Extension for Community Health Outcomes (ECHO) programs have successfully empowered primary care providers (PCPs) to deliver advanced care to patients lacking access to subspecialists. In designing an ECHO type 1 diabetes (T1D) program in Florida and California, the Neighborhood Deprivation Index (NDI) was used in conjunction with geocoding of primary care providers (PCPs) and endocrinologists in each state to concurrently identify areas with low endocrinology provider density and high health risk/poverty areas. The NDI measures many aspects of poverty proven to be critical indicators of community health outcomes such as cardiometabolic risk, adverse birth outcome, and substance use. Data from the 2013-2017 American Community Survey (ACS) 5-year estimates were used to create census tract- and block group-level NDI maps for California and Florida. In addition, geocoding and 30-minute drive-time buffers were performed using publicly available provider directories for PCPs and endocrinologists in both states by Google Geocoding API and TravelTime Search Application Programming Interface (API). Based on these findings, we defined high need catchment areas as census tracts or census block groups with: 1) more than a 30-minute drive to the nearest endocrinologist, but within a 30-minute drive to the nearest PCP; 2) an NDI in the highest quartile; and 3) a population above the median (5,199 for census tracts, and 1,394 for census block groups). Out of the 12,181 census tracts and 34,490 census block groups in California and Florida, we identified 57 tracts and 215 block groups meeting these criteria as high need catchment area. Geospatial analysis provides an important precursory methodologic step to effectively focus outreach efforts in diabetes program development. The integration of the NDI with geocoded provider directories enables more cost-effective and targeted interventions to reach the most vulnerable populations living with T1D.
A.F. Walker: None. H. Hu: None. N. Cuttriss: None. M.J. Haller: Advisory Panel; Self; Pancreum, SAB Biotherapeutics. C. Wang: None. C. Anez-Zabala: None. K. Yabut: None. M.J. Gurka: None. D.M. Maahs: Advisory Panel; Self; Novo Nordisk Inc. Consultant; Self; Abbott, Sanofi. Research Support; Self; Dexcom, Inc., Tandem Diabetes Care.
The Leona M. and Harry B. Helmsley Charitable Trust