Children’s Hospital also is using the index to help develop its latest needs assessment. Earlier, the hospital used the index to support several other research projects for its Patrick M. Magoon Institute for Healthy Communities, says Kelli Day, the institute’s senior director of operations and planning.  “The COI has really helped us to understand disparities based on geography,” she adds. 

For example, the institute used the COI and the hospital’s utilization data to identify two communities for concerted outreach efforts. Partnering with community groups, the hospital launched a violence prevention program, home safety education, home health programs for teens who are parents and other initiatives, Day explains.  The COI “helps us make the case for philanthropic funding,” she says. “It also helps us with our decision making on where the hospital is going to be making investments.” 

A national effort 

In one larger research project, the Children’s Hospital Association merged the Child Opportunity Index into its Pediatric Health Information System, which collects data from 49 hospitals on emergency department encounters and hospitalizations.  This compilation of data enables the tracking of healthcare use and many other factors down to the ZIP code level, says Matt Hall, the association’s principal biostatistician. The participating hospitals compare their statistics with those of others as they develop quality improvement programs, he adds.  Combining the two databases showed that in neighborhoods where child opportunity rates are lower, hospitalization rates are significantly higher, Hall says. “That’s likely a reflection of the resources in those areas,” he adds, pointing to, for example, a lack of local access to pediatricians at clinics. 

He advises hospitals to consider using the index “to help understand the needs of individuals that live in your community and to understand how to target those areas of greatest need.” 

About the author

Howard Anderson, contributing editor, was the founding editor of Health Data Management. 

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